Received: 19 October 2022 Accepted: 25 April 2023

DOI: 10.1111/eos.12935

ORIGINAL ARTICLE

Effect of collagen sponge and flowable resin composite on pain

management after free gingival graft harvesting: A randomized
controlled clinical trial

Jonathan Meza-Mauricio1 Elisa Ribeiro Sá Tscherbakowski Mourão2

Kelson Oliveira Marinho3 Andrea Vergara-Buenaventura4
Gerardo Mendoza-Azpur1 Francisco Wilker Mustafa Gomes Muniz5
Mauro Pedrine Santamaria6 Marcelo Faveri3

1 School of Dentistry, Universidad Cientifica

del Sur, Lima, Peru
2 ImplantMaster’s Program Pontifical
Catholic University of Minas Gerais, Belo
Horizonte, Minas Gerais, Brazil
3 Department of Periodontology and Oral
Implantology, Dental Research Division,
University of Guarulhos, São Paulo, Brazil
4 Schoolof Dentistry, Faculty of Health
Sciences, Universidad Peruana de Ciencias
Aplicadas, Lima, Peru
5 Department of Periodontology, Federal
University of Pelotas, Pelotas, Brazil
6 College
of Dentistry, University of
Kentucky, Lexington, Kentucky, USA
Correspondence
Jonathan Meza-Mauricio, Universidad
Cientifica del Sur, Calle Cantuarias 398,
15048, Miraflores, Lima, Peru.
Email: emezam@cientifica.edu.pe
Funding information
Coordenação de Aperfeiçoamento de
Pessoal de Nível Superior–Brasil (CAPES)
Abstract
The aim of this study was to compare the effect of the application of a flowable resin
composite coating, over a collagen sponge stabilized with suture, on postoperative
pain after free gingival graft harvesting. Thirty-two free gingival grafts were har-
vested from the palate in 32 patients, who were subsequently randomized to have
only a collagen sponge stabilized with sutures applied to the palatal wound (control),
or to have the collagen sponge coated with a flowable resin composite (test). Patients
were observed for 14 days, and the pain level was evaluated by using a numerical
rating scale. The consumption of analgesics during the postoperative period and the
characteristic of the graft were also analyzed. The patients in the test group reported
having experienced significantly less pain statistically than the patients in the con-
trol group throughout the study. The consumption of analgesics was lower in the test
group. The dimensions of harvested grafts in the control and test groups showed no
significant differences in height, width, and thickness. In conclusion, the addition of
flowable resin composite coating to the hemostatic collagen sponge on the palatal
wound following free gingival graft harvesting helped to minimize postoperative
pain.
KEYWORDS
free gingival graft, pain management, palatal protection, palatal wound, resin composite

INTRODUCTION The connective tissue obtained from a free gingival graft is

Soft tissue grafting is widely used for the treatment of gingival
recession and mucogingival deformities [1]. In cases where it
is necessary to increase the width of the keratinized mucosa,
a free gingival graft from the palate is the best option [2, 3].
mainly composed of lamina propria with less glandular and
adipose tissue [4]. Additionally, its ease of collection and
availability in the thin palatal mucosa has made this technique
popular [2, 5]. However, the main disadvantage and concern
of patients when using free gingival graft is postoperative

© 2023 Scandinavian Division of the International Association for Dental Research. Published by John Wiley & Sons Ltd.

Eur J Oral Sci. 2023;e12935. wileyonlinelibrary.com/journal/eos 1 of 10

https://doi.org/10.1111/eos.12935
2 of 10
pain, discomfort, and bleeding [6, 7].
Some studies have reported that healing by secondary
intention after free gingival graft harvesting is associated
with higher pain and morbidity than other graft harvesting
techniques [8, 9], while others have reported that patients’
experience with autogenous soft tissue grafts may influence
their decision to undergo further surgery, especially in patients
who had previously experienced increased postoperative pain
[10].
In an effort to reduce prolonged bleeding and pain caused
by the palatal wound, different agents such as acrylic stents
[11], cellulose [12], absorbable gelatin sponges [7], platelet-
rich fibrin [13], cyanoacrylate [14], and propylene mesh
[11] have been recommended to protect the palatal wound
and reduce the morbidity of the area. Among them, colla-
gen sponges are the most widely used for wound healing
because of their biocompatibility, non-toxicity, and low cost
[15, 16]. This material has shown numerous advantages, pro-
viding mechanical protection and establishing a matrix for
clot formation and organization [7, 17]. In addition, the use
of a collagen sponge decreases the time to achieve hemosta-
sis of the palatal wound [7] and produces early healing of
connective tissue graft donor sites [18]. Recently, studies of
the postoperative pain following graft harvesting procedures
have combined collagen sponges with other products, such
as cyanoacrylate tissue adhesive, to enhance the effect. This
combination has been reported to result in less postoperative
pain and less discomfort and analgesic consumption after free
gingival graft harvesting than collagen sponge alone [5, 14,
19]. However, in some countries, the cost of cyanoacrylate tis-
sue adhesive may represent an additional burden [14], leading
to the search for other options.
Several clinical trials have reported the use of resin com-
posites in periodontal plastic surgery to treat combined defects
(gingival recession associated with non-carious cervical
lesions) [20–22]. In this approach, approximately 50%–80%
of the restoration of the cervical lesion is covered by soft tis-
sue after the healing period, thereby reducing the recession
defect. Also, it was observed that the presence of the restora-
tion in this approach did not harm periodontal tissue health
[23, 24]. Flowable resin composite is widely used after dental
implant placement to make customized provisional prosthe-
ses fit tightly to the soft tissues, with a view to replicate the
anatomy of the future permanent prosthesis [25]. In this clin-
ical situation, the flowable resin composite is in contact with
the gingival tissue. One clinical study of patients who under-
went this approach showed complete epithelization of the soft
tissues, and no inflammation was detected [25]. It could be
speculated that the hemostatic properties of a collagen sponge,
together with an additional sealing and protective layer of
flowable composite resin, would contribute to decreasing the
palatal pain after free gingival graft harvesting more than the
use of a collagen sponge alone. To our knowledge, this is the
MEZA-MAURICIO ET AL.
first study reporting on the effectiveness of this combination
in periodontal surgery. Therefore, the aim of this study was
to compare the effect of covering a suture-stabilized collagen
sponge with flowable resin on postoperative pain after free
gingival graft harvesting.
MATERIAL AND METHODS
Trial design
The present study was a parallel, randomized, single-center
controlled clinical trial conducted to evaluate patients’ mor-
bidity after free gingival graft harvesting from the palate. The
study was conducted and reported according to the CON-
SORT statement (http://www.consort-statement.org/). The
study protocol was approved by Guarulhos University Board
(approval 2.290.510) and registered on ensaiosclinicos.gov.br
(Identifier number: RBR-974c9j). Informed consent was
obtained from all eligible patients. The study was conducted
in compliance with the principles outlined in the Declaration
of Helsinki on experimentation involving human subjects, as
revised in 2013.
Participants
Eligible patients were recruited from a pool of patients seek-
ing root coverage treatment at the Dental Clinic of Guarulhos
University (Guarulhos, SP, Brazil) between August 2020 and
July 2021. Participants were selected based on the inclusion
and exclusion criteria described below.
Inclusion criteria
The criteria for inclusion were as follows:
(i) Age ≥18 years
(ii) Full-mouth plaque score and full-mouth bleeding score
≤20% (probing of six sites per tooth)
(iii) Clinical indication for periodontal plastic surgery to
treat multiple recession defects (Cairo type I or II) [26],
located in the maxilla
(iv) No history of previous palatal harvesting
Exclusion criteria
Patients were excluded from participation if they met any of
the following criteria:
(i) Systemic diseases, pregnancy, or breast-feeding
EFFECT OF COLLAGEN SPONGE AND FLOWABLE RESIN
(ii) Presence of oral lesions in the palate
(iii) Use of dental prosthesis covering the palate
(iv) History of periodontitis
(v) Current smoking
Sample size
Postoperative pain was chosen as the primary outcome vari-
able and sample size was estimated based on a previous study
[27]. Power calculation was performed considering α = 0.05
and β = 0.20, equal to a power of 80%. Under this assump-
tion, a minimum of 13 patients was deemed necessary in each
group to reach the significance level, when a difference of
2.0 ± 1.8 in mean pain scores was assumed. This number was
increased to a total sample size of 16 patients in each group to
compensate for possible dropouts during the follow-up period.
Randomization, allocation concealment, and
blinding
Patient randomization was performed using a computer-
generated randomization table prepared by an investigator
with no clinical involvement in the trial (ERST). Allocation
concealment was obtained by using a sealed coded opaque
envelope containing the treatment for the specific subject.
The envelope with the patient’s allocation was only opened
immediately after the collagen sponge was stabilized with
suture. Patients were not aware of which palatal protection
they received.
Interventions, investigators, outcomes
Pre-surgical phase
All participants underwent a comprehensive periodontal
examination performed by a single calibrated examiner
(JMM). Prior to surgical therapy, all patients received prophy-
laxis dental cleaning (supragingival scaling/debridement and
polishing).
Surgical procedure
Surgical treatment was performed by a single blinded
investigator (MF) to minimize the influence on the surgical
technique. The recipient site for the grafting technique,
which was not in close proximity to the palatal donor site,
dictated the size of grafts that were harvested. On the day
of the surgery, 2% lidocaine with 1:100,000 epinephrine
was administered for a greater palatine nerve block. A free
3 of 10
gingival graft was harvested from one side of the palate
(opposite the recipient site) with the surgical technique
described by Zucchelli and colleagues [2]. A coronal hor-
izontal incision was performed using a 15C blade 2 mm
apical to gingival margin of the adjacent teeth, followed by
two vertical incisions perpendicular to the horizontal one. In
the horizontal incision, the blade was moved perpendicular
to the palatal bone reaching the depth of the desired soft
tissue thickness. Then, the blade was repositioned so that it
was parallel to the superficial surface. The blade was moved
carefully to reach the apical part, after which a horizontal
incision was made on the outer surface, perpendicular to the
vertical ones, in order to release the graft from the palatal
surface. The graft harvested was carefully de-epithelialized
extraorally, using a new scalpel blade. In both groups, the
palatal wound was sealed with an absorbable porcine-derived
collagen hemostatic sponge (Hemospon; Maquira), which
was kept in place by sling crossed sutures performed with 5-0
non-absorbable monofilament (Techsuture), anchored to the
soft tissue, apical to the palatal wound area (Figures 1 and 2).
After that, the graft was placed and sutured in the recipient
site to treat gingival recessions. Then, the envelope with the
patient’s allocation was opened. For the test group, two layers
of flowable resin composite were applied along the wound
margins. The entire collagen sponge was coated with it to
create a uniform superficial layer of resin. The step-by-step
illustration of this approach is shown in Figure 2.
Postoperative care
Patients were asked not to brush the palatal surface of the
maxillary teeth until the protective material and the sutures
were removed after 14 days. Pain was controlled with 600 mg
of ibuprofen; patients were instructed to take one tablet at the
end of the procedure and one after 8 h. After that, patients
were instructed to take a tablet only if needed and count the
number of pills taken to measure pain indirectly by means of
the consumption of analgesics. Also, study participants were
asked to use chlorhexidine mouth rinse (0.12%) twice daily
for 2 weeks.
Outcomes
The main aim of this randomized controlled clinical trial was
to compare the postoperative pain following application of
a collagen sponge stabilized with suture + flowable resin
composite (test group) against the pain observed following
application of a collagen sponge stabilized with suture only
(control group).
The primary endpoint was palatal discomfort (postopera-
tive pain) measured by a numerical rating scale (from 0 to 10)
4 of 10
F I G U R E 1 Procedures carried out in the control group. (A) Pre-operative view. (B) Protection of the palatal wound by applying a hemostatic
collagen sponge with sling crossed sutures performed around the teeth in order to stabilize the collagen sponge.
at time intervals of 1, 2, 3, 4, 5, 6, 7, 10, and 14 days after
the surgery. One blinded examiner (KMO) called the patients
by cell phone and asked them to indicate the severity of pain
from the palate.
The secondary endpoint was the consumption of anal-
gesics: Postoperative pain was assessed indirectly by
recording the consumption of analgesic pills for 7 days
postoperatively.
The following cofactors were considered:
∙ Palatal tissue thickness was measured in the mesial, central,
and distal parts of the area designated for graft harvesting by
using the same anesthesia needle with an adjustable silicon
disk stop. These measurements were taken approximately
2−3 mm apical to the gingival margin of the adjacent tooth.
The needle was inserted carefully, perpendicular to the
mucosal surface until it came into contact with the palatal
bone. After removing the needle, the distance between the
needle tip and silicon stop was estimated using a digital
caliper (0.01 mm accuracy) at baseline (before surgery).
∙ Graft height was measured by using an endodontic spreader
with a rubber cursor. The distance between the spreader
tip and the cursor was measured using a digital caliper
(0.01 mm accuracy).
∙ Graft width was measured with an endodontic spreader with
a rubber cursor. The distance between the spreader tip and
the cursor was measured using a digital caliper (0.01 mm
accuracy).
∙ Graft thickness was measured in the mesial, central, and dis-
tal parts of the graft using an endodontic spreader with a
rubber cursor. The distance between the spreader tip and
the cursor was measured using a digital caliper (0.01 mm
accuracy), before de-epithelialization and removal of fatty
tissue.
MEZA-MAURICIO ET AL.
Statistical analysis
Statistical analysis was performed using STATA software
(version 14.0) (StataCorp) by a blinded statistician. Data were
summarized in descriptive statistics by using mean ± SD
for quantitative variables and frequency for gender. The
primary outcome variable was patient discomfort (postop-
erative pain score) throughout the 14 days of follow-up.
For this outcome, the main effects of experimental group
(test/control) and day of follow-up and their interaction
were tested using mixed effects linear regression to account
for the fact that each participant was represented by nine
data points, one for each day of follow-up. Control group
and day 1 were used as the reference categories. Resid-
uals of the model were tested and presented a normal
distribution.
The secondary variable was the mean consumption of
analgesics, while palatal tissue thickness, graft height,
width, and thickness were considered as cofactors. For
all analyses, the statistical significance was established at
p < 0.05.
RESULTS
Participant retention, adverse effects, and
compliance
The study was conducted between August 2020 and July
2021. Figure 3 presents the flow diagram of the study
design. In total, 32 participants entered this study (test group,
n = 16; control group, n = 16). All participants com-
pleted the study and no postoperative complications were
observed.
EFFECT OF COLLAGEN SPONGE AND FLOWABLE RESIN 5 of 10

F I G U R E 2 Procedures carried out in the test group. (A) Pre-operative view. (B) Palatal wound after free gingival graft harvesting. (C)
Protection of the palatal wound by applying a hemostatic collagen sponge with sling crossed sutures performed around the teeth in order to stabilize
the collagen sponge. (D) A drop of 35% phosphoric acid gel was applied for 30 s, rinsed for 10 s, and the excess moisture blotted. (E) A drop of
adhesive was applied for 15 s. (F) Flowable resin composite was applied. (G) Flowable resin composite was placed on the borders of the collagen
sponge with retention on the palatal surface of the teeth. (H) Double-layered palatal protection using flowable resin composite.

Clinical findings Patient-reported outcomes

Demographic data of the study participants are shown in
Table 1. The average full-mouth plaque index [28] and full-
mouth gingival bleeding were ≤20% (data not shown) at
baseline (1 week before the surgery procedure), without find-
ing statistically significant differences between the groups.
Table 1 shows the dimensions of grafts harvested in the
control and test groups.
Table 2 shows the observed mean (SD) pain scores by day
and group. The intercept estimated using mixed effects lin-
ear regression (Table 3) shows that at day 1, the control
group had a mean pain score of 4.94 (95% confidence inter-
val [CI] = 4.47, 5.50). The experimental group had a mean
pain score that was 3.31 points (95% CI = 2.52, 4.11) lower
than seen for the control group at day 1. The pain scores were
6 of 10 MEZA-MAURICIO ET AL.

FIGURE 3 CONSORT flow chart of the study.

T A B L E 1 Demographic characteristics of the participants and T A B L E 2 Pain scores observed by day of follow-up and
mean ± SD of palatal thickness and dimensions of the harvested graft. experimental group.

Groups Groups
Collagen sponge + Collagen sponge
flowable resin Collagen sponge Collagen sponge + flowable resin
Characteristics composite (test) (control) (control), mean composite (test),
Age (years) 42 ± 10.3 41.6 ± 9.2 Day (SD) mean (SD)

Gender (male/female) 5/11 3/13 1 4.94 (1.73) 1.63 (1.26)

Palatal thickness 4.0 ± 0.53 4.1 ± 0.53 2 3.75 (1.06) 1.25 (1.13)
(mm) 3 2.81 (1.05) 1.13 (1.09)
Graft height (mm) 4.59 ± 0.73 4.32 ± 0.52 4 2.81 (1.33) 0.63 (0.88)
Graft width (mm) 19.6 ± 5.90 20.5 ± 5.98 5 1.75 (1.91) 0.57 (1.36)
Graft thickness (mm) 2.40 ± 0.36 2.31 ± 0.30 6 1.63 (1.96) 0.32 (0.79)
7 1.44 (1.71) 0.26 (0.68)
10 0.00 (0.00) 0.00 (0.00)
14 0.00 (0.00) 0.00 (0.0)
generally lower the longer the duration of the follow-up; at
day 2 the reduction amounted to an average of 1.19 (95%
CI = 0.53, 1.84) and this reduction continued until day 10
when the estimated pain score in the control group reached 0
(4.94-4.94, Table 3). There was a statistically significant inter- at 4.94, while the day 1 score for the test group was only
action between experimental group and day of follow-up such 1.63. When the postoperative pain was assessed by the anal-
that the rate of decline over time in pain scores among test gesic consumption during the first week, a significantly higher
group participants overall was lower than seen for the con- number of analgesic tablets were consumed by patients in the
trol group participants, whose pain score at outset was much control group (6.4 tablets) in contrast to the test group (3.6
higher. Hence, the day 1 score for the controls was estimated tablets) (p < 0.05).
EFFECT OF COLLAGEN SPONGE AND FLOWABLE RESIN 7 of 10

T A B L E 3 Results of mixed effects linear regression analysis of operations, and the healing process may take a few weeks [35,
the pain score as a function of the experimental group (test or control), 36]. The pain perceived after free gingival graft harvesting has
and day of follow-up period. been shown to be positively correlated with the palatal wound
95% confidence depth rather than the wound surface area [37, 38]. Burkhardt
Variables Coefficient interval for coefficient et al. reported that grafts with a thickness of over 2 mm were
Intercept 4.94 4.37, 5.50 associated with higher morbidity [37]. In this clinical trial,
Experimental group the evaluation of the graft thicknesses were 2.40 ± 0.36 mm
Control Ref. - in the experimental group and 2.31 ± 0.30 mm in the control
group, with no significant differences between the groups.
Test −3.31 −4.11, −2.52
To our knowledge there is no study indicating if pain at the
Day of follow-up period
receptor site could influence in the palatal pain (donor area).
Day 1 Ref. -
However, to avoid bias in the identification of the painful
Day 2 −1.19 −1.84, −0.53
area (recipient and donor area), grafts were removed from
Day 3 −2.13 −2.78, −1.47 the area contralateral to the recipient area.
Day 4 −2.13 −2.78, −1.47 With the aim of reducing postoperative morbidity in
Day 5 −3.19 −3.84, −2.53 patients following soft tissue graft harvesting, several clini-
Day 6 −3.31 −3.97, −2.67 cal trials have been conducted. The majority of these trials
Day 7 −3.50 −4.15, −2.85 achieved positive outcomes using different materials such
Day 10 −4.94 −5.59, −4.28 as acrylic stents [11], cellulose [12], absorbable collagen
Day 14 −4.94 −5.59, −4.28 sponge [7], platelet-rich fibrin [39], cyanoacrylate [19], and
Interactions of group#day propylene mesh [11]. Moreover, studies using platelet-rich
of follow-up fibrin [39], ozone therapy, and laser photobiomodulation
Test * Day 2 0.81 −0.11, 1.73 have demonstrated these techniques could result in faster
Test * Day 3 1.63 0.70, 2.55 palatal wound healing and reduced postoperative discomfort
Test * Day 4 1.13 0.20, 2.05
[40]. Recent studies are assessing the use of biomaterials to
enhance pain reduction. Parlak et al. showed that the use of
Test * Day 5 2.13 1.20, 3.05
cyanoacrylate and hyaluronic acid offers additional benefits
Test * Day 6 2.00 1.08, 2.92
for donor site management in comparison with a collagen
Test * Day 7 2.13 1.20, 3.05
sponge [41].
Test * Day 10 3.31 2.39, 4.24
In this study, the efficacy of a suture-stabilized collagen
Test * Day 14 3.31 2.39, 4.24 sponge covered or not with flowable resin on postoperative
pain after free gingival graft removal was compared over a
period of up to 14 days of follow-up. Our results demonstrated
DISCUSSION that the use of flowable resin composite in addition to a col-
lagen sponge on the palatal wound resulted in a significant
In the literature, the harvesting of free gingival graft has been decrease in pain perception when compared with a collagen
reported to be one of the most painful techniques experienced sponge alone. These results should be interpreted with caution
by patients [29–31]. In this study, we proposed a new approach as the pain progressively disappears with time. In addition, it
using flowable resin to decrease the postoperative pain in the was also observed that using flowable resin composite coating
palatal region after free gingival graft harvesting. Currently, reduced the analgesic consumption compared to the control
patient-reported outcomes are important components of peri- group during the first week.
odontal plastic surgery. As clinicians, our focus should be Collagen sponges are widely used for wound healing
not only on the final clinical outcome but also on patients’ because of their biocompatibility, non-toxicity, and low cost
experiences of postoperative morbidity [32, 33]. Improving [15, 16], and have been used in several clinical trials in an
postoperative comfort along with treatment outcomes is a endeavor to decrease postoperative pain after free gingival
dynamic area of periodontal research that promotes patient graft harvesting [2, 5, 19]. This material has shown numer-
well-being [34]. Our results clearly showed that the proposed ous advantages, such as providing mechanical protection and
approach using flowable resin reduced the postoperative pain establishing a matrix for clot formation and organization [7,
to a degree that was both statistically and clinically relevant. 17]. To further reduce the discomfort and bleeding caused
Although free gingival graft is a predictable and successful by the palatal wound after soft tissue graft harvesting, cov-
technique in treating mucogingival problems such as insuf- erage of the collagen sponge has been suggested [14, 42].
ficient attached gingiva and gingival recession, the donor To our knowledge, this is the first study reporting the cover-
site heals by secondary intention after free gingival graft age of the collagen sponge with flowable resin in periodontal
8 of 10
surgery. It could be speculated that the hemostatic and seal-
ing properties of collagen sponge, together with the placement
of a protective layer of flowable composite resin that iso-
lates the wound from the oral cavity, enhance the efficacy
of minimizing palatal pain versus the use of collagen sponge
alone.
The results of the present study are in agreement with
those of another clinical study which demonstrated that
cyanoacrylate tissue adhesive associated with hemostatic
sponge stabilized with sutures promoted a lower level of
postoperative palatal pain and analgesic consumption than a
hemostatic sponge secured only with sutures (p < 0.05) [5].
Our results could be attributed to the flowable resin compos-
ite coating being capable of forming two layers of a complete
seal above the collagen sponge and protecting the wound. It
would be reasonable to assume that the combination of colla-
gen sponge and a flowable resin coating produced a complete
seal and increased wound protection which would be the main
reason for the lower degree of postoperative morbidity in the
test group compared to the control. Another important point
to be considered is that these layers of flowable resin com-
posite remained in the mouth for 2 weeks. Only two patients
in the test group mentioned that this protection had become
detached 10 days after surgery. However, the literature reports
that pain tends to decrease after the first week post-surgery
[37].
Several clinical trials have used resin composites in
periodontal plastic surgery to treat combined defects (gingi-
val recession associated with non-carious cervical lesions)
[20–22]. In this approach, approximately 50%–80% of the
restoration is covered by soft tissue after the healing period,
reducing the recession defect. Also, it was observed that the
presence of the restoration did not influence the percentage of
root coverage and did not harm tissue health (with no bleeding
on probing) [23, 24]. On the other hand, flowable resin com-
posite is widely used in implant dentistry to make customized
provisional prostheses tightly fitting the soft tissues, which
could replicate the anatomy of the future permanent prosthe-
sis showing good behavior with soft tissues [25]. Moreover, in
a recent clinical study, the influence of different subgingival
restorations on periodontal health was evaluated via combined
restorative-periodontal treatment. The results indicated that
irrespective of the type of restorative materials, the subgingi-
val restorations did not produce significant changes in clinical
and microbiological examinations 12 months after surgery
[43].
Potential complications arising from the application of
flowable resin composite coating on the collagen sponge
could include its early detachment from the palatal wound.
However, by following the steps described in this study
(Figure 2), we observed that in almost all patients, the protec-
tion was found in place on the day of suture (and protection)
removal. As previously mentioned, this protection was found
MEZA-MAURICIO ET AL.
to be detached in only two patients 10 days after surgery.
Despite the application of a flowable resin composite coating
being capable of causing discomfort due to its additional vol-
ume on the palate, none of the patients reported discomfort
with this approach. This could be attributed to the fact that
the flowable resin composite provided a well-polished layer
of protection. Another advantage is that this approach is eco-
nomical in comparison with other approaches and could be
easily reproduced in clinical day-to-day practice [14]. Regard-
ing the limitations of this study, this study did not evaluate
palatal wound healing with this approach, and although no
clinical differences were observed between the groups in the
clinical evaluation after 14 days, the importance is recog-
nized of evaluating this parameter with a validated test such
as the peroxide test [44] or by photographic measurement
of the wound healing area (in mm2 ) [45]. Therefore, future
randomized clinical studies must assess this parameter.
In conclusion, the application of a flowable resin compos-
ite coating on the hemostatic collagen sponge placed in the
palatal area appeared to provide additional benefits in terms of
pain relief after free gingival graft harvesting. This study thus
indicates that adding a flowable resin composite coating over
a hemostatic collagen sponge placed on the palatal wound
may help minimize the postoperative pain and decrease anal-
gesic consumption in patients who undergo free gingival graft
harvesting versus placement of a suture-stabilized collagen
sponge alone.
AU T H O R C O N T R I B U T I O N S
Conceptualization: Jonathan Meza-Mauricio, Elisa Ribeiro
Sá Tscherbakowski Mourão, Kelson Oliveira Marinho,
Gerardo Mendoza-Azpur, Marcelo Faveri. Methodology:
Jonathan Meza-Mauricio, Mauro Pedrine Santamaria,
Marcelo Faveri. Formal analysis: Francisco Wilker
Mustafa Gomes Muniz, Marcelo Faveri. Investigation:
Jonathan Meza-Mauricio, Elisa Ribeiro Sá Tscherbakowski
Mourão, Kelson Oliveira Marinho. Writing—original draft
preparation: Jonathan Meza-Mauricio, Andrea Vergara-
Buenaventura. Writing—review and editing: Mauro Pedrine
Santamaria, Marcelo Faveri.
AC K N OW L E D G M E N T S
The authors are grateful to the study participants for taking
the time to participate in this study. Jonathan Meza-Mauricio
received a scholarship from Latin America Oral Health
Association (LAOHA). This study was financed in part by
the Coordenação de Aperfeiçoamento de Pessoal de Nível
Superior–Brasil (CAPES). The authors self-funded the other
part of the study.
CONFLICT OF INTEREST
The authors declare no potential conflicts of interest relevant
to this article.
EFFECT OF COLLAGEN SPONGE AND FLOWABLE RESIN
ORCID
Jonathan Meza-Mauricio https://orcid.org/0000-0002-
4878-9835
Elisa Ribeiro Sá Tscherbakowski Mourão https://orcid.org/
0000-0002-9233-0095
Kelson Oliveira Marinho https://orcid.org/0000-0003-
0242-8601
Andrea Vergara-Buenaventura https://orcid.org/0000-
0002-9395-1010
Francisco Wilker Mustafa Gomes Muniz https://orcid.org/
0000-0002-3945-1752
Mauro Pedrine Santamaria https://orcid.org/0000-0001-
9468-0729
Marcelo Faveri https://orcid.org/0000-0002-9830-1391
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How to cite this article: Meza-Mauricio J, Mourão
ERST, Oliveira Marinho K, Vergara-Buenaventura A,
Mendoza-Azpur G, Muniz FWMG, et al. Effect of
collagen sponge and flowable resin composite on pain
management after free gingival graft harvesting: A
randomized controlled clinical trial. Eur J Oral Sci.
2023;e12935. https://doi.org/10.1111/eos.12935