Topical phenytoin effects on palatal wound healing.

Abstract

The clinical benefits of autogenous soft tissue grafts are countered by donor site morbidity. The aim of this prospective split-mouth clinical trial is to assess clinical, histological and patient outcomes following topical phenytoin (PHT) treatment of experimental palatal wounds. Systemically healthy adults were recruited. One 6mm diameter wound (posterior) and one 4mm diameter wound (anterior), each 1-1.5mm deep, were created on both sides of the palate. Wounds on one randomly chosen side received 10% phenytoin USP and contralateral wounds received carrier alone. Biopsies were harvested from anterior wounds (Day1 or Day5) and were routinely processed for histology. Posterior wounds were left undisturbed to clinically evaluate healing (using photographs and Healing Score Index) on Days1, 5, 14, and 21. Questionnaires were used to assess patient-centered outcomes. Data analysis was performed using generalized logistic and generalized linear mixed models. Twenty participants completed all visits. 30% of participants reported more pain on control side than the PHT side at Day1 (P=0.014). 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 significantly and time-dependently affected granulation tissue appearance (P=0.004). Histologically, there were no significant differences between control and PHT, at any time point (P ≥ 0.853). The results of the present study, the first one to report on topical PHT as palatal wound treatment, suggest that PHT application on palatal wounds could result in improved healing outcomes.