Human Gingival Tissue Reactions to Silk and Expanded Polytetrafluoroethylene Sutures

Evaluation of the effects of silk and polyethylene terephthalate sutures on postoperative complications in impacted lower third molar surgery

The aim of this study was to compare the efficacy of silk and Polyethylene Terephthalate (PET) sutures on postoperative complications in impacted lower third molar surgery. This prospective, randomized, split-mouth, double-blind clinical study was performed between January 2021 and June 2022 at the Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Van Yüzüncü Yıl University. The patients were categorized into two groups in terms of using suture material. PET suture was used in Group 1, and the silk suture in Group 2 for wound closure following impacted lower third molar surgery. The statistical significance level was accepted as p < 0.05 in the study. Forty patients (21 women, 19 men; mean age: 26.1 ± 7.25 years) were included in the study. When values for swelling and trismus evaluation were analyzed, there was no significant intergroup difference (p > 0.05). However, the VAS values of the silk group patients were higher at the 12th and 24th hours (p < 0.05). In addition, the plaque accumulation value in the silk group was higher than that in the PET group on the second postoperative day (p < 0.05). The results indicated that the plaque accumulation in the PET suture was less on the second postoperative day. Also, PET suture group patients felt less pain during the 12th and 24th hours. These results support to use PET sutures in impacted lower third molar surgery.

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.

Biaxial stretching of polytetrafluoroethylene in industrial scale to fabricate medical ePTFE membrane with node-fibril microstructure

Expanded polytetrafluoroethylene (ePTFE) is promising in biomedical fields such as covered stents and plastic surgery owing to its excellent biocompatibility and mechanical properties. However, ePTFE material prepared by the traditional biaxial stretching process is with thicker middle and thinner sides due to the bowing effect, which poses a major problem in industrial-scale fabrication. To solve this problem, we design an olive-shaped winding roller to provide the middle part of the ePTFE tape with a greater longitudinal stretching amplitude than the two sides, so as to make up for the excessive longitudinal retraction tendency of the middle part when it is transversely stretched. The as-fabricated ePTFE membrane has, as designed, uniform thickness and node-fibril microstructure. In addition, we examine the effects of mass ratio of lubricant to PTFE powder, biaxial stretching ratio and sintering temperature on the performance of the resultant ePTFE membranes. Particularly, the relation between the internal microstructure of the ePTFE membrane and its mechanical properties is revealed. Besides stable mechanical properties, the sintered ePTFE membrane exhibits satisfactory biological properties. We make a series of biological assessments including in vitro hemolysis, coagulation, bacterial reverse mutation and in vivo thrombosis, intracutaneous reactivity test, pyrogen test and subchronic systemic toxicity test; all of the results meet the relevant international standards. The muscle implantation of the sintered ePTFE membrane into rabbits indicates acceptable inflammatory reactions of our sintered ePTFE membrane fabricated on industrial scale. Such a medical-grade raw material with the unique physical form and condensed-state microstructure is expected to afford an inert biomaterial potentially for stent-graft membrane.

Microbiological Retention on PTFE versus Silk Suture: A Quantitative Pilot Study in Third Molar Surgery

Background: Mandibular third molar (M3M) removal and management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. This potential quantitative study assessed the ability of two types of surgical sutures, Silk and polytetrafluoroethylene polymer (PTFE), to carry aerobic and anaerobic bacteria on wounds after mandibular third molar surgery, with a collection of the stitches at the suture removal and study in the laboratory on the basis of colony-forming units. Methods: This prospective quantitative study sampled a total of 10 consecutive healthy patients for mandibular third molar surgery at the Oral Surgery School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy. The mean age of the patients was 31 years (range 25–40 years), seven patients were male and three patients were female. Inclusion criteria were: presence of a partially impacted mandibular third molar. Exclusion criteria were: smoking and diabetes mellitus. Extraction of the mandibular third molar was performed under local anesthesia: after the third molar surgery, two sutures were applied on the surgical site distally to the second mandibular molar: one single 3/0 silk stitch; one single 3/0 PTFE stitch. No sutures were applied on the release incision. Sutures were removed after 7 days and were immediately conserved and sent to the laboratory to be rated on the basis of colony-forming units (CFUs). CFUs were evaluated and reported on GraphPad Prism and transformed into its base 10 logarithm. Data were analyzed with a non-parametric Wilcoxon test, and p-values < 0.05 were evaluated as statistically significant. Results: All the patients attended the suture removal date, and all the sutures were present in the site. None of the surgical sites presented dehiscence. No stitch loss was reported, and no patient reported mouth washing or tooth brushing in the surgery site. All interventions were uneventful and no major complications were reported after M3M surgery. Bacterial retention resulted as statistically greater in silk sutures rather than PTFE sutures, both in Brain Heart Infusion samples (p = 0.003) and Wilkins-Chalgren anaerobe samples (p = 0.002). Conclusions: We found the PTFE suture to be superior to the silk suture in a reduction in the bacterial biofilm in both aerobic and anaerobic evaluations after M3M surgery.

Characteristics of Suture Materials Used in Oral Surgery: Systematic Review

BACKGROUND

The aim of this review was to evaluate the most used suture materials with regards to their inflammatory response, their bacterial adhesion, and their physical properties when used to close oral wounds.

METHODS

Four databases (PubMed, Scopus, Dentistry & Oral Sciences, and OVID) were searched to retrieve relevant studies from January 1, 2000, to January 31, 2020.

RESULTS

Out of the 269 articles, only 13 studies were selected as they were relevant and met the systematic review's protocol. These studies showed that almost all suture materials studies (catgut, polyglycolic acid [PGA] sutures, nylon, expanded polytetrafluoroethylene, and silk sutures) caused bacterial adherence and tissue reaction. In nylon and chromic catgut, the number of bacteria accumulated was lowest. Silk and nylon were found to be more impacted than catgut and PGA in terms of physical characteristics such as tensile strength. PGA, on the other hand, was said to be the most susceptible to knot unwinding.

CONCLUSIONS

Following an oral surgical operation, all sutures revealed varied degrees of irritation and microbial accumulation. Nonresorbable monofilament synthetic sutures, however, exhibited less tissue response and less microbial accumulation.

Evaluation of Bacterial Colonization and Clinical Properties of Different Suture Materials in Dentoalveoler Surgery

PURPOSE

This study aimed to compare the effects of 10 different suture materials commonly used in dentoalveolar surgery on wound healing, their postoperative microbial colonization, and related clinical parameters.

METHODS

A total of 172 suture samples from patients who had undergone extraction of impacted third molars were included in the study. The suture materials studied were poly-glycolide-colactide, fast absorbable poly-glycolide-colactide, poly-glycolic acid-cocaprolactone, polydioxanone, silk, polypropylene, polyvinylidene difluoride, polyamide, polyester, and polytetrafluoroethylene (PTFE). The microbial colonization in all sutures and clinical parameters were evaluated after 1 week.

RESULTS

Multifilament sutures had higher bacterial colonization compared with monofilament sutures (P < .001). No dental plaque accumulation was observed in any samples of polypropylene sutures. Polydioxanone, PTFE, and poly-glycolic acid-cocaprolactone sutures exhibited less postoperative slack compared with all other sutures after 1 week. Patients with silk, polyvinylidene difluoride, and PTFE sutures had less suture-related discomfort. According to the Landry index score, monofilament sutures demonstrated superior wound healing to multifilament sutures (P = .019). In addition, nonabsorbable sutures showed significantly better wound epithelization than absorbable sutures (P ˂ .001).

CONCLUSIONS

Bacterial colonization and tissue reactions due to the surface properties of the suture affected the wound healing after dentoalveolar surgery. Multifilament sutures should not be applied for prolonged periods because of their tendency for microbial colonization. The tissue reaction to the absorbable suture materials may adversely affect wound healing.

Recurrent cervical stitch sinus arising from the deep neck space after thyroidectomy: case study and review

OBJECTIVE

We describe a one-stage surgical technique for the management of recurrent cervical stitch sinus after thyroidectomy.

METHOD

A retrospective, single-centre study of all patients who were operated on because of cervical neck sinus after thyroidectomy. We provide a detailed description of our surgical approach, based on guided sinus removal after prior tract staining with methylene blue and subsequent obliteration using local strap muscle flap.

RESULTS

A total of seven patients with a mean age of 46 years were included in the study. All patients had a past history of thyroidectomy because of goitre (n=5) or thyroid cancer (n=2) which had previously been unsuccessfully debrided two or three times. Surgical sinus removal was successful in all cases and no recurrence was observed during the follow-up time.

CONCLUSIONS

We conclude that a comprehensive en bloc resection down to the suture granuloma is essential in order to provide surgical cure and prevent recurrence.

Factors Affecting the Outcome of Frontalis Sling Surgery in Patients with Severe Blepharoptosis

Background:

Several factors play a role in the outcome of severe blepharoptosis correction by frontalis sling surgery, including the age of a patient, sex, causes of ptosis, and its severity, among others. Identifying the factors that most severely affect surgical outcomes could reduce the complication rate and improve patients’ satisfaction.

Methods:

This was a retrospective analytical study using logistic regression statistics to evaluate the effects of the following 6 factors on frontalis sling surgical outcomes: age, sex, cause of ptosis, type of anesthesia used, eye side (right or left), degree of ptosis, and levator function. These factors were compared with 10 types of surgical outcomes. The study included 120 eyelids in 95 patients, of which 70 eyelids were unilateral and 50 eyelids were bilateral. Patient ages ranged between 2 and 75; patient sex distribution was 47.5% females and 52.5% males.

Results:

The study yielded 60 comparison tables. Only statistically significant and clinically relevant data are presented and discussed. Overall, male patients showed better eye symmetry (P < 0.026) and better satisfaction (P < 0.004) than did females. Causes other than the congenital ptosis are characterized by better eye closure during sleep (P = 0), in comparison with congenital ptosis cases.

Conclusion:

The use of silk suture as a sling material is recommended for male patients, as its use produces better results, including eye symmetry and patient satisfaction, with a lower complication rate compared with that in female patients.

In vitro biocompatibility and biomechanics study of novel, Microscopy Aided Designed and ManufacturEd (MADAME) materials emulating natural tissue weaves and their intrinsic gradients

This study conducted biomechanical and biocompatibility tests of textiles and textile composites, created using recursive logic to emulate the properties of natural tissue weaves and their intrinsic mechanical stiffness gradients. Two sets of samples were created, first to test feasibility on textile samples designed as periosteum substitutes with elastane fibers mimicking periosteum's endogenous elastin and nylon fibers substituting for collagen, and then on composites comprising other combinations of suture materials before and after sterilization. In the first part, the bulk tensile mechanical stiffness of elastane-nylon textiles were tuned through respective fiber composition and orientation, i.e., aligned with and orthogonal to loading direction. Cell culture biocompatibility studies revealed no significant differences in proliferation rates of embryonic murine stem cells seeded on textiles compared to collagen membrane controls. Until the 15th day of culture, cells were rarely observed in direct contact with the elastane fibers, similar to previous observations with elastomeric sheets used in periosteum substitute implants. In the second part of the study textile samples were created from FDA-approved medical sutures comprising silk, expanded polytetrafluoroethylene, and polybutester. Biocompatibility and mechanical stiffness were assessed as a function of sterilization/disinfection mode (steam, ethylene oxide, and serial disinfection with ethanol). Cell proliferation rates did not differ significantly from controls, except for silk-suture containing textiles, which showed bacterial contamination and no viable cells after 15 days' culture for all sterilization methods. Sterilization had mixed (mostly not significant) effects on textile stiffness, except for the case of polybutester suture-based textiles that showed a significant increase in stiffness with ethylene oxide sterilization. In general, all textile combinations exhibited significantly higher stiffness than periosteum. Textiles comprising medical sutures of different stiffnesses arranged in engineered patterns offer a novel means to achieve mechanical gradients in medical device materials, emulating those of nature's own.

Preference of Suture Specifications in a Selected Periodontal and Implant Surgeries in Turkey

Objective Various suture materials and needles are now available for use in the dental surgery. The aim of this study was to determine the preference of suture materials among Turkish dentists by a dental survey.

Materials and Methods The survey was prepared and sent electronically to Turkish dentists through e-mail and/or Facebook. Dentists were asked to report their graduation year from dental school and their specialty if they have one. In addition, the type periodontal/implant operations and the frequency of those operations applied by them were questioned. The participants were to indicate their suture preferences for these procedures in a multiple-choice questionnaire.

Results Fifty-seven regular dentists, 49 periodontists, 22 oral surgeons, and 8 other specialists completed a self-administered survey. The majority of clinicians worked in private practice (77.9%). Nonabsorbable sutures were the most preferred for all procedures except periodontal plastic surgery. In regenerative surgeries, monofilament, 5–0 diameter suture material on a reverse cutting, 3/8 circle needle was preferred. In addition, for mucogingival surgery, 5–0 diameter suture material on a reverse cutting and 3/8 circle needle was favored. For dental implants, 4–0 diameter suture material on a reverse cutting and 3/8 circle needle was preferred. Monofilament and braided sutures were selected almost equally for implant operations.

Conclusions In periodontal and implant surgeries, dentists highly preferred the use of nonabsorbable sutures. In addition, the shape and diameter of needle had an important role in the selection of suture material. The present study's results may serve as a guide for the future studies.

A comparative study of immediate wound healing complications following cleft lip repair using either absorbable or non-absorbable skin sutures

Objectives

The aim of the study was to compare wound healing complications following the use of either absorbable or non-absorbable sutures for skin closure in cleft lip repair.

Materials and Methods

This was a randomized controlled trial conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria. Sixty subjects who required either primary or secondary cleft lip repair and satisfied all the inclusion criteria were recruited and randomized into two groups (Vicryl group or Nylon group). The surgical wounds in all subjects were examined on 3rd, 7th, and 14th postoperative days (POD) for presence or absence of tissue reactivity, wound dehiscence, and local wound infection.

Results

Hemorrhage, tissue reactivity, wound dehiscence, and local wound infection were identified as wound healing complications following cleft lip repair. The incidence of postoperative wound healing complications on POD3 was 33.3%. Tissue reactivity was more common throughout the evaluation period with the use of an absorbable (Vicryl) suture compared to a non-absorbable (Nylon) suture, although the difference was statistically significant only on POD7 (P=0.002). There were no significant differences in the incidences of wound dehiscence and infection between the two groups throughout the observation period.

Conclusion

There were no statistically significant differences in the incidences of wound dehiscence and surgical site wound infection following the use of either Vicryl or Nylon for skin closure during cleft lip repair. However, more cases of tissue reactivity were recorded in the Vicryl group than in the Nylon group on POD7. Particular attention must be paid to detect the occurrence of wound healing complications, most especially tissue reactivity, whenever a Vicryl suture is used for skin closure in cleft lip repair.

Gingival Tissue Response Following Placement of a Light Cure Dressing and a Non-eugenol Dressing after Periodontal Flap Procedure: A Comparative Clinical Study

Aim:

The aim was to compare the gingival tissue response following placement of a light cure dressing (Barricaid^®) and a non-eugenol periodontal dressing (Coe-Pak^™) after periodontal flap procedure. This was carried out by evaluating plaque deposition underneath both the dressings, healing response and the patient preference for each.

Materials and Methods:

A total of 12 patients with chronic generalized periodontitis requiring surgery in at least two different quadrants were enrolled for this split-mouth study. After periodontal flap surgery, Coe-Pak^™ was placed in the quadrant assigned to Group I and Barricaid^® was placed in the other quadrant assigned to Group II. Clinical parameters were recorded on day 7 and day 14. Patient comfort and pain levels were also evaluated by a questionnaire.

Results:

There were no statistically significant differences in wound healing and the clinical gingival parameters between two groups. The only significant difference was found in the plaque attached underneath the dressing, with Coe-Pak^™ showing greater plaque accumulation than Barricaid^®. Seventy five (75) % of the patients preferred Barricaid^® over Coe-Pak^™, based on its appearance and taste.

Conclusion:

The non-eugenol dressing seemed to retain more plaque on its undersurface than light-cure dressing. However, this did not have much influence on the healing outcome and clinical gingival parameters, which were optimal and comparable in both groups. The greater number of patients showed a preference for light cure dressing, based on its superior esthetics and taste.

Importance of absorbable surgical sutures for the prevention of stitch abscess after surgery in patients with oral squamous cell carcinoma

Background

To elucidate the significance of absorbable surgical sutures in the occurrence of stitch abscess after surgery in patients with oral squamous cell carcinoma (SCC).

Material and Methods

The subjects were 251 patients who underwent excision and/or reconstruction and/or neck dissection for oral SCC using absorbable surgical sutures. Detection rates and characteristics of patients with stitch abscess were retrospectively evaluated by comparing between our present and previous data.

Results

There was only one stitch abscess among the 251 patients. A significant difference in the incidence of stitch abscess was found between the present data and our previous data. Of course, no significant correlations were found between the occurrence of stitch abscess using absorbable surgical sutures and the various factors seen in our previous analysis.

Conclusions

A complete switch of surgical sutures from silk to absorbable surgical sutures is needed for surgery in patients with oral SCC.

Key words:Stitch abscess, oral cancer, occurrence, absorbable surgical sutures, silk suture.

In Vitro Tensile Strength Study on Suturing Technique and Material

Suture technique and materials are important in preventing complications such as wound dehiscences. The purpose of this study was to determine the tensile strength of different suturing techniques, comparing several materials with different diameters. One hundred sixty sutures were performed using silk, e-PTFE, and 2 types of polyamide (monofilament and Supramid). Ten simple, 10 horizontal mattress, and 10 combinations of the two stitches were performed with 4-0 gauge of each material. Additionally, 10 simple sutures were performed with the 5-0 gauge of each material. The maximum tensile force resisted by each suture was recorded. When 5 mm of traction was applied, the polyamide monofilament resisted significantly better without untying or breaking compared with Supramid or silk, while the e-PTFE was superior to all the others. However, the force when e-PTFE 4-0 sutures untied or broke was lower than for either type of polyamide. The combined technique withstood a significantly higher tensile force before unknotting or breaking than did the simple and mattress stitches. The 5-0 gauges of silk and both types of polyamide showed lower tensile strengths than the 4-0 materials. Among the 5-0 sutures, Supramid showed a higher tensile strength than silk. The combined suture technique possessed greater tensile strength than did a simple or a horizontal mattress suture, and e-PTFE 4-0 withstood more traction without untying or breaking than did all the other materials, although at a lower tensile force. With the exception of e-PTFE, 4-0 sutures had greater tensile strength than did 5-0 sutures.

Pain and quality of life related to suture removal after 3 or 7 days at the extraction sites of impacted lower third molars

BACKGROUND

This study aimed to evaluate the patient's pain and quality of life after suture removal at either 3 or 7 days following the bilateral surgical extraction of impacted lower third molars.

METHODS

This study was a prospective, randomized controlled clinical trial carried out in 30 patients, who acted as their own control. Each patient required the bilaterally impacted mandibular third molars to be extracted. The impacted teeth were removed and the wound margins were approximated and sutured with black braided silk. The suture material was removed on day 3 on one side and on day 7 on the other. Each participant was asked to complete a questionnaire after the removal of the suture material on each designated day.

RESULTS

Regarding overall clinical symptoms, the mean VAS scores of male and female participants on day 3 were not significantly different from those on day 7. A significant difference was found in female participants, in that overall daily activity was better on day 7. There were significant differences in the ability to smile and laugh in both sexes and the ability to chew in the male participants was better on day 7.

CONCLUSIONS

There were no significant differences in the patient's pain and quality of life between suture removal on day 3 or on day 7 following surgery to remove impacted lower third molars.

Physical and Mechanical Evaluation of Five Suture Materials on Three Knot Configurations: An in Vitro Study

The aim of this study was to evaluate and compare the mechanical properties of five suture materials on three knot configurations when subjected to different physical conditions. Five 5-0 (silk, polyamide 6/66, polyglycolic acid, glycolide-e-caprolactone copolymer, polytetrafluoroethylene) suture materials were used. Ten samples per group of each material were used. Three knot configurations were compared A.2=1=1 (forward⁻forward⁻reverse), B.2=1=1 (forward⁻reverse⁻forward), C.1=2=1 (forward⁻forward⁻reverse). Mechanical properties (failure load, elongation, knot slippage/breakage) were measured using a universal testing machine. Samples were immersed in three different pH concentrations (4,7,9) at room temperature for 7 and 14 days. For the thermal cycle process, sutures were immersed in two water tanks at different temperatures (5 and 55 °C). Elongation and failure load were directly dependent on the suture material. Polyglycolic acid followed by glycolide-e-caprolactone copolymer showed the most knot failure load, while polytetrafluoroethylene showed the lowest (P < 0.001). Physical conditions had no effect on knot failure load (P = 0.494). Statistically significant differences were observed between knot configurations (P = 0.008). Additionally, individual assessment of suture material showed statistically significant results for combinations of particular knot configurations. Physical conditions, such as pH concentration and thermal cycle process, have no influence on suture mechanical properties. However, knot failure load depends on the suture material and knot configuration used. Consequently, specific suturing protocols might be recommended to obtain higher results of knot security.

Tissue reactivity and suture handling characteristics of "jimat" against silk and chromic gut in cat thigh muscle: A comparative study

AIM

This study was conducted to evaluate and compare the tissue reactivity and suture handling characteristics of chromic gut, silk, and 'jimat' suture materials in cat thigh muscle.

MATERIALS AND METHODS

This experimental study was conducted from November, 2013 to April, 2014 in Kombolcha Animal Diseases Survey, Research and Diagnostic Laboratory, Kombolcha, Ethiopia. A total of 36 local breed male cats were randomly assigned into chromic gut, silk, and "jimat" groups of 12 cats each as A, B, and C, respectively. The hind leg muscle biceps femoris was incised and sutured with suture materials according to their groups. The muscle samples with its suture were collected at six different days interval i.e. 1, 3, 7, 14, 21, and 28 and processed histopathologically to assess the degree of leukocytic infiltration and fibrous and granulation tissue formation (GTF). In addition, all suture materials were evaluated intraoperatively about their handling characteristics, by rating the precision of knot tying, square knot positioning, and resistance to knot slippage. The statistical analysis was done with two-way ANOVA, Kruskal-Wallis, and Chi-square tests.

RESULTS

The histopathology showed that "jimat" thread (2.4±1.2) had produced least leukocytic infiltration than chromic gut (4.5±1.9) and silk (4.3±1.5) sutures during the study period. Higher GTF was seen at day 3 (6 [100%]), 7 (6 [100%]) and day 14 (4 [66.7%]) in all sutures, whereas "jimat" showed significantly (p<0.05) higher fibrous tissue formation (10 [83.3%]) than others. Moreover, "jimat" suture had equal suture handling characteristics (p>0.05) with both chromic gut and silk.

CONCLUSION

The result indicated that a single strand "jimat" thread appears to be the most satisfactory suture material as regards to both tissue reaction and suture handling characteristics for skeletal muscle approximation in cats and provided that studies on its carcinogenic effects should be done.

How do absorbable sutures absorb? A prospective double-blind randomized clinical study of tissue reaction to polyglactin 910 sutures in human skin

OBJECTIVE

To compare the tissue reaction produced by 2 gauges of implanted polyglactin 910(Vicryl) suture material in human skin.

METHODS

A prospective, double masked, parallel randomized IRB approved clinical trial. Consecutive patients with involutional entropion and horizontal eyelid laxity were randomly allocated to 5/0 or 7/0 gauge test suture groups. Symptoms were alleviated during the wait for definitive surgery by placement of eyelid everting sutures. After 28 days, surgical entropion correction including eyelid wedge excision was achieved. Histological analysis was carried out, masked to the suture gauge used, on the excised eyelid containing one of the temporary everting sutures. Both patient and analyst were masked to the suture group. The four primary outcome measurements were granuloma outer diameter, central cellular diameter, giant cell number and area of fibrous coat and a statistical comparison made between suture gauge groups.

RESULTS

21 patients were allocated to each group, and histological analysis was possible in 36 patients. Significant suture-related granulomatous inflammatory reactions were found in all specimens. Medians of the measurements for 5/0 and 7/0 gauge sutures, respectively, were 0.855 mm versus 0.387 mm granuloma outer diameter (p = 0.0001); 0.464 mm versus 0.250 mm central cellular element diameter (p = 0.0003); 0.194 mm(2) versus 0.053 mm(2) fibrous coat area (p = 0.0009) and 0.8 versus 1.2 giant cell number (p = 0.7511).

CONCLUSIONS

Polyglycolic acid sutures elicit a significant foreign body inflammatory response proportional to suture gauge. This reaction may be minimized by early suture removal. The study validates a novel and ethical approach to the examination of human skin response to implanted suture material.

Development of silver nano-coatings on silk sutures as a novel approach against surgical infections

The infections give rise to a range of clinical problems and prolong hospitalization with increased healthcare costs. Moreover, persistent infections exasperate the problem of antibiotic resistance. The aim of this study was the development of effective and low-cost antibacterial silver coatings on surgical sutures by adopting an innovative photochemical deposition process to prevent early contamination of surgical wounds. The silver deposition technology adopted in this work is an innovative process based on the in situ photoreduction of a silver solution. The samples were dipped in the silver solution and then exposed to UV radiation in order to induce the synthesis of silver clusters on the surface of the suture. The homogeneous distribution of silver particles on the surface and on the cross-section of the treated sutures was demonstrated. All the antibacterial studies clearly demonstrated that the use of novel silver treated sutures could represent clinical advantages in terms of the prevention of surgical infections against bacterial colonization. The silver coating deposited on the sutures demonstrated no cytotoxic effect on a selected cell population. The results obtained suggested that the antibacterial silver-coated sutures developed in this work could represent an interesting alternative to conventional sutures, with evident advantages in terms of prevention of the surgical infections and on the health costs. In addiction, very low concentrations of silver significantly inhibited the microbial load, without affecting the cell viability.

Light-cured resin "Barricaid" - An aesthetic and biocompatible dressing: A step ahead

BACKGROUND

Periodontal dressings have been used for several years as a protection over injured tissue to shield the area from further insult. Several dressings are commercially available. A recently introduced light-cured resin, claimed to be more biocompatible and esthetic, needs critical evaluation.

AIM

To compare this dressing with most widely used non-eugenol pack in the perspective of esthetics, acceptance, and healing following periodontal flap surgery.

MATERIALS AND METHODS

Twenty patients suffering from generalized chronic periodontitis, requiring periodontal flap surgery on contralateral sides of the arch, were selected and divided randomly into Group I (control) and Group II (test). In Group I, a non-eugenol dressing and in Group II light-cured dressing were applied after flap surgery. Pain and discomfort scores were recorded on day 1, 2, and 3 while plaque scores, gingival index, and bleeding index were recorded on day 7. Patient's subjective evaluation and preference for the dressing material were recorded. The data was collected and statistically analyzed.

RESULTS

Group II showed better results than Group I when plaque scores, bleeding scores, modified gingival index scores, and pain and discomfort scores were compared though the differences were not statistically significant. Subjects found no unpleasant taste/smell and perceived the light-cured dressing to be better. A significantly higher number of patients preferred light-cured resin as a post-surgical dressing over Coe-pak.

CONCLUSION

The light-cured dressing showed better patient acceptability and proves to be a better alternative to Coe-pak as a dressing material.

Tissue reactions to various suture materials used in oral surgical interventions

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.

Minimally invasive periodontal therapy

Minimally invasive dentistry is a concept that preserves dentition and supporting structures. However, minimally invasive procedures in periodontal treatment are supposed to be limited within periodontal surgery, the aim of which is to represent alternative approaches developed to allow less extensive manipulation of surrounding tissues than conventional procedures, while accomplishing the same objectives. In this review, the concept of minimally invasive periodontal surgery (MIPS) is firstly explained. An electronic search for all studies regarding efficacy and effectiveness of MIPS between 2001 and 2009 was conducted. For this purpose, suitable key words from Medical Subject Headings on PubMed were used to extract the required studies. All studies are demonstrated and important results are concluded. Preliminary data from case cohorts and from many studies reveal that the microsurgical access flap, in terms of MIPS, has a high potential to seal the healing wound from the contaminated oral environment by achieving and maintaining primary closure. Soft tissues are mostly preserved and minimal gingival recession is observed, an important feature to meet the demands of the patient and the clinician in the esthetic zone. However, although the potential efficacy of MIPS in the treatment of deep intrabony defects has been proved, larger studies are required to confirm and extend the reported positive preliminary outcomes.

Immunohistochemical comparison of indermil with traditional suture materials in dental surgery

The aim of this experimental study was to evaluate the effects of indermil on the closure of oral mucosa wounds in comparison with conventional sutures by investigating interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) markers immunohistochemically in an animal model.The animals were anesthetized by intraperitoneal injection of ketamine (90 mg/kg body weight). Straight incisions were made to the buccal mucosa of the animals. Animals were randomly assigned to 5 groups. Five different materials were used in the study. These were silk, plain catgut, monocryl, vicryl rapide (polyglactin 910), and indermil (N-butyl-2-cyanoacrylate). The wounds were closed primarily. After the region of wounds was examined clinically at the 2nd, 7th, 14th, and 21st days, excisional biopsies were performed, and the tissue samples were examined histopathologically and immunohistochemically.On the 14th day, TNF-α and IL-1β levels were high in the plain catgut group, moderate in the indermil group, and mild in the monocryl, silk, and vicryl rapide groups. On the 21st day, TNF-α and IL-1β levels were moderate in the plain catgut group, mild in the indermil and monocryl groups, and nonsignificant in the silk group. After the second day, TNF-α and IL-1β levels were mild in the monocryl, silk, and vicryl rapide groups.Plain catgut had more negative effects than indermil on wound healing. Indermil should be applied to oral mucosa wounds together with sutures to provide better tissue support.

Tissue reactions to suture materials in the oral mucosa of beagle dogs

Purpose

The objective of this study was to compare and evaluate the inflammatory responses of three widely used suture materials in the keratinized gingiva and buccal mucosa of beagle dogs.

Methods

Silk, polyglycolic acid, and nylon sutures were placed within the mandibular keratinized gingiva and maxillary buccal mucosa of four male beagle dogs. Biopsies were taken 3, 7, and 14 days after suturing. Specimens were prepared with hematoxylin-eosin stain for evaluation under a light microscope.

Results

The suture materials placed in the oral mucosa elicited more inflammatory reactions than did those placed in the keratinized gingiva. The multifilament suture materials caused more inflammatory tissue reactions than did the monofilament suture materials in the oral mucosa.

Conclusions

If oral hygiene is well maintained and suture materials are placed in the keratinized gingiva, silk, nylon, and polyglycolic acid are considered to be proper suture materials for oral surgery. However, it is advisable to use monofilament suture materials if the suture site is within the oral mucosa.

Uncommon foreign body reactions occurring in the lip: clinical misdiagnosis and the use of special techniques of analysis

This study reports three interesting cases of nodular submucosal lip lesions where foreign-body reactions of unknown origin were detected on hematoxylin and eosin (H&E) analysis. These materials were evaluated under polarized light microscopy, scanning electron microscopy and by energy dispersive X-ray analysis. The results revealed the following materials: an interdental toothbrush bristle, silica, and iron. Unusual mucosal foreign body reaction cases have been reported, but few publications used special techniques to identify the specific foreign material. Clinicians and pathologists might consider these techniques for identifying the precise origin of these foreign bodies.

A comparative study between two different suture materials in oral implantology

OBJECTIVE

The prospective study compares, in split-mouth design, the use of two different suture materials, silk vs. Teflon-coated, multi-filament braided polyester threads suture.

MATERIAL AND METHODS

Ten edentulous or partially edentulous patients were surgically treated for implant installation. Each side was sutured with either, randomly selected one or the other suture material. Seven days postsurgically, the sutures were removed and three knots per patient and side were collected for microbiological testing. Additionally, a piece of each suture thread was analysed before clinical use to test its susceptibility for bacterial adherence. To evaluate the patient's subjective opinion, a questionnaire based on Visual Analogue Scale had to be filled out by all included patients 1 week after the intervention.

RESULTS

The results showed a more pronounced plaque accumulation for silk sutures but there was not a statistical difference. The intraoperative handling of the silk sutures was less comfortable and the patient comfort was worse than Teflon-coated polyester suture.

CONCLUSION

The bacterial adherence on Teflon-coated polyester suture was slightly inferior than silk suture although it did not show the expected differences.

Antibacterial protection of suture material by chlorhexidine-functionalized polyelectrolyte multilayer films

The formation of bacterial biofilms on the surface of implanted materials is a critical factor that may lead to chronic microbial infection and tissue necrosis. In the present study we analysed the stability of polyelectrolyte multilayer (ML) films on suture materials and the antibacterial effect obtained with chlorhexidine (CHX)-functionalized films built on different types of suture materials such as silk, polyester and copolymer of glycolide and L: -lactide. The comparison of Escherichia coli culture on glass coverslips and glass coverslips with ML and CHX showed at 24 h an inhibition of the bacterial relative luminescence (40.68%, P < 0.5) and at 48 h (99.46%, P < 0.001). In another way, simple soaking of suture material overnight in CHX digluconate 20% without polyelectrolyte films did not at all protect sutures from bacterial colonization but CHX-functionalized polyelectrolyte films, made from poly-L: -glutamic acid and poly-L: -lysine, inhibited Escherichia coli proliferation.

A retrospective study and gene analysis of canine sterile panniculitis

In this study, a retrospective analysis was conducted to assess the current aspects and predisposing factors of canine sterile panniculitis. Miniature dachshund, neutered, and younger dogs appeared to be predisposed. In addition, histories of previous surgery and injection were associated in 46.5% of the cases, with several types of surgical suture materials used. About 88% of the dogs had multifocal lesions, frequently with signs of systemic illnesses. Whereas systemic immunosuppressive therapy was effective in most dogs, surgical excision of lesions was rarely curative. In order to prevent recurrences, over 65% of the cases required prolonged immunosuppressive therapy. Polymorphism of canine alpha(1)AT gene was investigated as a candidate gene for sterile panniculitis. Eight polymorphisms were discovered in seven Miniature dachshunds by direct nucleotide sequencing, which included a 12-bp deletion, three non-synonymous single nucleotide polymorphisms, and four silent substitutions. Genotyping of the two polymorphisms, c.109_120del12 and c.483A>C, which identified at high incidence in the dachshunds, was conducted in 83 dogs of 6 popular breeds. The frequencies of neither polymorphism differed between Miniature dachshunds and other breeds, suggesting that neither is responsible for developing panniculitis.

Tissue reactions to sutures in the presence and absence of anti-infective therapy

BACKGROUND

In the oral cavity, sutures are placed within tissues of high vascularity in a moist environment with infectious potential. The objective of this study was to evaluate tissue reactions at silk and expanded polytetrafluoroethylene (ePTFE) sutures in the presence and absence of anti-infective therapy (AT).

METHODS

Thirty-six sutures were placed within the mandibular keratinized gingiva in six Beagle dogs. Each animal received one braided silk (4-0) and one ePTFE (CV-5) suture in contra-lateral jaw quadrants at 14, 7, and 3 days prior to biopsy. Three animals received daily AT including topical 2% chlorhexidine solution and a systemic broad-spectrum antibiotic. Biopsy specimens allowed histometric analysis of tissue reactions along the central part of the suture loop including the area of perisutural epithelium, ratio inflammatory cells (ICs)/epithelial cells and IC/fibroblasts, and presence/absence of bacterial plaque in the suture track.

RESULTS

A perisutural epithelial sheath was forming within 3 days. The cross-sectional area of the epithelium increased with time for both suture materials (p=0.003) but was particularly pronounced for the silk sutures in the absence of AT. Clusters of IC were present in the perisutural connective tissue and epithelium. Over time, a more prominent increase in IC/fibroblasts was evident for the silk sutures in the absence of AT. The pooled material revealed a significantly higher IC/fibroblast ratio for silk compared with ePTFE sutures (p=0.017). Bacterial plaque influx was detected in 6/9 silk and 0/9 ePTFE suture channels in the presence, and 6/6 and 3/6 suture channels, respectively, in the absence of AT.

CONCLUSIONS

AT may reduce biofilm formation and inflammation along the suture track. Braided silk, however, elicits more severe tissue reactions than ePTFE regardless of infection control.