Free gingival graft donor site: CTA alone shortens closure time and reduces mid-healing pain

Free gingival grafts (FGGs) remain the gold-standard procedure for augmenting keratinized tissue width around implants and teeth — but the palatal donor site is a well-known source of postoperative morbidity. The wound left after harvest is large, exposed, and painful. Traditional management relies on sutures combined with a gelatin sponge, but clinicians have long sought alternatives that reduce patient discomfort and simplify wound closure. This randomized controlled trial investigated whether α-cyanoacrylate tissue adhesive (CTA) — used alone or in combination with conventional suturing — could improve donor-site outcomes after FGG surgery.

Sixty patients undergoing FGG procedures were randomly divided into three equal groups: Group A received sutures plus a gelatin sponge (control); Group B received sutures, a gelatin sponge, and CTA; Group C received CTA alone. Outcomes were assessed over 14 days and included pain intensity via visual analog scale (VAS) at days 1, 2, 3, 5, 7, and 14; analgesic consumption; early wound healing index (EHI) at days 5 and 14; intraoperative wound closure time; complication rates; and patient willingness to undergo reoperation.

The most clinically striking finding was in operative efficiency: Group C achieved significantly shorter wound closure times compared with both Groups A and B (p<0.001), which has direct implications for chair time and procedural complexity. On the pain front, patients treated with CTA alone reported significantly lower VAS scores on days 5 and 7 compared with the suture-only control group (p<0.05), suggesting a meaningful mid-healing-phase advantage. Early wound healing scores also favored Group C over Group A at both assessment timepoints (p<0.05). Notably, analgesic consumption, complication incidence, and patient willingness to repeat the procedure were statistically comparable across all three groups — meaning CTA did not introduce additional risk.

For the periodontist or implantologist performing FGG surgery, these findings offer a practical takeaway: CTA alone appears to be a viable, patient-friendly alternative to suturing at the palatal donor site. It shortens the procedure, reduces mid-term pain, and supports early tissue healing without compromising safety. While the study is preliminary and limited in sample size, it provides a credible foundation for incorporating tissue adhesives into soft tissue augmentation workflows — particularly in patients with low pain tolerance or in contexts where minimizing chair time is a priority. Larger trials with longer follow-up are needed to confirm durability of outcomes.