A variety of suture materials are available for primary wound closure following oral surgical procedures. The aim was to review the tissue reactions to the various suture materials used in oral surgical interventions. Databases were searched using the following keywords: cotton, nylon, polyglecaprone 25, polytetrafluoroethylene (ePTFE), Polyglactin 910, polyglycolic acid (PGA), polylactic acid, silk, surgery, suture, and tissue reaction. Articles published only in English language were included. Seventeen studies were included. Two studies reported that polyglecaprone 25 had positive effects on wound-healing as compared to silk. Six studies reported that silk elicits more intense tissue inflammatory response and delayed wound healing as compared to other suture materials (including ePTFE, polyglecaprone-25, PGA, and nylon). Polyglactin 910 sutures were associated with the development of stitch abscess in one clinical study. Eight studies reported that tissue reactions are minimal with nylon sutures. Tissue reactions to suture materials used for oral surgical interventions may vary depending on the surface properties and bacterial adherence properties of the material. 1. Introduction Most oral surgical interventions require primary wound closure using a previously raised flap. For this purpose, a variety of suture materials are available which may be classified upon their origin (organic and synthetic) or according to their durability in host tissues (absorbable and nonabsorbable) [1, 2]. The essential features of suture material include (1) knot safety, (2) stretch capacity, (3) tissue reactivity, and (4) wound safety. Besides the adopted surgical and suturing technique, the choice of suture material may also influence the healing of the incised soft tissues [1–3]. In their study, Vastardis and Yukna [4] reported three case reports of complications after the use of an subepithelial connective tissue graft where an abscess occurred following the initial healing phase. This study [4] concluded that a stitch abscess or reaction to the suture material used for the submerged sutures could be a possible cause of the abscesses. Thus the selection of the suture material should be brought under consideration during treatment planning for oral surgical interventions. Tissue reaction is reflected through an inflammatory response, which develops during the first two to seven days after suturing the tissue [1–3]. Several studies published over the past four decades have reported that synthetic materials exhibit a superior behavior to oral tissues in terms of tissue
References
[1]
T. Okamoto, K. S. Rosini, G. I. Miyahara, and M. F. Gabrielli, “Healing process of the gingival mucosa and dental alveolus following tooth extraction and suture with polyglycolic acid and polyglactin 910 threads. Comparative histomorphologic study in rats,” Brazilian dental journal, vol. 5, no. 1, pp. 35–43, 1994.
[2]
L. H. Silverstein and G. M. Kurtzman, “A review of dental suturing for optimal soft-tissue management,” Compendium of continuing education in dentistry, vol. 26, no. 3, pp. 163–209, 2005.
[3]
G. E. Lilly, J. H. Armstrong, J. E. Salem, and J. L. Cutcher, “Reaction of oral tissues to suture materials. Part II,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 26, no. 4, pp. 592–599, 1968.
[4]
S. Vastardis and R. A. Yukna, “Gingival/soft tissue abscess following subepithelial connective tissue graft for root coverage: report of three cases,” Journal of Periodontology, vol. 74, no. 11, pp. 1676–1681, 2003.
[5]
G. E. Lilly, J. E. Salem, J. H. Armstrong, and J. L. Cutcher, “Reaction of oral tissues to suture materials. Part III,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 28, no. 3, pp. 432–438, 1969.
[6]
W. R. Wallace, G. R. Maxwell, and C. J. Cavalaris, “Comparison of polyglycolic acid suture to black silk, chromic, and plain catgut in human oral tissues,” Journal of oral surgery, vol. 28, no. 10, pp. 739–746, 1970.
[7]
N. Yilmaz, S. Inal, M. Mu？lali, T. Güven？, and B. Ba？, “Effects of polyglecaprone 25, silk and catgut suture materials on oral mucosa wound healing in diabetic rats: an evaluation of nitric oxide dynamics,” Medicina Oral, Patologia Oral y Cirugia Bucal, vol. 15, no. 3, pp. e526–e530, 2010.
[8]
F. Sortino, C. Lombardo, and A. Sciacca, “Silk and polyglycolic acid in oral surgery: a comparative study,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 105, no. 3, pp. e15–e18, 2008.
[9]
G. Banche, J. Roana, N. Mandras et al., “Microbial adherence on various intraoral suture materials in patients undergoing dental surgery,” Journal of Oral and Maxillofacial Surgery, vol. 65, no. 8, pp. 1503–1507, 2007.
[10]
K. N. Leknes, I. T. R？ynstrand, and K. A. Selvig, “Human gingival tissue reactions to silk and expanded polytetrafluoroethylene sutures,” Journal of Periodontology, vol. 76, no. 1, pp. 34–42, 2005.
[11]
K. N. Leknes, K. A. Selvig, O. E. B？e, and U. M. E. Wikesj？, “Tissue reactions to sutures in the presence and absence of anti-infective therapy,” Journal of Clinical Periodontology, vol. 32, no. 2, pp. 130–138, 2005.
[12]
J. E. Otten, M. Wiedmann-Al-Ahmad, H. Jahnke, and K. Pelz, “Bacterial colonization on different suture materials—a potential risk for intraoral dentoalveolar surgery,” Journal of Biomedical Materials Research B, vol. 74, no. 1, pp. 627–635, 2005.
[13]
Y. Charbit, C. Hitzig, M. Bolla, C. Bitton, and M. F. Bertrand, “Comparative study of physical properties of three suture materials: silk, e-PTFE (Gore-Tex), and PLA/PGA (Vicryl),” Biomedical Instrumentation and Technology, vol. 33, no. 1, pp. 71–75, 1999.
[14]
K. A. Selvig, G. R. Biagiotti, K. N. Leknes, and U. M. E. Wikesj？, “Oral tissue reactions to suture materials,” International Journal of Periodontics and Restorative Dentistry, vol. 18, no. 5, pp. 475–487, 1998.
[15]
R. S. Abi Rached, B. E. de Toledo, T. Okamoto et al., “Reaction of the human gingival tissue to different suture materials used in periodontal surgery,” Brazilian Dental Journal, vol. 2, no. 2, pp. 103–113, 1992.
[16]
T. Okamoto, M. F. Gabrielli, and M. A. Gabrielli, “Influence of different types of non-resorbable suture material on the healing of extraction wounds—a histological study in rats,” The Journal of Nihon University School of Dentistry, vol. 32, no. 2, pp. 104–115, 1990.
[17]
W. A. Castelli, C. F. Nasjleti, R. Diaz-Perez, and R. G. Caffesse, “Cheek mucosa response to silk, cotton, and nylon suture materials,” Oral Surgery Oral Medicine and Oral Pathology, vol. 45, no. 2, pp. 186–189, 1978.
[18]
G. E. Lilly, J. L. Cutcher, J. C. Jones, and J. H. Armstrong, “Reaction of oral tissues to suture materials. IV,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 33, no. 1, pp. 152–157, 1972.
[19]
G. E. Lilly, “Reaction of oral tissues to suture materials,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 26, no. 1, pp. 128–133, 1968.
[20]
G. J. Reul, “Use of vicryl (polyglactin 910) sutures in general surgical and cardiothoracic procedures,” American Journal of Surgery, vol. 134, no. 2, pp. 297–299, 1977.
[21]
S. D. Macht and T. J. Krizek, “Sutures and suturing: current concepts,” Journal of Oral Surgery, vol. 36, no. 9, pp. 710–712, 1978.
[22]
N. Ananthakrishnan, R. S. Rao, and S. Shivam, “Bacterial adherence to cotton and silk sutures,” The National medical journal of India, vol. 5, no. 5, pp. 217–218, 1992.
[23]
S. Katz, M. Izhar, and D. Mirelman, “Bacterial adherence to surgical sutures. A possible factor in suture induced infection,” Annals of Surgery, vol. 194, no. 1, pp. 35–41, 1981.
[24]
F. Javed and G. E. Romanos, “Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review,” Journal of Periodontology, vol. 80, no. 11, pp. 1719–1730, 2009.
[25]
D. Bandyopadhyay, N. M. Marlow, J. K. Fernandes, and R. S. Leite, “Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes,” Journal of Clinical Periodontology, vol. 37, no. 6, pp. 501–509, 2010.
[26]
F. Javed, K. N？sstr？m, D. Benchimol, M. Altamash, B. Klinge, and P. E. Engstr？m, “Comparison of periodontal and socioeconomic status between subjects with type 2 diabetes mellitus and non-diabetic controls,” Journal of Periodontology, vol. 78, no. 11, pp. 2112–2119, 2007.
[27]
H. Inaba and A. Amano, “Roles of oral bacteria in cardiovascular diseases—from molecular mechanisms to clinical cases: implication of periodontal diseases in development of systemic diseases,” Journal of Pharmacological Sciences, vol. 113, no. 2, pp. 103–109, 2010.
[28]
F. Javed, L. Klingspor, U. Sundin, M. Altamash, B. Klinge, and P. E. Engstr？m, “Periodontal conditions, oral Candida albicans and salivary proteins in type 2 diabetic subjects with emphasis on gender,” BMC Oral Health, vol. 9, no. 1, article 12, 2009.
[29]
F. Javed, M. Chotai, A. Mehmood, and K. Almas, “Oral mucosal disorders associated with habitual gutka usage: a review,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 109, no. 6, pp. 857–864, 2010.
[30]
F. Javed, M. Altamash, B. Klinge, and P. E. Engstr？m, “Periodontal conditions and oral symptoms in gutka-chewers with and without type 2 diabetes,” Acta Odontologica Scandinavica, vol. 66, no. 5, pp. 268–273, 2008.
