A preliminary histologic study of the wound healing of mucogingival flaps when secured with the cyanoacrylate tissue adhesives

Beyond the Needle: A Comparative Evaluation of Silk Sutures and Cyanoacrylate for Periodontal Flap Closure

Introduction As the incidence of periodontal diseases continues to surge, there is a concurrent elevation in the demand for periodontal treatment. Periodontal surgical therapy is done to control and eliminate disease activity. Conventionally, silk sutures have been considered the gold standard for post-operative flap closure that leads to biofilm accumulation and tissue trauma. Cyanoacrylates are alternate options to avoid the limitations. Objective The objective of the study was to assess clinical outcomes by comparing the healing after periodontal flap surgery when secured with 3-0 braided silk suture versus cyanoacrylate. Methodology Twenty surgical sites from 10 patients with moderate to severe periodontitis were selected and randomly divided into two groups after phase-1 therapy: the test group (isoamyl 2-cyanoacrylate) and the control group (3-0 silk braided suture). Post-operative wound healing, pain assessment using a verbal rating scale (VRS), and analgesic tablets taken were evaluated on the third, fifth, seventh, and 14th days. Statistical analysis was done using the ANOVA test with the post-hoc Bonferroni test. Results There was no statistically significant difference between the VRS and wound healing index at different levels of intervals during intergroup comparison, but the number of analgesics consumed post-operatively was less in the test group as compared to the control group. Conclusion The present study concluded that isoamyl 2-cyanoacrylate can be used as an alternative to conventional silk sutures as it decreases post-operative pain and discomfort.

Evaluation and comparison of the efficacy of autologous fibrin glue with 4-0 silk sutures in periodontal flap closure and wound healing - A split mouth randomized controlled trial

BACKGROUND

Fibrin glue has shown to be a pioneering remedy to overcome the inconvenience of suturing. Autologous products reduce the risk of contamination and immunological responses compared to commercial fibrin glue. Hence using autologous fibrin glue (AFG) as a tissue sealant in periodontal flap closure would be of added value for a predictable outcome.

OBJECTIVE

To evaluate and compare the efficacy of AFG with 4-0 silk sutures in periodontal flap closure and healing.

MATERIAL AND METHODS

Total of 17 patients diagnosed with generalized periodontitis in the age group of 18 to 60 years with probing pocket depth of ≥ 6 mm and clinical attachment level of ≥5 mm in at least two quadrants were categorized into test group (AFG) and control group (4-0 silk sutures). Primary outcome measures [modified gingival index (MGI), early wound index (EHI) and interleukin 1 beta (IL-1ß) and secondary outcome measures (oral hygiene index, plaque index and visual analog scale (VAS) were recorded at baseline, 1, 2, 3 and 4 weeks.

RESULTS

A statistically significant reduction of IL-1ß value (p =.005); MGI (p = .02); EHI (p = .004), VAS scores (p < .001) and a positive Spearman's correlation (rho = 0.15) was seen between EHI scores & IL-1ß levels in test group at 1week period in comparison to control group.

CONCLUSION

AFG showed promising results as an alternative to sutures. The use of AFG significantly improved clinical parameters and reduced the levels of pro-inflammatory cytokines making it an effective adhesive with healing properties in the era of suture-less periodontal flap surgery.

The Effects of Cyanoacrylate on Clinical Healing and Self-Reported Outcomes Following Free Gingival Graft Surgery: A Randomized Clinical Study

Objective: This study aims to reveal the effects of cyanoacrylate application at the recipient bed and the donor site in free gingival graft surgery on graft dimensions, clinical healing parameters and patient-based outcomes. Methods: Free gingival graft operations were conducted on individuals who were randomly assigned to control or test groups. In the test group, the graft was stabilized and the donor site was coated with cyanoacrylate. In the control group, 6/0 polyvinylidene fluoride sutures were used for stabilization, while the donor site was left untreated. Variables including re-epithelization, post-operative complications, pain, bleeding and quality of life at recipient site, and color match, graft dimensions at donor site were assessed for up to 6 months. Results: Twenty-three individuals completed the study. No differences were observed in any variable between groups except horizontal dimension loss of the graft, which was more abundant in the cyanoacrylate group at six months (p>0.05, p

Biocompatible alkyl cyanoacrylates and their derivatives as bio-adhesives

Cyanoacrylate adhesives and their homologues have elicited interest over the past few decades owing to their applications in the biomedical sector, extending from tissue adhesives to scaffolds to implants to dental material and adhesives, because of their inherent biocompatibility and ability to polymerize solely with moisture, thanks to which they adhere to any substrate containing moisture such as the skin.

Comparative evaluation of healing after periodontal flap surgery using isoamyl 2-cyanoacrylate (bioadhesive material) and silk sutures: A split-mouth clinical study

BACKGROUND

Many factors contribute to uneventful and healthy postoperative healing. Hence, closure of periodontal flap postsurgery for the attainment of primary union between flap margins is of utmost importance. Isoamyl 2-cyanoacrylate is a tissue adhesive, which can be used for the closure of elevated flaps to overcome the problems associated with conventional suture material like silk.

AIM

This study aims to compare healing after periodontal flap surgery using isoamyl 2-cyanoacrylate (bioadhesive material) and silk sutures.

MATERIALS AND METHODS

The study was carried out on twenty patients who needed flap surgical procedure for pocket therapy.

STATISTICAL ANALYSIS USED

Results were subjected to statistical analysis. Paired t-test was used for intragroup postprocedure improvement in each parameter, and independent sample t-test was used for intergroup comparison.

RESULTS

Early healing was seen with isoamyl 2-cyanoacrylate during the 1^st week when compared with silk. However, no significant difference was seen in the 2^nd week when both the materials were compared.

CONCLUSIONS

It can be concluded that cyanoacrylate aids in early initial healing.

Tissue adhesive in free gingival graft

The aim of the present study was to review the literature regarding the utilization of 2-octyl cyanoacrylate's (Dermabond®, Ethicon US, USA) as a tissue adhesive in dentistry; also, to report its use in the stabilization and fixation of a free gingival graft, indicated to increase the width of the keratinized attached mucosa at the lower incisive region. Literature analysis revealed numerous indications for this tissue adhesive in the medical field related to maxillofacial injuries. In dentistry, clinical reports, as well as controlled clinical studies conducted in humans and in animal models, using histological analysis described positive results for the use of different cyanoacrylate-based tissue adhesives. These studies reported that the use of tissue adhesives reduced the surgical procedure time period, eliminated postoperative visits as well as the discomfort of suture removal and, in addition, did not interfere with the clinical repair process. Favorable results, like the ones described in the literature, were obtained in the present case report using Dermabond®.

Effect of n-butyl-2-cyanoacrylate on high-risk colonic anastomoses

We investigated the effect of n-butyl-2-cyanoacrylate (BCA) on colonic anastomosis under clean contaminated procedure (CCP) and bacterial peritonitis (BP) conditions in rats. Male Wistar albino rats (n = 80) were divided into two groups: CCP and BP. In the CCP group, colonic resection and anastomosis were performed. BP was induced by cecal ligation and puncture. BCA was administered to the anastomosis in half of the rats in both groups. Anastomotic assessment was done on postoperative days 3 and 7 by evaluating the burst pressure, and gross anastomotic and histopathologic healing indices. The presence and severity of adhesion formation was also investigated. There were no differences in terms of gross healing parameters on days 3 and 7. Burst pressures were also similar on both days (p = 0.244 and p = 0.101, respectively). In the early phase (day 3), adhesion development (p < 0.001), granulocytic cell infiltration (p = 0.02), inflammation (p = 0.019) and necrosis (p = 0.019) were higher in the BCA groups. Mononuclear cell infiltration (p = 0.659), fibroblastic cell infiltration (p = 0.538) and capillary formation (p = 0.316) were similar. In the late phase (day 7), adhesion development (p < 0.001), necrosis (p = 0.001) and granulocytic cell infiltration (p = 0.034) were higher in the treatment groups. Fibroblastic cell infiltration (p = 0.017) and capillary formation (p = 0.016) were lower in BCA treated rats, particularly in the BP condition. Mononuclear cell infiltration did not differ (p = 0.176). The application of BCA did not provide any benefit under either CCP or BP conditions. Moreover, BCA caused increased inflammatory reactions, necrosis and adhesion formation. During the late phase of healing, the ongoing enhanced inflammation caused a reduction in capillary formation and fibroblastic infiltration, particularly under BP conditions.

Histoacryl blue versus sutured left colonic anastomosis: experimental study

BACKGROUND

Cyanoacrylates have been advocated as a protective seal in colonic anastomosis to prevent leakage. In order to assess the effects of n-butyl-2-cyanoacrylate on left colonic anastomosis it was compared to the sutured anastomosis in the rat.

METHODS

Forty male Wistar albino rats were divided into two groups of 20 each. On days 3 and 7, 10 animals in each group were killed. The comparisons between n-butyl-2-cyanoacrylate and sutured groups were made with respect to outcome measures including anastomotic leakage, anastomotic stricture, peritonitis and wound infections, and adhesion formation, anastomotic bursting pressure, histological appearance of the anastomotic area.

RESULTS

Although the adhesion formation was significantly more extensive in the n-butyl-2-cyanoacrylate group on day 3 (P < 0.001), there was no significant difference between the groups on day 7. The more inflammatory reaction also occurred in the n-butyl-2-cyanoacrylate group. The mean +/- SD anastomotic bursting pressure was significantly higher in the suture group than in the n-butyl-2-cyanoacrylate group (63 +/- 14 mmHg vs 43 +/- 8 mmHg) on day 3. The bursting pressure was also found to be higher on day 7 in the suture group (187 +/- 26 mmHg vs 49 +/- 12 mmHg, P < 0.0001). The suture group had a significantly higher bursting pressure on day 7 compared to day 3 (P < 0.05).

CONCLUSIONS

Left colonic anastomosis with n-butyl-2-cyanoacrylate in rats does not improve the healing process; on the contrary, it has a negative influence during the first week. As a consequence, the routine use of n-butyl-2-cyanoacrylate in colonic anastomosis in the clinical situation does not appear to be justifiable.

Clinical and electron microscope comparison of silk sutures and n-butyl-2-cyanoacrylate in human mucosa

The use of tissue adhesives as an alternative to or replacement for sutures in wound closure has long been an area of interest. One of these tissue adhesives is a cyanoacrylate. In 15 patients, who underwent root resections of the upper incisors on both sides, the incision lines were closed with silk sutures on one side and by n-butyl-2-cyanoacrylate on the other side of the frenum. Clinical comparison was made on the 1st, 2nd, 3rd, 7th, 14th and 21st postoperative days. On the seventh postoperative day following the removal of sutures and the coating, small punch biopsies were obtained from n-butyl-2-cyanoacrylate treated and sutured sides. The tissue specimens were examined under transmission electron microscope. Clinical observations revealed that on the third and seventh postoperative days epithelialization was better on the sides treated with n-butyl-2-cyanoacrylate. On the twenty-first postoperative day it was observed that the scar formation was significantly more marked and there was more local inflammation during the healing period on the sutured side. Electron microscopic observations of both tissue specimens revealed normal ultrastructural morphology.

Comparison of silk sutures and n-butyl-2-cyanoacrylate on the healing of skin wounds. A pilot study

The synthetic tissue adhesive n-butyl-2-cyanoacrylate (Histoacryl Blue) and silk sutures were compared on the backs of guinea-pigs as the means for closing skin incisions. On the post-operative 3rd, 7th, 14th and 21st days, specimens from each group were obtained and evaluated under light microscopy. Sections were analysed for the degree of inflammation, giant cell reaction, fibroblastic and capillary cell activity and were ranked statistically. The results showed that the silk sutures caused severe inflammatory and giant cell reaction when compared with Histoacryl and the healing process was slower than with n-butyl-2-cyanoacrylate.

Periodontal dressing materials

A detailed review of periodontal dressings is presented, covering physical, chemical and biological aspects. Areas requiring further research are outlined, particularly in the physico-chemical sphere; and some contra-indications to particular substances are described. It is concluded that there is a definite place for dressings, but that more knowledge is required before optimal properties can be developed.

Healing of periodontal flaps following use of MBR 4197 (flucrylate) in rhesus monkeys. A clinical and histological evaluation

Experimental periodontal surgery was performed on six adult Rhesus monkeys, using the modified Widman flap technique. Each monkey provided four or six segments for flap surgery, and three different experimental time intervals were used. Flaps were immobilized after surgery by conventional sutures or by application of MBR 4197 cyanoacrylate spray. Each animal provided its own contralateral comparison, and the mode of flap immobilization was reversed in the corresponding segments in the other animal of each experimental group. One monkey died approximately 12 hours after surgery, and the other animals were sacrificed at 14, 35 and 180 days. Histological sections were prepared from all operated areas, and examined for the pattern of healing. A special staining technique was used to determine the presence of MBR 4197 within the tissues.

Cyanoacrylate spray in the treatment of prolonged oral bleeding

n-Butyl-cyanoacrylate is an effective hemostatic agent. Optimal efficiency depends on local application via a spray to achieve a thin and elastic film. Construction of a spray applicable to the oral cavity is illustrated using a plastic ampule with Histoarkryl as reservoir. This spray has been used in 27 cases of prolonged bleeding to achieve hemostasis. In 18 cases the patients suffered from different hemorrhagic diatheses and general hemostatic procedures would normally have been necessary to achieve hemostasis. In nine patients without hemorrhagic diathesis, the cyanoacrylate spraying replaced more complicated local procedures. In 24 cases the cyanoacrylate spraying was a sufficient hemostatic treatment.