https://pubmed.ncbi.nlm.nih.gov/38017650/
Bienz S.P., Gadzo N., Zuercher A.N., Wiedemeier D., Jung R.E., Thoma D.S. (2023)

Original title: Bienz, S. P., Gadzo, N., Zuercher, A. N., Wiedemeier, D., Jung, R. E., & Thoma, D. S. (2024). Clinical and histological wound healing patterns of collagen-based substitutes: An experimental randomized controlled trial in standardized palatal defects in humans. Journal of clinical periodontology, 51(3), 319–329. https://doi.org/10.1111/jcpe.13903

BACKGROUND

Collagen matrices have shown effectiveness in pre-clinical and clinical studies for various dental applications. There are two types: one for increasing keratinized mucosa width or alveolar ridge preservation, which can be exposed, and another for augmenting soft-tissue volume around implants or replacing connective tissue grafts in root coverage, which must be fully submerged. While many collagen-based substitutes are available, no comparative studies on their performance in palatal defects exist.

AIM

This study aimed to determine if there is a difference in wound healing progression among three distinct collagen-based wound substitutes compared to a control group, focusing on wound closure, profilometric measurements, and descriptive histology.

METHODS

Twenty participants were enrolled in this randomized controlled trial, each receiving four palatal defects (6 mm diameter, 3 mm depth). The defects were randomly assigned to one of four treatment groups: C (control, spontaneous healing), MG (Mucograft^®), MD (mucoderm^®), and FG (Fibro-Gide^®). Evaluation of wound closure progression, as well as patient reports on pain were conducted before treatment and at 5, 7, 9, 12, 14, and 16 days post-surgery. All participants wore a palatal splint for 16 days. Biopsy samples were obtained at Day 16 and Day 32 for histological analysis.

RESULTS

All groups, including the spontaneous healing without a collagen-based dressing, achieved complete wound closure by 14 days. On day 7, the percentages of remaining open wounds were 49.3% for the control group (IQR: 22.6), 70.1% for FG (IQR: 20.7), 56.8% for MD (IQR: 26.3), and 62.2% for MG (IQR: 34.4). Statistically significant differences were found between FG and the control group (p = .01) and between MD and FG (p = .04). MD had an established connection to underlying lamina propria with no rete peg formation, displaying predominantly dense connective tissue. Full epithelialization was observed with formation of connective tissue, and the healing process in all groups was completed by two weeks. The highest reported pain score was 4 out of 10 for all groups during the whole study period.

CONCLUSION

It was concluded that collagen-based substitute intended for open healing showed a beneficial healing pattern, whereas collagen-based wound dressings provide coverage of open defects, without acceleration of wound closure or reduction of pain. mucoderm^® showed faster wound closure compared to the other collagen matrices.