Comparison Of Colour Stability Of Two Commercially Available Composite Resin Materials After Thermocycling - An In Vitro Study

Keywords

Healing; Wound; Innovative Technique; Suturing Materials; Periodontal Flap Surgery.

Introduction

Periodontitis is a chronic inflammatory disease which affects both the soft and hard tissues around the tooth. The primary etiology of the disease is bacterial plaque, however the disease is associated with various risk factors including age, gender, smoking, stress, socioeconomic status, genetic factors, systemic diseases and hormonal changes [1-9]. If the condition is left untreated, it leads to increase in pocket depth, gingival recession, clinical attachment loss, bone loss, furcation involvement, pathological migration and tooth mobility eventually leading to tooth loss [10-15].

The management of periodontitis involves scaling and root planning followed by flap surgery. In periodontal surgery, the most common method of wound closure is by sutures [16]. Suture materials play an important role in the healing of wounds by reconstruction and of the tissue separated by any trauma or the surgical procedure by promoting healing and hemostasis. The primary function of the suture is to maintain wound closure and wound healing. Wound healing mainly depends on the formation and organization of the blood clot that is more resistant to mechanical forces acting on the flap and opposing surfaces in the wound closure [17, 18]. The healing in periodontal and peri-implant defects are more complex processes than is wound healing in most other sites in the body [19]. There is evidence that suturing in periodontal surgery receives a higher degree of attention.

The wound healing process can be affected by the amount of suture material used, type of suturing material, suture type, suturing technique and the amount of tension on the suture. There is a lack of information on the behavior of the suturing materials used in the oral cavity [20, 21]. Oral environment is characterized by the presence of saliva, pH, and the contents of immunoglobulins, bacteria that cause pathogenic effects by the accumulation of plaque on the surface of suturing material, especially on the knots [22]. Ideal suture materials have certain properties, such as resistance to traction, absence of memory, dimension stability, knot safety, and flexibility sufficient to avoid oral mucosa damage, limited bacterial adhesion, and contamination of the wound [23]. Suture materials are classified based on several criteria such as origin, structure, and biological properties. Based on origin, sutures can be natural and synthetic; by structure, they can be monofilament and multifilament and by biological properties, they can be absorbable and non-absorbable. The ideal choice of the suture material mainly depends on the size and depth of tissue to stitch. The use of non-absorbable materials (usually silk sutures) are used routinely, which are removed 5–7 days postoperatively [24, 25]. The important features of absorbable suture materials are their way of absorption will promote wound healing and loss of tensile strength over time. Superficial wound injury usually takes 5 to 10 days to heal, but the surgical procedures require sutures that persist 14 to 28 days. The absorbable suture materials are dissolved under the influence of proteolytic enzymes or hydrolysis [26-28].

Our team has extensive knowledge and research experience that has translated into high quality publications [29-48]. Through extensive literature search, it was revealed that there is a lack of adequate studies assessing the influence of suturing materials on wound healing following periodontal flap surgery. Hence, the rationale of this study was to assess the influence of absorbable and non-absorbable suturing materials on wound healing following periodontal surgery.

Materials and Methods

The single centered cross-sectional study was conducted among 100 patients who had undergone periodontal flap surgery in the Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, India. The ethical clearance was obtained from the Institutional Ethical Committee and a written informed consent was obtained from all the study participants.

The patients were categorized based on the suturing materials used as follows: Group 1: Non absorbable materials (50 patients), Group 2: Absorbable materials (50 patients). After one week of periodontal flap surgery, all the patients were recalled for suture removal. After suture removal, wound healing index score based on Huang et al., 2005 was given for all the patients [49].

Statistical Analysis:

The data was analyzed using Statistical Package for Social Sciences (SPSS Software, Version 23.0). Descriptive and inferential statistics were done for data summarization and presentation. Frequency, percentage and Chi-square test were calculated.

Results

A total of 100 patients were enrolled. Of which 50 patients had undergone periodontal flap surgery with non-absorbable suturing materials and another 50 patients had undergone periodontal flap surgery with absorbable suturing materials. Wound healing index (WHI) scores were recorded and compared between both the groups.

Among 50 patients with non-absorbable suturing materials, 14 patients who underwent periodontal flap surgery showed WHI score of 1, 20 patients showed WHI score of 2 and 16 patients showed WHI score of 3. Whereas, among 50 patients with absorbable suturing materials, 30 patients who underwent periodontal flap surgery showed WHI score of 1, 14 patients showed WHI score of 2 and 6 patients showed WHI score of 3. Majority of the patients with absorbable suturing materials had better wound healing when compared with the patients with non-absorbable suturing materials. The association between type of suturing materials and wound healing index was done by Chi square test and was found to be statistically significant with the p value of 0.032 (p<0.05) (Figure 1).

×

Figure 1:

Close

Figure 1. The bar chart represents the association between Wound Healing Index (WHI) and the suturing materials in the patients who underwent periodontal flap surgery. X axis represents different suturing materials and Y axis represents the percentage of patients who had undergone periodontal flap surgery. Blue denotes WHI score of 1 and green colour denotes WHI score of 2 and brown colour denotes WHI score of 3. Majority of the patients with absorbable suturing materials (30%) had better wound healing when compared with the patients with non-absorbable suturing materials (14%). The association between type of suturing materials and wound healing index was done by Chi square test and was found to be statistically significant with the p value of 0.032 (p<0.05).

Discussion

The present study was done to assess the influence of suturing materials on wound healing following periodontal flap surgery. Closure of periodontal flap post surgically are essential for the establishment of primary union between flap margins. So the proper choice of surgical suture materials and techniques are most important for this process of healing. As a basic principle in periodontal surgery, atraumatic suture materials are used [50]. In this study absorbable suturing material has better wound healing as compared to non absorbable suturing material. Gazivoda D et al., studied the influence of suturing material on oral wound healing. In this study, three different absorbable synthetic suture materials (Catgut, Dexon and Vicryl rapide), commonly used in oral surgery were compared in terms of wound healing. The results showed that Vycril contributes to faster healing of human wounds, with fewer incidences of wound dehiscence and milder local reactions when compared to other materials [51]. Selvig KA et al., suggested that appropriate sutural material is crucial in reducing wound inflammation and absorbable suture materials improves wound healing [52].

Dragovic M et al., in his randomized controlled clinical trial compared different suture materials with respect to oral wound healing, microbial colonization, tissue reaction and clinical features. And found out that poor soft tissue healing was found around non absorbable suture materials and also this suture elicited more inflammatory reaction and microbial adherence [24]. Also, Duprez K et al., highlighted that absorbable suture material is the material of choice for oral surgeries in terms of tolerance, rapid resorption, the comfort of the patient and the cost [53].

Sergi S et al ., in his randomized clinical study evaluated the clinical and microbiological impact of absorbable and silk suture and found out that absorbable suturing material has lesser bacterial adherence as compared to non-absorbable suturing material [54]. The results obtained in the present study are in accordance with the previous studies as absorbable sutures showed better healing as compared to non-absorbable suture materials. However, future studies assessing the influence of different absorbable and non-absorbable suture materials, suturing technique, surgical procedure and the patient related factors on wound healing need to be conducted to confirm these findings.

Conclusion

The present study suggests that absorbable suturing materials showed better wound healing than non-absorbable suturing materials following periodontal flap surgery.

Acknowledgement

The author would like to acknowledge the help and support rendered by Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai.

Source of Funding

The present project was sponsored by

• Saveetha Institute of Medical and Technical Sciences
• Saveetha Dental College and Hospitals
• Saveetha University
• R.K.V Planers Private Ltd., Pattukkottai.