Epithelialized fragments from free gingival graft as alternative to palatal wound protection: A randomized clinical trial

BACKGROUND: This study aimed to evaluate clinical and patient-centered outcomes of palatal donor sites protected with epithelialized fragments (EF) of the free gingival graft (FGG) or a hemostatic sponge (HEM). METHODS: Forty-four patients with deep single gingival recessions in lower incisors were treated using subepithelial connective tissue graft (SCTG) of standardized size (17 × 6 mm). Patients were randomized to HEM (n = 22) or EF (n = 22), both stabilized with sutures and a palatal stent. Remaining wound area of healing was assessed through standardized photographs by a blinded, calibrated examiner over 28 days. RESULTS: Significant effects were observed for group (p = 0.031) and time (p < 0.001), with no group×time interaction (p = 0.132). EF showed lower values than HEM (β = -7.02; 95% confidence interval [CI]: -13.2, -0.80). A significant reduction in wound area occurred at 7, 14, and 28 days (p < 0.001). Between-group differences were significant only at day 14 (β = -12.26; 95% CI: -23.4, -1.17), with no statistically significant differences at days 7 and 28. Between-subject variability was low-to-moderate (intraclass correlation coefficient [ICC] = 0.276). Pain scores and analgesic consumption decreased significantly over time in both groups, with no differences between interventions or interactions. CONCLUSIONS: EF demonstrated improved palatal healing compared to HEM at day 14, while pain levels and analgesic consumption were similar between groups, indicating comparable postoperative discomfort. TRIAL REGISTRATION: Plataforma Brasil, 52609021.0.1001.5318.