Hemostasis in the donor area of the hard palate using 445 nm wavelength laser radiation

Relevance. This study aimed to evaluate the effectiveness of hemostasis using laser radiation with a wavelength of 445 nm in the donor site of the hard palate. Chronometric analysis was performed to determine the time required to achieve hemostasis in the wound. Additionally, traditional methods of bleeding control commonly used in surgical dental practice during free gingival graft transplantation from the palate were analyzed.

Materials and methods. A study was conducted involving 48 patients with an average age of 39.00 ± 8.43 years who were treated with gingivoplasty and vestibuloplasty with a free gingival graft from the palate. In 75% of cases (n = 36), a free de-epithelialized gingival graft was obtained from the hard palate, while in 25% of cases (n = 12), a free full-thickness mucosal graft was used. Hemostasis in the hard palate donor site was achieved using laser radiation with a wavelength of 445 nm. The procedure was performed in a non-contact, dynamic manner with a non-initiated fiber at 1 W power in continuous mode.

Results. The mean donor site wound area was 248.65 ± 8.78 mm², and the mean time to achieve complete hemostasis was 167.65 ± 7.37 seconds. Regression analysis of coagulation time identified defect size and the presence of epithelium on the graft as significant factors. In cases where a free de-epithelialized connective tissue graft was used, the mean coagulation time increased by 6.8 seconds (p = 0.0005), as determined through contrast assessment in the regression model. No instances of postoperative bleeding at the donor site were observed over the long term.

Conclusion. Laser-assisted hemostasis using 445 nm wavelength radiation offers distinct advantages over conventional hemostatic methods for controlling bleeding at the donor site of the hard palate. Its application reduces the risk of postoperative complications, making it a valuable technique in periodontal and oral surgical practice.

1. Ashurko IP, Magdalyanova ML, Galyas AI, Balyasin MV, Skulbeda DV, Krylova DА, et al. Comparative analysis of various soft tissue augmentation technique effectiveness around implants. Parodontologiya. 2023;28(3):286–295 (In Russ.). doi: 10.33925/1683-3759-2023-783.

2. De Angelis P, De Angelis S, Passarelli PC, Liguori MG, Pompa G, Papi P, et al. Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants. International Journal of Oral and Maxillofacial Surgery. 2021;50(7):956-963. doi: 10.1016/j.ijom.2020.11.014

3. Bassetti RG, Stähli A, Bassetti MA, Sculean A. Soft tissue augmentation procedures at second-stage surgery: a systematic review. Clinical oral investigations. 2016;20(7):1369–1387. doi: 10.1007/s00784-016-1815-2

4. Durnovo EA, Galkina ES, Orlinskaya NY, Kvashnina MS, Sopina AY. Histological and immunohistochemical analysis of autografts and xenografts synergy in rectifying attached keratinized gingiva deficiency. Parodontologiya. 2024;29(1):35–44 (In Russ.). doi: 10.33925/1683-3759-2023-843

5. Nosova MA, Volova LT, Sharov AN, Trunin DA, Postnikov MA. Surgical treatment of multiple gingival recessions by the combination of autograftand allogenic lyophilized dura mater: a clinical case. Parodontologiya. 2021;26(2):125–136 (In Russ.). doi: 10.33925/1683-3759-2021-26-2-125-136

6. Farkhshatova R, Gerasimova L, Usmanova I, Daurova F, Golub A, Aletdinova S. Diagnosis and treatment of Miller class I gingival recession using free connective tissue autograft from the hard palate. Clinical observation. Archiv EuroMedica. 2022;12(4):17. doi: 10.35630/2199-885X/2022/12/4.17

7. Kulkarni MR, Shettar LG, Bakshi PV, Nikhil K. Palatal pre-suturing for perioperative hemostasis at free gingival graft donor sites: A randomized, controlled clinical trial. Journal of periodontology. 2021;92(10):1441–1447. doi: 10.1002/JPER.20-0754

8. Ashurko I, Tarasenko S, Magdalyanova M, Bokareva S, Balyasin M, Galyas A, et al. Comparative analysis of xenogeneic collagen matrix and autogenous subepithelial connective tissue graft to increase soft tissue volume around dental implants: a systematic review and meta-analysis. BMC Oral Health. 2023;Oct10;23(1):741. doi: 10.1186/s12903-023-03475-0

9. Rossmann JA, Rees TD. A comparative evaluation of hemostatic agents in the management of soft tissue graft donor site bleeding. Journal of Periodontology. 1999;70(11):1369–1375. doi: 10.1902/jop.1999.70.11.1369

10. Keceli HG, Aylikci BU, Koseoglu S, Dolgun A. Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery. Journal of Clinical Periodontology. 2015;42(6):582–589. doi: 10.1111/jcpe.12404

11. Luchsheva LF, Kravchenko VA, Shchulzhenko VG, Yakimov NN. The operation of transplantation of a full-thickness mucous graft in the area of the hard palate. Public health of the Far East. 2013;2(56):107–111 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=30630065

12. Sementsov IV, Peshko AP, Goman MYu. Closing a donor site of a palate autograft with a fibrin membrane. Pacific Medical Journal. 2020;2:92–93 (In Russ.). doi: 10.34215/1609-1175-2020-2-92-93

13. Ozcan M, Ucak O, Alkaya B, Keceli S, Seydaoglu G, Haytac MC. Effects of platelet-rich fibrin on palatal wound healing after free gingival graft harvesting: a comparative randomized controlled clinical trial. The International Journal of Periodontics and Restorative Dentistry. 2017;37:e270–278. doi: 10.11607/prd.3226

14. Edranov SS, inventor; Limited Liability Company "Professor's Clinic of Edranov", assignee. Method for closing a donor palatine wound during collection of a free gingival graft according to Edranov using a multifunctional non-contact plasma high-voltage coagulator. Russian Federation patent RU2754062C1. 2021 Aug 25 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=46604797

15. Morshedzadeh G, Aslroosta H, Vafaei M. Effect of GaAlAs 940 nm Photobiomodulation on palatal wound healing after free gingival graft surgery: a split mouth randomized controlled clinical trial. BMC oral health. 2022;22(1):202. doi: 10.1186/s12903-022-02229-8

16. Prityko DA, Sergeenko EYu, Timokhin EV, Savlaev KF, Gusev LI. Prospects of the use of laser therapy treatment of oral mukosites in children (literature review). Pediatric dentistry and dental prophylaxis. 2018;17(1):14–17 (In Russ.). Available from: https://www.detstom.ru/jour/article/view/116/117

17. Palaia G, D’Alessandro L, Pergolini D, Carletti R, Di Gioia CRT, Romeo U. In vivo clinical and histological thermal effect of a 445 nm diode laser on oral soft tissues during a biopsy. Journal of Oral Science. 2021;63(3):280–282. doi: 10.2334/josnusd.20-0665

18. Etemadi A, Taghavi NS, Hodjat M, Kosarieh E, Hakimiha N. Assessment of the Photobiomodulation Effect of a Blue Diode Laser on the Proliferation and Migration of Cultured Human Gingival Fibroblast Cells: A Preliminary In Vitro Study. Lasers in Medical Sciences. 2020;11(4):491–496. doi: 10.34172/jlms.2020.77

19. Romanenko NV, Tarasenko SV, Davtyan AA, Serezhnikova NB, Djidjavadze SV, Derevyankin AA, et al. The features of the reparative regeneration of an oral mucosa wound created under the exposure of a laser at a wavelength of 445 nm (a pilot study). Lasers in Medical Sciences. 2024;39(1):152. doi: 10.1007/s10103-024-04105-z

20. Tarasenko SV, Pozdniakova TI, Stepanov MA. The use of laser-assisted technologies for the combined treatment of patients presenting with lichen planus of oral mucosa. Russian Journal of Stomatology. 2013;6(4):38–44 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=21080580

21. Kazakova RT, Tomov GT, Kissov CK, Vlahova AP, Zlatev SC, Bachurska SY. Histological Gingival Assessment after Conventional and Laser Gingivectomy. Folia medica. 2018;60(4): 610–616. doi: 10.2478/folmed-2018-0028