Topical Hyaluronic Acid for Palatal Donor-Site Healing After Autogenous Gingival Graft Harvesting: A Systematic Review and Time-Specific Meta-Analysis with Clinical Implications for Postoperative Care

Background: Palatal graft harvesting can cause pain, bleeding, and delayed healing, with postoperative recovery varying across patients and over time. Topical hyaluronic acid (HA) may reduce donor-site morbidity and promote tissue repair. Identifying the postoperative time points and clinical domains in which HA may provide benefit could support more informed, patient-centered postoperative management. Objective: To evaluate the time-specific effects of topical HA on palatal wound healing and postoperative morbidity after autogenous gingival graft harvesting and to examine their clinical implications for postoperative care. Methods: Randomized clinical trials comparing topical HA with placebo, no application, or standard care were reviewed. Separate random-effects meta-analyses were performed at each postoperative time point using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Between-study variance was estimated using REML. Leave-one-out, Hartung–Knapp, and formulation-based sensitivity analyses were performed. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Results: Eight randomized trials were included. HA increased complete epithelialization at day 14 (RR = 2.11; 95% CI, 1.13–3.94) and day 21 (RR = 1.62; 95% CI, 1.29–2.03). WHI favored HA at day 7 (MD = 0.58; 95% CI, 0.42–0.75). Pain reductions at days 3 and 7 and bleeding reductions at days 1 and 3 were not statistically significant. Analgesic consumption was lower at day 3 (MD = −0.80; 95% CI, −1.34 to −0.26), while color match favored HA at days 14 and 21. Hartung–Knapp analyses increased uncertainty for WHI, pain, and color match. No result was rated at high overall risk of bias; certainty ranged from low to very low. Conclusions: Topical HA appears to provide its most consistent benefit in accelerating palatal epithelialization and selected healing outcomes rather than uniformly reducing all dimensions of postoperative morbidity. These time- and outcome-specific effects may inform patient-centered and risk-adapted postoperative strategies, particularly when early wound closure is a clinical priority. However, the current aggregate evidence does not permit identification of individual treatment responders. Future adequately powered randomized trials incorporating standardized HA formulations, patient-level characteristics, potential effect modifiers, and harmonized outcome assessment are needed to support precision treatment selection.