Oral mucosal wound healing: A photograph-based prospective study.

Abstract

<h4>Background</h4>Oral mucosa heals with minimal scar formation compared with other tissues. The aim of this study was to explore the differential healing properties between keratinized gingiva and non-keratinized alveolar mucosa, and to analyze the healing dynamic of these tissues through a clinical photograph-based prospective study.<h4>Methods</h4>Fourteen patients received 26 interdental piezocisions as part of orthodontic therapy. Piezocisions penetrated through the oral mucosa, the periosteum, and the cortical bone. They overlapped both keratinized gingiva and non-keratinized alveolar mucosa. Wounds were evaluated at four time points (1, 3, 8, and 20 weeks) by measuring the Mucosal Scarring Index (MSI) on standardized photographs.<h4>Results</h4>The analysis included 364 incisions evaluated at four time-points. The scar length showed a significant reduction up to 3 weeks in the alveolar mucosa (p < 0.001) and up to 8 weeks in the gingiva (p = 0.048). At 1 week, the posterior regions had higher MSI scoring than the anterior regions, particularly in the mandibular alveolar mucosa. No significant changes in the scar length or MSI scores were observed after 8 weeks, indicating stabilization of the healing processes. By 20 weeks, 64.05% and 52.22% of the incisions were devoid of scars in the gingiva and alveolar mucosa, respectively.<h4>Conclusion</h4>The study confirmed that both oral mucosa and gingiva heal with no scar or minimal scarring, following full-thickness incisions. Neither keloid nor hypertrophic scars were observed. No significant differences were found between gingiva and alveolar mucosa in terms of final scar visibility. However, healing outcomes were notably less favorable in the posterior regions, highlighting the influence of anatomical location.<h4>Plain language summary</h4>Oral mucosa exhibits minimal scar formation compared with other tissues. Studies evaluating the healing dynamics of the various intraoral tissue types remain limited. This prospective study investigates the healing characteristics of keratinized gingiva and non-keratinized alveolar mucosa, by focusing on scar formation following piezocision. Complete wound closure was observed at all sites 1 week after surgery. More than half of the piezocisions produced no visible scarring. Notably, even though the incisions penetrated the full thickness of the tissue and involved perforation of the vestibular cortical bone, no significant scarring was observed. However, increased scar visibility was noted in patients with pigmented gingiva. The healing results appear to vary according to anatomical regions.