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BMC Oral Health
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Diode Laser | Research

Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial

Authors: Basma Khalil Yakout, Fatma Ramzy Kamel, Maha Abd El-Aziz Abou Khadr, Lamia Ahmed Hassan Heikal, Gillan Ibrahim El-Kimary

Published in: BMC Oral Health | Issue 1/2023

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Abstract

Background

Surgical gingivectomy can be considered the gold standard treatment for gingival enlargement. The healing of wound site after gingivectomy occurs slowly by secondary intention. To accelerate the wound healing process, several studies have been conducted evaluating the effect of various treatment modalities. Photobiomodulation therapy (PBMT) was proposed to provide minimally invasive and painless treatment as well as to decrease discomfort of the patient following the surgical process. Another factor that is expected to improve the healing after surgery is topical application of chemotherapeutic agents such as Hyaluronic acid (HA). This study aims to assess the effect of topically applied HA gel after PBMT on the healing of wound site after surgical gingivectomy.

Methods

This randomized controlled clinical trial included twenty-six surgical gingivectomy wound sites, equally divided into two groups, Group-I (test group): the surgical sites after gingivectomy were irradiated with a diode laser (980 nm, 0.2 W) then covered by 2% HA gel loaded in a special custom-made soft transparent tissue guard appliance for each patient. Group II (control group): the surgical sites were irradiated with a diode laser (980 nm, 0.2 W) only. Wound healing was assessed subjectively by Landry healing index on the 3rd, 7th, 14th and 21st days after surgery, and pain perception was assessed by the patients using visual analog scale (VAS) throughout the 21 days of the follow up period. Comparisons between the two study groups were performed using Mann-Whitney U test, while comparisons between different time points were performed using Friedman test. Significance was inferred at p value < 0.05.

Results

By the end of the follow-up period, surgical sites of the test group showed excellent healing compared to the control group. There were no significant differences in VAS scores between both groups (p > 0.05).

Conclusions

Application of 2% HA gel as an adjunctive to PBMT was found to have significant clinical effects and higher power of repair among test group when compared to that achieved by PBMT alone in control group.

Trial registration

This study was retrospectively registered on ClinicalTrials.gov and first posted on 28th of March 2023 with an identifier number: NCT05787912.
Literature
1.
Uslu M, Akgül S. Evaluation of the effects of photobiomodulation therapy and ozone applications after gingivectomy and gingivoplasty on postoperative pain and patients’ oral health-related quality of life. Lasers Med Sci. 2020;35:1637–47.PubMedCrossRef
2.
Reddy SP, Koduganti RR, Panthula VR, Surya Prasanna J, Gireddy H, Dasari R, et al. Efficacy of low-level laser therapy, Hyaluronic Acid Gel, and Herbal Gel as Adjunctive Tools in Gingivectomy Wound Healing: a Randomized Comparative Clinical and histological study. Cureus. 2019;11:e6438.PubMedPubMedCentral
3.
Goldman HM. Gingivectomy; indications, contraindications, and method. Am J Orthod Oral Surg. 1946;32:323–6.PubMedCrossRef
4.
Takei HH, Carranza FA, Shin K. Gingival surgical techniques. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA, editors. Carranza’s clinical periodontology. 12th ed. Philadelphia: W.B. Saunders and Company; 2015. pp. 576–81.
5.
6.
Stanton G, Levy M, Stahl SS. Collagen restoration in healing human gingiva. J Dent Res. 1969;48:27–31.PubMedCrossRef
7.
Sigusch B, Beier M, Klinger G, Pfister W, Glockmann E. A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly Progressive periodontitis. J Periodontol. 2001;72:275–83.PubMedCrossRef
8.
Carroll JD, Milward MR, Cooper PR, Hadis M, Palin WM. Developments in low level light therapy (LLLT) for dentistry. Dent Mater. 2014;30:465–75.PubMedCrossRef
9.
Zhao H, Hu J, Zhao L. The effect of low-level laser therapy as an adjunct to periodontal Surgery in the management of postoperative pain and wound healing: a systematic review and meta-analysis. Lasers Med Sci. 2021;36:175–87.PubMedCrossRef
10.
Kohale BR, Agrawal AA, Raut CP. Effect of low-level laser therapy on wound healing and patients’ response after scalpel gingivectomy: a randomized clinical split-mouth study. J Indian Soc Periodontol. 2018;22:419–26.PubMedPubMedCentralCrossRef
11.
Mahmoud ES, Abd El-Baky AM, Said OM, Hussein HG. Low level diode laser therapy on wound healing post gingivectomy. J Life Sci Biomed. 2020;10:80–6.CrossRef
12.
Madi M, Mahmoud MM. The evaluation of healing effect of low-level laser treatment following gingivectomy. Beni-Suef Univ J Basic Appl Sci. 2020;9:25.CrossRef
13.
Ebrahimi P, Hadilou M, Naserneysari F, Dolatabadi A, Tarzemany R, Vahed N, et al. Effect of photobiomodulation in secondary intention gingival wound healing—a systematic review and meta-analysis. BMC Oral Health. 2021;21:258.PubMedPubMedCentralCrossRef
14.
Naidu I, Gajendran PL. Comparative evaluation of wound healing following gingivectomy using diode laser and erbium, chromium-doped Yttrium, Scandium, Gallium and Garnet (Er: Cr: YSGG) laser–in patients undergoing fixed orthodontic treatment-a randomized controlled trial. Int J Orthod Rehabil. 2022;13:16–22.CrossRef
15.
de Freitas LF, Hamblin MR. Proposed mechanisms of Photobiomodulation or Low-Level Light Therapy. IEEE J Sel Top Quantum Electron. 2016;22.
16.
Zhai P, Peng X, Li B, Liu Y, Sun H, Li X. The application of hyaluronic acid in bone regeneration. Int J Biol Macromol. 2020;151:1224–39.PubMedCrossRef
17.
18.
Moseley R, Waddington RJ, Embery G. Hyaluronan and its potential role in periodontal healing. Dent Update. 2002;29:144–8.PubMedCrossRef
19.
Romeo U, Libotte F, Palaia G, Galanakis A, Gaimari G, Tenore G, et al. Oral soft tissue wound healing after laser Surgery with or without a pool of amino acids and sodium hyaluronate: a randomized clinical study. Photomed Laser Surg. 2014;32:10–6.PubMedCrossRef
20.
Yıldırım S, Özener H, Doğan B, Kuru B. Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: an examiner-masked, randomized, controlled clinical trial. J Periodontol. 2018;89:36–45.PubMedCrossRef
21.
World Medical Association Declaration. Of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.CrossRef
22.
23.
Petrie A, Sabin C. Medical statistics at a glance. 4th ed. Hoboken, New Jersey: John Wiley & Sons; 2019.
24.
Miller CS, Damm DD. Incidence of verapamil-induced gingival hyperplasia in a dental population. J Periodontol. 1992;63:453–6.PubMedCrossRef
25.
26.
Schulz KF, Grimes DA. Generation of allocation sequences in randomised trials: chance, not choice. Lancet. 2002;359:515–9.PubMedCrossRef
27.
28.
29.
Galante R, Pinto TJA, Colaço R, Serro AP. Sterilization of hydrogels for biomedical applications: a review. J Biomed Mater Res B Appl Biomater. 2018;106:2472–92.PubMedCrossRef
30.
Dantas MG, Reis SA, Damasceno CM, Rolim LA, Rolim-Neto PJ, Carvalho FO, et al. Development and evaluation of Stability of a gel Formulation containing the Monoterpene Borneol. ScientificWorldJournal. 2016;2016:7394685.PubMedPubMedCentralCrossRef
31.
Huerta-Ángeles G, Nešporová K, Ambrožová G, Kubala L, Velebný V. An effective translation: the development of Hyaluronan-Based Medical products from the Physicochemical, and preclinical aspects. Front Bioeng Biotechnol. 2018;6:62.PubMedPubMedCentralCrossRef
32.
Becker LC, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG Jr., Shank RC, et al. Final report of the safety assessment of hyaluronic acid, potassium hyaluronate, and sodium hyaluronate. Int J Toxicol. 2009;28:5–67.PubMedCrossRef
33.
Silberman SL, Le Jeune RC, Serio FG, Devidas M, Davidson L, Vernon K. A method for determining patient oral care skills: the University of Mississippi oral Hygiene Index. J Periodontol. 1998;69:1176–80.PubMedCrossRef
34.
Sonal S, Vivek G, Sunil V, Divya Mahendra D, Vivek S, Siddharta Shanker S. The effects of low level laser therapy on healing of gingiva after gingivectomy. Univ J Dent Sci. 2019;5:39–46.
35.
Landry RG, Turnbull RS, Howley T. Effectiveness of benzydamyne HCl in the treatment of periodontal postsurgical patients. Res Clin Forums. 1988;10:105–18.
36.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), short-form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of intermittent and constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):240–52.
37.
Ozcelik O, Cenk Haytac M, Kunin A, Seydaoglu G. Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study. J Clin Periodontol. 2008;35:250–4.PubMedCrossRef
38.
Amorim JC, de Sousa GR, de Barros Silveira L, Prates RA, Pinotti M, Ribeiro MS. Clinical study of the gingiva healing after gingivectomy and low-level laser therapy. Photomed Laser Surg. 2006;24:588–94.PubMedCrossRef
39.
Talluri S, Altuhafy M, Khan J. The efficacy of Photobiomodulation in Wound healing following Gingivectomy: a systematic review of clinical studies. Int J Experiment Dent Sci. 2023;10:63–70.CrossRef
40.
Kusakci-Seker B, Demirayak-Akdemir M. The effect of non-thermal atmospheric pressure plasma application on wound healing after gingivectomy. Int Wound J. 2020;17:1376–83.PubMedPubMedCentralCrossRef
41.
Kotry GS, Taalab MR. Clinical evaluation of Ribes nigrum and Vaccinium myrtillus extract on the healing of gingivectomy wounds. Egypt Dent J. 2018;64:2361–9.CrossRef
42.
Rodríguez-Aranda M, Iborra-Badia I, Alpiste-Illueca F, López-Roldán A. Hyaluronic acid for periodontal tissue regeneration in intrabony defects. A systematic review. Dentistry Rev. 2022;2:100057.CrossRef
43.
Hammad HM, Hammad MM, Abdelhadi IN, Khalifeh MS. Effects of topically applied agents on intra-oral wound healing in a rat model: a clinical and histomorphometric study. Int J Dent Hyg. 2011;9:9–16.PubMedCrossRef
44.
Xu Y, Höfling K, Fimmers R, Frentzen M, Jervøe-Storm PM. Clinical and microbiological effects of topical subgingival application of hyaluronic acid gel adjunctive to scaling and root planing in the treatment of chronic periodontitis. J Periodontol. 2004;75:1114–8.PubMedCrossRef
45.
Fawzy El-Sayed KM, Dahaba MA, Aboul-Ela S, Darhous MS. Local application of hyaluronan gel in conjunction with periodontal Surgery: a randomized controlled trial. Clin Oral Investig. 2012;16:1229–36.PubMedCrossRef
46.
Turgut Çankaya Z, Gürbüz S, Bakirarar B, Ünsal B, Kurtiş B. Evaluation of the effect of the application of hyaluronic acid following laser-assisted frenectomy: an examiner-blind, randomized, controlled clinical study. Quintessence Int. 2020;51:188–201.PubMed
47.
Rooney P, Kumar S. Inverse relationship between hyaluronan and collagens in development and angiogenesis. Differentiation. 1993;54:1–9.PubMedCrossRef
48.
49.
Lingamaneni S, Mandadi LR, Pathakota KR. Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: a randomized, double-blind, split-mouth clinical pilot study. J Indian Soc Periodontol. 2019;23:53–7.PubMedPubMedCentralCrossRef
50.
Masse JF, Landry RG, Rochette C, Dufour L, Morency R, D’Aoust P. Effectiveness of soft laser treatment in periodontal Surgery. Int Dent J. 1993;43:121–7.PubMed
51.
Damante CA, Greghi SL, Sant’Ana AC, Passanezi E, Taga R. Histomorphometric study of the healing of human oral mucosa after gingivoplasty and low-level laser therapy. Lasers Surg Med. 2004;35:377–84.PubMedCrossRef
Metadata
Title
Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial
Authors
Basma Khalil Yakout
Fatma Ramzy Kamel
Maha Abd El-Aziz Abou Khadr
Lamia Ahmed Hassan Heikal
Gillan Ibrahim El-Kimary
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Diode Laser
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03519-5

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