Dear Editor,
We read with great interest the prospective clinical study by Pattnaik et al., which investigates the use of a thermoresponsive, propolis-based in situ gel to enhance gingival wound healing following diode laser depigmentation.1 The authors are to be commended for their formulation of a mucoadhesive gel using Carbopol 974 and for incorporating in vitro drug release testing, physicochemical stability assessments, and histologic healing indices across a well-powered randomized design. These methodological strengths contribute meaningfully to the evolving landscape of bioactive adjuncts in periodontal esthetics. However, several design and interpretive aspects warrant closer scrutiny.
The decision to withhold gel application until the sixth postoperative day, although intended to preserve clot integrity, may have inadvertently delayed the observation of potential early-phase benefits of propolis on inflammation resolution and neovascularization. Healing in gingival soft tissue progresses rapidly in the initial 72–120 h, and bioactive agents with known immunomodulatory properties, such as caffeic acid phenethyl ester in propolis, may exert their maximal effect during this early window.2 A comparative arm with immediate gel application or an additional earlier evaluation time point may have helped delineate whether the absence of intergroup pain score differences stemmed from therapeutic equivalence or delayed onset of action.
The use of Landry's Healing Index provided a structured and reproducible assessment of epithelial recovery, yet the exclusive reliance on macroscopic healing scores omits cellular-level validation of fibroblast proliferation, angiogenesis, or epithelial thickness. Given that propolis is postulated to influence nitric oxide synthesis and modulate transforming growth factor-beta pathways,3 inclusion of immunohistochemical markers could have established mechanistic plausibility and addressed potential placebo-equivalent outcomes observed in pain metrics. This omission becomes clinically relevant in light of the study's claim of superior regenerative activity, which was not mirrored by significant analgesic superiority.
The formulation's mucoadhesive and syringeability profile was rigorously tested in vitro, but its in vivo retention at the application site, particularly in the highly mobile anterior maxillary vestibule, remains speculative. Salivary flow, lip movement, and mucogingival elasticity are known to influence topical agent dwell time in periodontal zones.4 Without confirmatory data such as salivary dilution assays or radiolabel tracking, clinical effectiveness may be overestimated in ambulatory conditions. This translational gap may be bridged in future studies through pharmacokinetic modeling or patient-reported adherence metrics.
We commend the authors for integrating a novel, thermoresponsive delivery platform into the context of periodontal soft tissue recovery. Their development of a stable, sustained-release propolis formulation tailored for gingival application represents an important contribution to bioactive wound care in esthetic dentistry. Further investigations incorporating early-phase application, molecular healing markers, and real-world adherence dynamics may enhance the clinical generalizability of this promising therapeutic adjunct.
Declaration of financial interests
The authors declare no financial interests relevant to this study.
Declaration of non-financial interests
The authors declare no non-financial interests relevant to this study.
Ethical approval
Not required.
Clinical trial registration details/number
Not applicable, as this study does not report a clinical trial.
Research registry number
Not applicable.
Human ethics and consent to participate declarations
Not applicable as no patient data were collected or analyzed in this study.
Data availability statement
Not applicable, as no data were generated or analyzed in this study.
Generative AI use statement
Grammarly and ChatGPT were tools were used solely to assist with language refinement and formatting. All scientific content, interpretations, and critical analyses were developed by the authors, who take full responsibility for the integrity and accuracy of the manuscript.
Source of funding
No funding was received for this study.
Conflict of interest
The authors declare to have no conflict of interests relevant to this study.
Footnotes
Peer review under responsibility of Taibah University.
References
- 1.Pattnaik N., Mohanty S., Singh D.K., Sahoo A., Pathi J., Jalaluddin M. Thermoresponsive propolis gel for gingival wound healing post-depigmentation: a prospective clinical study. J Taibah Univ Med Sci. 2026;21(1):67–77. doi: 10.1016/j.jtumed.2025.12.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Olgierd B., Kamila Ż., Anna B., Emilia M. The pluripotent activities of caffeic acid phenethyl ester. Molecules. 2021;26(5):1335. doi: 10.3390/molecules26051335. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.M Ammar E.S. Chinese Propolis attenuates In-Vivo and In-Vitro asthmatic reactions. J Allergy Ther. 2013;1(S11) [Google Scholar]
- 4.Rath R., Tevatia S., Rath A., Behl A., Modgil V., Sharma N. Mucoadhesive systems in dentistry: a review. Int J Dent Res. 2016;4(2):25. [Google Scholar]
Associated Data
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Data Availability Statement
Not applicable, as no data were generated or analyzed in this study.