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Anuja Doshi Thesis Final.pdf (21.17 MB)

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Topical Phenytoin Effects on Palatal Wound Healing

Doshi, Anuja
http://rave.ohiolink.edu/etdc/view?acc_num=osu1563487879484746

Abstract Details

2019, Master of Science, Ohio State University, Dentistry.
Objectives: The proven clinical benefits of palatal soft tissue grafts are countered by associated donor site morbidity and occasional healing delays, indicating a need to improve donor site outcomes. Studies have shown improved healing with phenytoin (PHT) application on chronic and acute wounds in various tissues. The aim of this prospective split-mouth clinical trial is to assess clinical, histological and patient-centered outcomes following topical PHT treatment of experimental palatal wounds. Material and Methods: 20 systemically healthy adult non-smokers were recruited. One 6 mm diameter wound (posterior) and one 4 mm diameter wound (anterior), each 1-1.5 mm deep, were created on both sides of the palate using custom stents and biopsy punches. Wounds on one randomly chosen side received PHT (10% Phenytoin USP in 30% poloxamer gel; test) and on the other received carrier alone (30% poloxamer gel; control). Participants were blinded to treatment allocation. Customized stents were worn after medication application for wound protection. Treatments were reapplied on postoperative Days 1 (D1) and 5 (D5). Biopsies were harvested from the anterior wounds, either on D1 (Group 1) or on D5 (Group 2), and were routinely processed for histology (H&E, Masson trichrome). Posterior wounds were left undisturbed to clinically evaluate healing (using photographs and Healing Score Index) on D1, D5, D14 and D21. Questionnaires and Oral Health Impact Profile-14 (OHIP-14) was used to assess patient-centered outcomes. Histomorphometry was performed on both H&E and Masson-stained sections. Descriptive statistics were calculated. Data analysis was performed using Generalized Logistic Model and Generalized Linear Mixed Model. Results: All 20 participants completed all visits. No adverse events were observed on PHT side; one control side exhibited liver clot formation (D1). Clinically, PHT treated sites were more likely to not exhibit swelling (OR=9.35; p=0.009) and to not experience pain on palpation (OR=6.278; p=0.007). PHT also had a significant and time-dependent effect on granulation tissue appearance (p=0.004). Overall, the Healing Score Index was significantly higher (suggestive of better healing) on PHT side at Day 5 ( p= 0.037) and Day 21 (p=0.003) than the control side. As for patient-reported outcomes, at Day 1, 30% reported more pain on the control side whereas none of the participants reported more pain on PHT side. This difference in relative pain was statistically significant (p=0.014). Although the mean VAS (pain) scores were consistently lower on PHT sites than the control sites, the difference was not statistically significant (p=0.533). There was no statistically significant difference in OHIP-14 scores between the two biopsy time groups. However, the total analgesic consumption was significantly higher in Group 1 than in Group 2 (p<0.0001). Conclusions: Topical PHT application on experimental palatal wounds that model free gingival graft donor sites results in improved objective clinical outcomes. This study provides new information on post-harvesting palatal wound morbidity and healing, and is the first one to report on the possible effects of topical PHT as a palatal wound treatment regimen.
Dimitris Tatakis, DDS, PhD (Advisor)
Binnaz Lebleblicioglu, DDS, MS, PhD (Committee Member)
James McAuley, RPh, PhD, FAPhA (Committee Member)
96 p.
Dentistry
Topical Phenytoin; Wound healing; Palatal wounds; Periodontology

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Citations

  • Doshi, A. (2019). Topical Phenytoin Effects on Palatal Wound Healing [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1563487879484746

    APA Style (7th edition)

  • Doshi, Anuja. Topical Phenytoin Effects on Palatal Wound Healing. 2019. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1563487879484746.

    MLA Style (8th edition)

  • Doshi, Anuja. "Topical Phenytoin Effects on Palatal Wound Healing." Master's thesis, Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1563487879484746

    Chicago Manual of Style (17th edition)

osu1563487879484746
533
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