Non-Cochrane · intervention · PM42930767
Topical Hyaluronic Acid for Palatal Donor-Site Healing After Autogenous Gingival Graft Harvesting: A Systematic Review and Time-Specific Meta-Analysis with Clinical Implications for Postoperative Care.
Chauca-Bajaña Luis, Lema Gutierrez Hector Alfredo, Zambrano-Manzaba Gabriela Guadalupe, et al. · Journal of personalized medicine · 2026 · PubMed · doi:10.3390/jpm16100492
Findings
53 findings
| Population | ||||
|---|---|---|---|---|
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 21 | MD 0.53 [0.24, 0.82] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 113 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 21 · Leave-one-out: excluding Lektemur Alpan 2023 | RR 1.74 [1.21, 2.52] GRADE not reported 2 studies |
| Adults undergoing autogenous gingival graft harvesting from the palate | Topical hyaluronic acid (HA as sole active component; gel, mucoadhesive or HA-saturated sponge) | Placebo/vehicle, no topical agent, or standard donor-site care (periodontal dressing or sponge) | Postoperative bleeding Postoperative day 1 · Periodontal and peri-implant plastic surgery; palatal donor-site wound · Formulation sensitivity: HA-only plus one multicomponent HA-containing product trial | RR 0.42 [0.14, 1.23] GRADE not reported 3 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 14 · Leave-one-out: excluding Ceylan Şen 2025 | MD 1.85 [1.37, 2.34] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 7 · Leave-one-out: excluding Ceylan Şen 2025 | MD -1.49 [-5.26, 2.27] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 7 · Leave-one-out: excluding Nabiyi 2024 | MD 0.63 [0.45, 0.8] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 7 · Leave-one-out: excluding Ceylan Şen 2025 | MD 0.44 [0.05, 0.83] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 14 · Leave-one-out: excluding Lektemur Alpan 2023 | MD 1.08 [0.26, 1.91] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 21 · Leave-one-out: excluding Ceylan Şen 2025 | MD 1.69 [0.7, 2.68] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 3 · Leave-one-out: excluding Lektemur Alpan 2023 | MD 0.37 [0.03, 0.71] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 14 | MD 0.42 [0.23, 0.6] GRADE not reported 3 studies · 113 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Daily 500-mg paracetamol tablets Postoperative day 1 | MD -0.6 [-1.73, 0.52] GRADE not reported 2 studies · 74 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 14 · Leave-one-out: excluding Lektemur Alpan 2023 | RR 2.2 [0.97, 4.98] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 14 · Leave-one-out: excluding Ceylan Şen 2025 | RR 2.23 [0.94, 5.29] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 3 · Leave-one-out: excluding Nabiyi 2024 | MD -2.34 [-6.78, 2.1] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 21 | MD 1.33 [0.43, 2.22] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 110 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Daily 500-mg paracetamol tablets Postoperative day 3 | MD -0.8 [-1.34, -0.26] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies · 74 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 21 · Leave-one-out: excluding Yıldırım 2018 | RR 1.73 [1.21, 2.48] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 3 | MD 0.38 [0.19, 0.56] GRADE not reported 3 studies · 113 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 21 · Leave-one-out: excluding Lektemur Alpan 2023 | MD 1.41 [-0.14, 2.95] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 14 · Leave-one-out: excluding Lektemur Alpan 2023 | MD 0.34 [0.05, 0.63] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 14 · Leave-one-out: excluding Nabiyi 2024 | MD 0.49 [0.28, 0.7] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 21 · Leave-one-out: excluding Ceylan Şen 2025 | RR 1.47 [1.14, 1.9] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 14 · Hartung–Knapp sensitivity analysis | MD 1.43 [-0.18, 3.04] GRADE not reported 3 studies · 110 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 7 | MD -0.97 [-3.27, 1.34] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 119 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 3 | MD -1.61 [-4.52, 1.3] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 119 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 14 · Leave-one-out: excluding Yıldırım 2018 | MD 1.36 [0.18, 2.54] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 14 · Leave-one-out: excluding Yıldırım 2018 | RR 2 [1.04, 3.86] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 14 | MD 1.43 [0.67, 2.19] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 110 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative bleeding Postoperative day 1 Unresolved: the two extractors disagree on this row. | RR 0.72 [0.37, 1.4] -129 [-289, 184] per 1000 patients Very low 2 studies · 74 participants |
| Adults undergoing autogenous gingival graft harvesting from the palate | Topical hyaluronic acid (HA as sole active component; gel, mucoadhesive or HA-saturated sponge) | Placebo/vehicle, no topical agent, or standard donor-site care (periodontal dressing or sponge) | Postoperative bleeding Postoperative day 3 · Periodontal and peri-implant plastic surgery; palatal donor-site wound · Formulation sensitivity: HA-only plus one multicomponent HA-containing product trial | RR 0.29 [0.07, 1.18] GRADE not reported 3 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 21 · Leave-one-out: excluding Lektemur Alpan 2023 | MD 0.51 [0.02, 0.99] GRADE not reported 2 studies |
| Adults undergoing autogenous gingival graft harvesting from the palate | Topical hyaluronic acid (HA as sole active component; gel, mucoadhesive or HA-saturated sponge) | Placebo/vehicle, no topical agent, or standard donor-site care (periodontal dressing or sponge) | Postoperative pain (VAS 0 to 10) Postoperative day 3 · Periodontal and peri-implant plastic surgery; palatal donor-site wound · Formulation sensitivity: HA-only plus one multicomponent HA-containing product trial | MD -1.59 [-3.65, 0.47] GRADE not reported 4 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 21 · Leave-one-out: excluding Ceylan Şen 2025 | MD 0.43 [0.11, 0.75] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 3 · Leave-one-out: excluding Nabiyi 2024 | MD 0.46 [0.25, 0.66] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative bleeding Postoperative day 3 Unresolved: the two extractors disagree on this row. | RR 0.36 [0.07, 1.8] -104 [-151, 130] per 1000 patients Very low 2 studies · 74 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 21 · Hartung–Knapp sensitivity analysis | MD 0.53 [-0.1, 1.16] GRADE not reported 3 studies · 113 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 21 · Leave-one-out: excluding Nabiyi 2024 | MD 0.67 [0.47, 0.86] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 14 · Leave-one-out: excluding Ceylan Şen 2025 | MD 0.36 [-0.0, 0.73] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 7 · Leave-one-out: excluding Yıldırım 2018 | MD 0.1 [-0.38, 0.59] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 7 · Leave-one-out: excluding Lektemur Alpan 2023 | MD 0.48 [0.05, 0.9] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 3 · Hartung–Knapp sensitivity analysis | MD 0.38 [-0.04, 0.79] GRADE not reported 3 studies · 113 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 3 · Leave-one-out: excluding Yıldırım 2018 | MD -0.13 [-0.82, 0.56] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 3 · Leave-one-out: excluding Ceylan Şen 2025 | MD 0.3 [0.1, 0.51] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 21 · Hartung–Knapp sensitivity analysis | MD 1.33 [-0.64, 3.29] GRADE not reported 3 studies · 110 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 7 · Hartung–Knapp sensitivity analysis | MD -0.97 [-6.11, 4.18] GRADE not reported 3 studies · 119 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 3 · Leave-one-out: excluding Ceylan Şen 2025 | MD -2.39 [-6.74, 1.96] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 21 | RR 1.62 [1.29, 2.03] 354 [166, 429] per 1000 patients Low 3 studies · 110 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 3 · Hartung–Knapp sensitivity analysis | MD -1.61 [-8.04, 4.81] GRADE not reported 3 studies · 119 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Complete epithelialization Postoperative day 14 | RR 2.11 [1.13, 3.94] 227 [27, 600] per 1000 patients Low 3 studies · 110 participants |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Palatal tissue color match (0–10) Postoperative day 21 · Leave-one-out: excluding Yıldırım 2018 | MD 0.9 [0.35, 1.45] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Postoperative pain (0–10 VAS) Postoperative day 7 · Leave-one-out: excluding Nabiyi 2024 | MD -1.69 [-5.03, 1.65] GRADE not reported 2 studies |
| Adults undergoing palatal autogenous gingival graft harvesting | Topical hyaluronic acid as sole active therapeutic component | Placebo, vehicle, no topical agent or standard donor-site care | Wound Healing Index (1–5) Postoperative day 7 | MD 0.58 [0.42, 0.75] Low 3 studies · 113 participants |
Included primary studies 8
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Baroudi 2024 Clinical and Patient-Reported Outcome Measures of Palatal Donor Site Healing Using Polyvinylpyrrolidone-Sodium Hyaluronate Gel as a… PMID:39529394 | 2024 | this review only | not stated | not extracted yet |
| Bulut 2025 The effect of Polyvinylpyrrolidone-Sodium hyaluronate gel on palatal wound healing: a randomized controlled clinical trial. PMID:40781616 | 2025 | this review only | not stated | not extracted yet |
| Ceylan Sen 2025 Comparative evaluation of hyaluronic acid and injectable platelet-rich fibrin in palatal wound healing: a randomized clinical trial. PMID:41162972 | 2025 | this review only | not stated | not extracted yet |
| Hassan 2021 Clinical Comparison of MEBO and Hyaluronic Acid Gel in the Management of Pain after Free Gingival Graft Harvesting: A Randomized Clinical… PMID:34426739 | 2021 | this review only | not stated | not extracted yet |
| Khalil 2022 Local application of hyaluronic acid in conjunction with free gingival graft: a randomized clinical trial. PMID:34623507 | 2022 | this review only | not stated | not extracted yet |
| Lektemur Alpan 2023 Comparison of hyaluronic acid, hypochlorous acid, and flurbiprofen on postoperative morbidity in palatal donor area: a randomized… PMID:36595064 | 2023 | this review only | not stated | not extracted yet |
| Nabiyi 2024 Effect of Hyaluronic Acid Mucoadhesives on Palatal Wound Healing and Postoperative Discomfort in Free Gingival Graft Surgery: A Clinical… PMID:39906371 | 2024 | this review only | not stated | not extracted yet |
| Yildirim 2018 Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: An examiner-masked, randomized, controlled… PMID:28914592 | 2018 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) undergoing harvesting of an autogenous gingival or soft-tissue graft from the hard palate for periodontal or peri-implant plastic surgery; standardized palatal wounds eligible but analyzed separately | Adults undergoing free gingival graft harvesting from the palate (n=8 RCTs; 2 or 3 RCTs and 74 to 119 participants per meta-analysis) |
| Intervention | Topical or locally delivered hyaluronic acid, hyaluronan or sodium hyaluronate (gel, mucoadhesive, impregnated sponge, dressing or other local formulation); multicomponent products only in sensitivity analyses | Topical HA: Gengigel 0.2%/0.8% gel, 0.6% high-molecular-weight sodium hyaluronate gel, HA 0.2%/0.8% mucoadhesive, PVP-sodium hyaluronate gel (Gelclair; multicomponent) and 0.8% PVP-sodium hyaluronate saturated gelatin sponge |
| Comparison | Placebo, no topical application, spontaneous healing, vehicle or carrier without HA, or standard donor-site care; active comparators only when HA effect could be isolated | Periodontal dressing alone, no topical agent, vehicle mucoadhesive, saline sponge, sterile gelatin sponge, chlorhexidine alone, Coe-Pak dressing |
| Outcomes | Primary: postoperative pain; complete wound epithelialization. Secondary: clinical wound-healing scores, wound area reduction, analgesic consumption, burning sensation, tissue color match, postoperative bleeding, patient satisfaction, oral health-related quality of life, adverse events | Complete epithelialization (days 14, 21; n=3 each); Wound Healing Index (days 3, 7, 14, 21; n=3 each); pain VAS (days 3, 7; n=3 each); analgesic consumption (days 1, 3; n=2 each); postoperative bleeding (days 1, 3; n=2 each); color match (days 14, 21; n=3 each). Wound area, burning, satisfaction, OHRQoL and adverse events not pooled |
| Study designs | Parallel-group, split-mouth or crossover RCTs | RCTs (n=8) |
| Timing | Each prespecified postoperative assessment analyzed separately (time-specific meta-analyses) | Postoperative days 1, 3, 7, 14 and 21 |
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 | Yes | Partial Yes | no |
| 3Choice of study designs explained | No | Yes | no |
| 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 | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | 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 | Yes | no |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |