Non-Cochrane · intervention · PM42927627
Is There a Difference in Postoperative Pain After Harvesting a Palatal Soft Tissue Graft Aiming for Primary Versus Secondary Intention Healing? A Systematic Review and Meta-Analysis.
Asquino Natalia, Esteves Lima Rafael, Andrade Ernesto, et al. · Clinical and experimental dental research · 2026 · PubMed · doi:10.1002/cre2.70476
Findings
Population Patients undergoing soft tissue augmentation around teeth or implants with a palatal soft tissue graft
4 findings
| Palatal graft harvesting aiming for secondary intention healing (FGG/D-FGG) | Palatal graft harvesting aiming for primary intention healing (S-CTG, split-thickness flap) | Postoperative pain at the palatal donor site (VAS 0-10) at 7 days 7 days | MD 1.03 [-0.12, 2.17] Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 125 participants |
| Palatal graft harvesting aiming for secondary intention healing (FGG/D-FGG) | Palatal graft harvesting aiming for primary intention healing (S-CTG, split-thickness flap) | Postoperative pain at the palatal donor site (VAS 0-10) at 3 days 3 days | MD 0.73 [-0.32, 1.78] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 75 participants |
| Palatal graft harvesting aiming for secondary intention healing (FGG/D-FGG) | Palatal graft harvesting aiming for primary intention healing (S-CTG, split-thickness flap) | Postoperative pain at the palatal donor site (VAS 0-10) at 7 days 7 days · Studies without palatal wound protection | MD 0.96 [-1.57, 3.50] GRADE not reported 2 studies |
| Palatal graft harvesting aiming for secondary intention healing (FGG/D-FGG) | Palatal graft harvesting aiming for primary intention healing (S-CTG, split-thickness flap) | Postoperative pain at the palatal donor site (VAS 0-10) at 3 days 3 days · Studies without palatal wound protection | MD 1.02 [-1.50, 3.55] GRADE not reported 2 studies |
Included primary studies 7
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Bakhishov 2021 De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions… PMID:33751615 | 2021 | 1 other review | not stated | not extracted yet |
| Zucchelli 2010 Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative… PMID:20590963 | 2010 | 1 other review | not stated | not extracted yet |
| Beymouri 2023 Comparison of morbidity at the donor site and clinical efficacy at the recipient site between two different connective tissue graft… PMID:38357340 | 2023 | this review only | not stated | not extracted yet |
| Del Pizzo 2002 The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. PMID:12423299 | 2002 | this review only | not stated | not extracted yet |
| Isler 2018 Oral flurbiprofen spray for mucosal graft harvesting at the palatal area: A randomized placebo-controlled study. PMID:30007054 | 2018 | this review only | not stated | not extracted yet |
| Lessa 2025 Clinical evaluation of two techniques of soft tissue graft removal (free gingival graft/de-epithelialized and linear/subepithelial… PMID:41399641 | 2025 | this review only | not stated | not extracted yet |
| Wessel 2008 Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. PMID:18315424 | 2008 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing a soft tissue augmentation procedure around natural teeth or dental implants with a soft tissue graft harvested from the palate | 188 patients with 200 donor sites (n=7 studies); sample sizes 12 to 50 |
| Intervention | Palatal graft harvesting technique aiming for secondary intention healing (SIH) | FGG or D-FGG, SIH (93 sites) |
| Comparison | Palatal graft harvesting technique aiming for primary intention healing (PIH) | S-CTG with split-thickness flap, PIH (107 sites) |
| Outcomes | Primary: postoperative pain at the donor site (VAS, presence/absence of pain, analgesic intake; including morbidity and discomfort). Secondary: wound healing at the donor site, sensitivity disturbances, effect on eating habits | Pain VAS meta-analysed at 3 days (n=3 RCTs) and 7 days (n=4 RCTs); pain proportion, analgesic intake, complete epithelialization, sensitivity, eating habits, inability to chew, stress and burning sensation reported narratively |
| Study designs | RCTs and non-randomized controlled clinical trials (CTs); meta-analysis for RCTs with VAS pain | 5 RCTs (4 parallel, 1 split-mouth) and 2 CTs (n=7) |
| Timing | No restriction on follow-up period | Follow-up 1 to 4 weeks; pooled at 3 and 7 days |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | Yes | Yes | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | Yes | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |