Effect of Oral Bromelain on Wound Healing, Pain, and Bleeding at Donor Site Following Free Gingival Grafting: A Clinical Trial
AbstractObjectives: Considering the optimal efficacy of bromelain for pain relief and wound healing, this study aimed to assess the effect of bromelain on wound healing, pain, and bleeding at the donor site following free gingival grafting (FGG). Materials and Methods: This randomized, controlled double-blind clinical trial was performed on 26 patients with gingival recession. The patients were randomly divided into two groups of bromelain and placebo (n=13). Treatment was started on the day of surgery and was continued for 10 days. Pain, bleeding, and epithelialization at the donor site were the variables evaluated in this study using a questionnaire. The level of pain was determined using a visual analog scale (VAS) considering the number of analgesic tablets taken within 7 days postoperatively. Bleeding was determined according to the patient’s report, and epithelization was assessed by applying 3% hydrogen peroxide (H2O2) to the donor site. The donor site epithelialization was assessed at 7 and 10 days after surgery. Results: Bromelain caused a significant reduction in pain at the donor site (2.605±0.509) compared to the placebo (4.885±0.519; P<0.05). The number of donor sites with complete epithelialization was higher in the bromelain group compared to the placebo, but this difference was not statistically significant (P>0.05). The two groups were the same regarding postoperative bleeding (P>0.05). Conclusions: The results showed that oral bromelain (500 mg/day) can be effective in the reduction of pain at the donor site after FGG and may also enhance wound healing. Oral bromelain does not increase the risk of postoperative bleeding. Key words: Bromelain; Wound Healing; Transplant Donor Site; Operative Surgical Procedure
. Takei H, Azzi R, Han T. Periodontal plastic and esthetic surgery. Carranza's Clinical Periodontology 10ma ed St Louis Missouri: Saunders Elsevier. 2006:1005-26.
. Gaspani L, Limiroli E, Ferrario P, Bianchi M. In vivo and in vitro effects of bromelain on PGE2 and SP concentrations in the inflammatory exudate in rats. Pharmacology. 2002;65(2):83-6.
. Maurer H. Bromelain: biochemistry, pharmacology and medical use. Cellular and Molecular Life Sciences CMLS. 2001;58(9):1234-45.
. Ho D, Jagdeo J, Waldorf HA. Is There a Role for Arnica and Bromelain in Prevention of Post-Procedure Ecchymosis or Edema? A Systematic Review of the Literature. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2016;42(4):445-63.
. Tadikonda A, Pentapati KC, Urala AS, Acharya S. Anti-plaque and anti-gingivitis effect of Papain, Bromelain, Miswak and Neem containing dentifrice: A randomized controlled trial. Journal of clinical and experimental dentistry. 2017;9(5):e649-e53.
. Aiyegbusi A, Duru F, Anunobi C, Noronha C, Okanlawon A. Bromelain in the early phase of healing in acute crush Achilles tendon injury. Phytotherapy research. 2011;25(1):49-52.
. MacKay DJ, Miller AL. Nutritional support for wound healing. Alternative medicine review. 2003;8(4):359-78.
. Tan Y, Li P. Bromelain has significant clinical benefits after extraction of the third molar during chemotherapy in patients with hematologic tumor. Oncology letters. 2018;15(3):2962-6.
. Muhammad ZA, Ahmad T. Therapeutic uses of pineapple-extracted bromelain in surgical care - A review. JPMA The Journal of the Pakistan Medical Association. 2017;67(1):121-5.
. Orsini RA. Bromelain. Plastic and reconstructive surgery. 2006;118(7):1640-4.
. Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the knee with oral enzymes. Clinical Drug Investigation. 2000;19(1):15-23.
. Murray MT. The healing power of herbs: the enlightened person's guide to the wonders of medicinal plants. Revised and expanded second edition. Rocklin, California: Prima Publishing xiv, 410p ISBN. 1995;1559587008.
. Silva CO, Ribeiro EDP, Sallum AW, Tatakis DN. Free gingival grafts: graft shrinkage and donor-site healing in smokers and non-smokers. Journal of periodontology. 2010;81(5):692-701.
. Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. Journal of Oral and Maxillofacial Surgery. 2014;72(6):1043-8.
. Inchingolo F, Tatullo M, Marrelli M, Inchingolo A, Picciariello V, Inchingolo A, et al. Clinical trial with bromelain in third molar exodontia. Eur Rev Med Pharmacol Sci. 2010;14(9):771-4.
. María C, Yáñez-Vico RM, Batista-Cruzado A, Heurtebise-Saavedra JM, Castillo-de Oyagüe R, Torres-Lagares D. Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period. Medicina oral, patologia oral y cirugia bucal. 2014;19(2):e157.
. Metzig C, Grabowska E, Eckert K, Rehse K, Maurer HR. Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells and thrombus formation in rat vessels in vivo. in vivo. 1999;13(1):7-12.