Postoperative pain control after free gingival graft: a systematic review and meta-analysis of RCTS

This systematic review and meta-analysis evaluated the efficacy of interventions for managing postoperative pain following a free gingival graft (FGG) harvested from the palate. A comprehensive search was conducted in eight major databases, without language restrictions, following PRISMA guidelines. Randomized clinical trials (RCTs) involving adults undergoing FGG and assessing postoperative pain were included. Pain was evaluated using the Visual Analog Scale (VAS). Risk of bias was assessed using the Cochrane RoB 2 tool. The protocol was registered on INPLASY (ID INPLASY2022120077). Among 48 studies, 16 had a low risk of bias, 27 presented some concerns, and 5 showed a high risk, mainly related to blinding and allocation concealment. The analysis identified Leukocyte-Platelet Rich Fibrin (L-PRF) + Sutures as the most effective intervention for pain reduction on Day 1 (-6.80; 95% CI [-7.68, -5.92]) compared to sutures and surgical cement. Additionally, Gelatin Sponge + 0.2% Hyaluronic Acid + Sutures significantly reduced pain (-4.80; 95% CI [-6.03, -3.57]) compared to Gelatin Sponge + Sutures. Heterogeneity among studies was substantial (I² = 78-92%), indicating variability in study designs and outcomes, affecting generalizability. Funnel plot analysis suggested a moderate risk of publication bias, potentially overestimating treatment effects. L-PRF and 0.2% HA gel were the most effective interventions for postoperative pain reduction. Palatal protection plates emerged as a viable alternative in resource-limited settings due to their ease of fabrication and affordability. However, substantial heterogeneity and moderate risk of publication bias highlight the need for further high-quality trials.