Beyond sutures: a focused review of contemporary concepts in periodontal wound closure
DOI:
https://doi.org/10.2340/biid.v13.47084Keywords:
Periodontics, sutures, tissue adhesives, wound healingAbstract
Wound closure is a critical part of periodontal and mucogingival surgery, as it directly affects tissue stability, healing, patient comfort, and esthetic outcomes. This focused review examines the current evidence on periodontal wound closure, with particular attention to suture materials, microsurgical suturing, tissue adhesives, and suture removal protocols. The available literature suggests that closure materials differ in their biologic and mechanical behavior, with monofilament and synthetic sutures generally demonstrating less bacterial retention and lower tissue reactivity than braided materials. Microsurgical suturing appears to offer advantages in soft tissue adaptation and esthetic refinement, although supporting evidence remains limited in certain regenerative procedures. Tissue adhesives, particularly cyanoacrylate-based formulations, may provide a useful alternative in selected cases, with studies reporting satisfactory healing and improved patient comfort, although the evidence remains limited. The studies also suggest that suture removal should be based on the specific surgical procedure and healing requirements rather than on a routine time-based rule. Overall, the evidence remains heterogeneous and often limited, supporting thoughtful material selection and procedure-specific clinical judgment rather than definitive recommendations.
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References
Newman MG, Takei HH, Klokkevold PR, Carranza FA. Newman and Carranza’s clinical periodontology. 13th ed. Philadelphia, PA: Elsevier; 2019. 913 p.
Moore RL, Hill M. Suturing techniques for periodontal plastic surgery. Periodontol 2000. 1996;11(1):103–11. DOI: https://doi.org/10.1111/j.1600-0757.1996.tb00188.x
Silverstein LH, Kurtzman GM, Shatz PC. Suturing for optimal soft-tissue management. J Oral Implantol. 2009;35(2):82–90. DOI: https://doi.org/10.1563/1548-1336-35.2.82
Faris A, Khalid L, Hashim M, Yaghi S, Magde T, Bouresly W, et al. Characteristics of suture materials used in oral surgery: systematic review. Int Dent J. 2022;72(3):278–87. DOI: https://doi.org/10.1016/j.identj.2022.02.005
Javed F, Al-Askar M, Almas K, Romanos GE, Al-Hezaimi K. Tissue reactions to various suture materials used in oral surgical interventions. ISRN Dent. 2012;2012:762095. DOI: https://doi.org/10.5402/2012/762095
Jeyashree T, Rajasekar A. Comparison of microbial load on absorbable and non absorbable suture materials after periodontal flap surgery. Int J Dent Oral Sci. 2021;8(9):4624–7. DOI: https://doi.org/10.19070/2377-8075-21000942
Katz S, Izhar M, Mirelman D. Bacterial adherence to surgical sutures. A possible factor in suture induced infection. Ann Surg. 1981;194(1):35–41. DOI: https://doi.org/10.1097/00000658-198107000-00007
Banche G, Roana J, Mandras N, Amasio M, Gallesio C, Allizond V, et al. Microbial adherence on various intraoral suture materials in patients undergoing dental surgery. J Oral Maxillofac Surg. 2007;65(8):1503–7. DOI: https://doi.org/10.1016/j.joms.2006.10.066
Leknes KN, Røynstrand IT, Selvig KA. Human gingival tissue reactions to silk and expanded polytetrafluoroethylene sutures. J Periodontol. 2005;76(1):34–42. DOI: https://doi.org/10.1902/jop.2005.76.1.34
Dilan OZ, Levent C, Volkan K, Mehmet G, Abdurrahman G, Mohammad A, et al. Evaluation of the effects of silk and polyethylene terephthalate sutures on postoperative complications in impacted lower third molar surgery. J Mater Sci Mater Med. 2023;34(11):51. DOI: https://doi.org/10.1007/s10856-023-06756-w
Parrini S, Bovicelli A, Chisci G. Microbiological retention on PTFE versus silk suture: a quantitative pilot study in third molar surgery. Antibiotics (Basel). 2023;12(3):562. DOI: https://doi.org/10.3390/antibiotics12030562
Koyuncuoglu CZ, Yaman D, Kasnak G, Demirel K. Preference of suture specifications in a selected periodontal and implant surgeries in Turkey. Eur J Dent. 2019;13(1):108–13. DOI: https://doi.org/10.1055/s-0039-1688732
Makrygiannis IH, Nikolaidis AK, Tilaveridis I, Kouvelas AD, Lykakis IΝ, Venetis G. Coated sutures for use in oral surgery: a comprehensive review. Clin Oral Investig. 2025;29(2):109. DOI: https://doi.org/10.1007/s00784-025-06176-w
Tabrizi R, Mohajerani H, Bozorgmehr F. Polyglactin 910 suture compared with polyglactin 910 coated with triclosan in dental implant surgery: randomized clinical trial. Int J Oral Maxillofac Surg. 2019;48(10):1367–71. DOI: https://doi.org/10.1016/j.ijom.2019.01.011
La Rosa GRM, Scapellato S, Cicciù M, Pedullà E. Antimicrobial activity of antibacterial sutures in oral surgery: a scoping review. Int Dent J. 2024;74(4):688–95. DOI: https://doi.org/10.1016/j.identj.2024.01.029
Suleiman AS, Abbass M, Hossain M, Choudhary P, Bhattacharya P, Islam MA. Impact of antibiotic-coated sutures on surgical site infections: a second-order meta-analysis. Int J Surg. 2024;110(1):507–19. DOI: https://doi.org/10.1097/JS9.0000000000000822
Etemadi A, Bitaraf T, Amini A, Goudarzi M, Nadafpour N. Bacterial accumulation on triclosan-coated and silk sutures after dental implant surgery. J Res Dent Maxillofac Sci. 2019;4(3):1–4. DOI: https://doi.org/10.29252/jrdms.4.3.1
Chaganti S, Kunthsam V, Velangini SY, Alzahrani KJ, Alzahrani FM, Halawani IF, et al. Comparison of bacterial colonization on absorbable non-coated suture with triclosan- or chlorhexidine-coated sutures: a randomized controlled study. Eur Rev Med Pharmacol Sci. 2023;27(18):8371–83.
Burkhardt R, Hürzeler MB. Utilization of the surgical microscope for advanced plastic periodontal surgery. Pract Periodontics Aesthet Dent. 2000;12(2):171–80; quiz 182.
Jindal U, Pandit N, Bali D, Malik R, Gugnani S. Comparative evaluation of recession coverage with sub-epithelial connective tissue graft using macrosurgical and microsurgical approaches: a randomized split mouth study. J Indian Soc Periodontol. 2015;19(2):203–7. DOI: https://doi.org/10.4103/0972-124X.148641
Wang HL, Boyapati L. ‘PASS’ principles for predictable bone regeneration. Implant Dent. 2006;15(1):8–17. DOI: https://doi.org/10.1097/01.id.0000204762.39826.0f
Cortellini P, Prato GP, Tonetti MS. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restorative Dent. 1999;19(6):589–99.
Burkhardt R, Lang NP. Fundamental principles in periodontal plastic surgery and mucosal augmentation – a narrative review. J Clin Periodontol. 2014;41(Suppl. 15):S98–107. DOI: https://doi.org/10.1111/jcpe.12193
Tatakis DN, Chambrone L. The effect of suturing protocols on coronally advanced flap root-coverage outcomes: a meta-analysis. J Periodontol. 2016;87(2):148–55. DOI: https://doi.org/10.1902/jop.2015.150394
Ariceta A, Chambrone L, Stuhr S, Couso-Queiruga E. Effect of suturing in root coverage via coronally advanced flaps: a systematic review. Clin Adv Periodontics. 2025;15(2):179–90. DOI: https://doi.org/10.1002/cap.10312
Shekarian M, Shekarian S, Heydari M, Afshari Z, Meshkinnejad R. Efficacy of different suturing techniques on gingival grafts: a scoping review. J Adv Periodontol Implant Dent. 2026;18(1):55–69. DOI: https://doi.org/10.34172/japid.025.3805
Pippi R. Post-surgical clinical monitoring of soft tissue wound healing in periodontal and implant surgery. Int J Med Sci. 2017;14(8):721–8. DOI: https://doi.org/10.7150/ijms.19727
Stefanini M, Rendón A, Zucchelli A, Sangiorgi M, Zucchelli G. Avoiding errors and complications related to immediate implant placement in the esthetic area with a mucogingival approach. Periodontol 2000. 2023;92(1):362–72. DOI: https://doi.org/10.1111/prd.12491
Parirokh M, Asgary S, Eghbal MJ. The effect of different suture removal time intervals on surgical wound healing. Iran Endod J. 2006;1(3):81–6.
Dragovic M, Pejovic M, Stepic J, Colic S, Dozic B, Dragovic S, et al. Comparison of four different suture materials in respect to oral wound healing, microbial colonization, tissue reaction and clinical features-randomized clinical study. Clin Oral Investig. 2020;24(4):1527–41. DOI: https://doi.org/10.1007/s00784-019-03034-4
Manimegalai A. A comparative study on the efficacy of a commercial fibrin adhesive (Tisseel®) vis-à-vis silk suture on wound closure following periodontal surgical procedures. J Indian Soc Periodontol. 2010;14(4):231–5. DOI: https://doi.org/10.4103/0972-124X.76925
Medeiros I, Pascoal S, Castro F, Macedo JP, Lopes O, Pereira J. Tissue adhesives for closure of intraoral surgical incisions: a systematic review and meta-analysis. Int Wound J. 2024;21(10):e70047. DOI: https://doi.org/10.1111/iwj.70047
Pulikkotil SJ, Nath S. Effect on interleukin-1β and interleukin-8 levels following use of fibrin sealant for periodontal surgery. Aust Dent J. 2014;59(2):156–64. DOI: https://doi.org/10.1111/adj.12178
Mounsif M, Smouni FE, Bouziane A. Fibrin sealant versus sutures in periodontal surgery: a systematic review. Ann Med Surg (Lond). 2022;76:103539. DOI: https://doi.org/10.1016/j.amsu.2022.103539
Binnie WH, Forrest JO. A study of tissue response to cyanoacrylate adhesive in periodontal surgery. J Periodontol. 1974;45(8):619–25. DOI: https://doi.org/10.1902/jop.1974.45.8.2.619
Aeran H, Tuli AS, Sharma I. A clinico-histological comparative evaluation of healing of periodontal flaps when approximated with silk sutures and n-butyl cyanoacrylate. Int J Oral Health Dent. 2022;8(3):222–6. DOI: https://doi.org/10.18231/j.ijohd.2022.043
Saquib AS, Chavan A, Dani NH, Al-Qahtani NA, Al-Qahtani SM, Priyanka N. Comparative evaluation of N-butyl cyanoacrylate and silk sutures on healing of periodontal flaps: a clinico histological evaluation. Kathmandu Univ Med J (KUMJ). 2018;16(63):253–8.
Khurana JV, Mali AM, Mali RS, Chaudhari AU. Comparative evaluation of healing after periodontal flap surgery using isoamyl 2-cyanoacrylate (bioadhesive material) and silk sutures: a split-mouth clinical study. J Indian Soc Periodontol. 2016;20(4):417–22. DOI: https://doi.org/10.4103/0972-124X.194267
Dipika, Sankari M, Nambi G. A comparative study on the effectiveness of iso–amyl cyanoacrylate tissue adhesive to silk sutures in the closure of periodontal flap: a split-mouth study. Res J Pharm Technol. 2020;13(8):3671–4. DOI: https://doi.org/10.5958/0974-360X.2020.00649.6
Kaur G, Kaur S, Vandana, Singh ST, Sharma A, Prashar P. A clinical study to compare and evaluate the potency of isoamyl 2 cyanoacrylate (Amcrylate)® in contrast to braided silk sutures in intraoral wound coaptation after open flap debridement. Baba Farid Univ Dent J. 2020;10(2):19–24. DOI: https://doi.org/10.5958/2230-7273.2020.00005.8
Vyas M. Healing after periodontal flap surgery after using bio-adhesive material and silk sutures: a split-mouth comparative clinical study. Int J Med Res Prof. 2018;4(4):114–17.
Jeevitha M, Kaarthikeyan G, Natarajan PM. Comparison of clinical effectiveness between tissue adhesives and sutures for wound closure in periodontal flap surgery: a systematic review and meta-analysis. Front Oral Health. 2025;6:1556690. DOI: https://doi.org/10.3389/froh.2025.1556690
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