Evaluation of a bioadhesive device for the management of aphthous ulcers

A Comparison Between the Effectiveness of Isoamyl 2-Cyanoacrylate Tissue Adhesive and Silk Sutures in Wound Closure Following Minor Oral Surgical Procedures: A Prospective Clinical Study

Background In order to maintain the surgery site's shape, functionality, and aesthetics, closure of the wound is essential for intra-oral and general surgical procedures. Wound closure speeds up healing by reducing the buildup of inflammatory cells. For a wound to heal well, the incision must be precise, the tissue must be handled delicately, the wound must be precisely repositioned, and the closure material must have optimum functional properties and be sterile. Aim This study aims to conduct a clinical comparison of the effectiveness of silk suture versus isoamyl 2-cyanoacrylate (IAC) for intra-oral mucosal incisions. Methodology Fifty patients who needed a minor oral surgical operation under local anesthesia from the Department of Oral and Maxillofacial Surgery were recruited for this prospective clinical trial. Ethical clearance and informed consent were obtained for this study. Two groups were created from the sample of 50 patients in this investigation. An intra-oral mucosal incision was closed in one group using a 3-0 silk suture and in the second using two drops of IAC. An accurate approximation of the incised edges was used to avoid leaving any gaps between them. Parameters such as the time taken for closure, pain, bleeding, swelling, mouth opening, wound dehiscence, wound infection, and local ulceration were evaluated in this study. A visual analog scale (0-10) was used to assess the pain score. Facial swelling was evaluated by the tape method given by Gabka and Matsumura. The measurement was done from tragus to pogonion, tragus to oral commissure, and outer canthus to gonion. The sum of these measurements was calculated. By measuring the distance between the incisal edges of the upper and lower central incisors, the trismus was evaluated using a graduated metal scale. Assessment of bleeding (0-4) was done by asking the patient. Assessment of wound dehiscence and local ulceration was done based on visual inspection and palpation on the first, second, and seventh days postoperatively. All the recorded parameters were tabulated. The statistical analysis was done using SPSS version 25.0 (IBM Corp., Armonk, NY). The Chi-square test was used to compare the categorical variables between the study groups. The independent t-test was used to compare the means between the study groups. The statistical significance was kept at a p-value less than 0.05. Results The results showed that there was no statistically significant difference between suture and IAC in terms of incidence of pain and wound dehiscence. But the time taken for wound closure was less with IAC, and the pain score on the seventh day was higher with IAC and statistically significant. Conclusion We observed that IAC was as effective as the gold standard silk suture. The advantages of IAC are its hemostatic and bacteriostatic qualities, and IAC also took less time to complete the procedure.

Evolution of Drug Delivery Systems for Recurrent Aphthous Stomatitis

Recurrent aphthous stomatitis (RAS) is a disease marked by painful oral lesions on the buccal and labial mucosa or tongue. Drug delivery systems (DDS) for RAS include topical forms that manage wound healing, cover the ulcer, and relieve the associated pain. DDS targeting the oral mucosa face a major challenge, especially the short residence times in the mouth due to the effect of “saliva wash-out”, which continually removes the drug. The objective of this review is to study the development of preparation forms and delivery systems of various types and preparations that have been used for RAS management from 1965 until February 2020. There are 20 types of DDS for RAS which were discussed in 62 articles. The preparations were classified into 4 preparation forms: liquid, semi-solid, solid, and miscellaneous. In addition, the ultimate DDS for RAS preparations is the semi-solid forms (41.94%), which include 5 types of DDS are gel, paste, patch, cream, and ointment. This preparation was developed into new preparation form (11.29%), such as adhesive alginates, dentifrice, OraDisc, membranes, bioresorbable plates, pellicles, and gelosomes. Generally, the mucosal drug delivery system is the method of choice in RAS treatment because the ulcer is commonly located in the oral mucosa. In conclusion, these preparations are designed to improve drug delivery and drug activity for the treatment of RAS ulcers. Moreover, almost all of these DDS are topical preparations that use various types of mucoadhesive polymers to increase both residence time in the oral mucosa and pain relief in RAS treatment.

Biomimetic characteristics of mussel adhesive protein-loaded collagen membrane in guided bone regeneration of rabbit calvarial defects

Purpose

The aim of the present study was to evaluate the biocompatibility and barrier function of mussel adhesive protein (MAP)-loaded collagen membranes in guided bone regeneration (GBR).

Methods

Eight male New Zealand white rabbits were used. Four circular defects (diameter: 8 mm) were created in the calvarium of each animal. The defects were randomly assigned to 1) a negative control group, 2) a cyanoacrylate (CA)-loaded collagen membrane group (the CA group), 3) a MAP-loaded collagen membrane group (the MAP group), and 4) a group that received a polycaprolactone block with MAP-loaded collagen membrane (the MAP-PCL group). Specimens were harvested at 2 weeks (n=4) and 8 weeks (n=4) postoperatively for observational histology and histometric analysis.

Results

In the histologic analysis, MAP was completely absorbed without any byproducts. In contrast, some of the CA adhesive remained, showing an inflammatory reaction, at 8 weeks. In the MAP-PCL group, the MAP-loaded collagen membranes served as a barrier membrane despite their fast degradation in GBR. No significant difference was found in the amount of new bone between the MAP-PCL and MAP groups (1.82±0.86 mm² and 2.60±0.65 mm², respectively).

Conclusions

The MAP-loaded collagen membrane functioned efficiently in this rabbit calvarial GBR model, with excellent biocompatibility. Further research is needed to assess clinical applications in defect types that are more challenging for GBR than those used in the current model.

Evaluation of salivary tumour necrosis factor-alpha in patients with recurrent aphthous stomatitis

Purpose

Present study was undertaken to evaluate and compare the salivary levels of tumour necrosis factor alpha (TNF-α) in subjects with RAS, traumatic ulcers (TUs) in the oral mucosa and in healthy controls.

Materials and Methods

Present study involved 90 participants of which 30 subjects were diagnosed with RAS, 30 subjects with TUs and 30 healthy controls grouped as group 1, group 2 and group 3 respectively. Unstimulated saliva was collected from the subjects through 'Spit Technique' and the estimation of TNF-α was done by enzyme linked immunosorbent assay. The data collected was statistically analysed.

Results

Salivary level of TNF-α was significantly higher in RAS patients than in patients with TUs and healthy controls. Difference between the Salivary TNF-α level in our study groups were statistically significant (p<0.001).

Conclusion

Present study suggests that saliva is a convenient and ideal medium for the detection of TNF-α. Statistically significant difference in the level of salivary TNF-α between the RAS and TUs subjects as well as controls suggests the significant contribution of TNF-α in pathogenesis of RAS.

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.

Quality of life in patients with recurrent aphthous stomatitis treated with a mucoadhesive patch containing citrus essential oil

PURPOSE

To assess 1) patient satisfaction of a mucoadhesive biopatch with citrus essential oil and 2) the change in pain severity and the oral health-related quality of life in patients with recurrent aphthous stomatitis.

PATIENTS AND METHODS

Thirty-seven patients with recurrent aphthous stomatitis participated in the study. Baseline records of personal data, ulcer assessment, visual analog scale, and Oral Health Impact Profile-14 were documented. A mucoadhesive patch was applied over the ulcer. Patients were recommended more applications if pain continued. On the fifth day, a post-therapy assessment was made.

RESULTS

The mean visual analog scale scores at baseline and posttreatment were significantly different (7.3±2.11 and 4.9±2.6, respectively; P=0.001). The mean duration of pain reduced after patch application. The mean total Oral Health Impact Profile-14 scores before and after treatment showed a statistically significant difference (P=0.001). In total, 78.4% of patients reported a considerable improvement in oral functions after treatment (P=0.008).

CONCLUSION

The mucoadhesive biopatch containing citrus essential oil resulted in satisfying pain alleviation and restoration of oral functions with a significant improvement in the oral health-related quality of life.

Cyanoacrylate Adhesive as an Alternative Tool for Membrane Fixation in Guided Tissue Regeneration

AIM

To report a well succeeded use of cyanoacrylate adhesive for fixating a resorbable membrane during a guided tissue regeneration procedure (GTR).

BACKGROUND

The immobilization of membranes in GTR is essential for establishing proper environment for cell differentiation and tissue regeneration. However, some membranes are very difficult to be kept in position by sutures and its fixation by mini screws or pins may be time consuming and expensive.

CASE DESCRIPTION

A 47-year-old woman presenting a vertical bone defect at the palatal aspect of the left central incisor was treated by GTR using particulate autogenous bone graft associated to a collagen membrane. The membrane was glued to the bone surrounding the defect and to the tooth surface with cyanoacrylate adhesive. The postoperative period was uneventful and 4 years later, excellent results in terms of radiographic filling of the defect and reduction of the probing depth were seen. For illustrative purposes, histological findings obtained during a previous experiment in calvaria of guinea pigs is shown, characterizing a foreign body granuloma and proving that the cyanoacrylate adhesive is a safe tool in GTR.

CONCLUSION

The use of a membrane glued with cyanoacrylate to immobilize membranes in GTR is viable and safe from both technical and biological standpoints and may be advantageous for clinical and research purposes.

CLINICAL SIGNIFICANCE

The alternative method for membrane fixation shown in this case report can contribute to simplify the technique in GTR procedures.

Using adhesive glue to repair first degree perineal tears: a prospective randomized controlled trial

Our objective was to evaluate the effectiveness of adhesive glue in repairing first degree perineal tears. We conducted a noninferiority prospective, randomized, controlled trial comparing adhesive glue with traditional suturing. Each case was evaluated immediately after birth and after the puerperium. The two-sample t-test and the Mann-Whitney nonparametric test were applied to compare quantitative variables between the treatment groups. The chi-squared test and Fisher's exact test were used to assess the association between qualitative variables. A total of 102 women participated, 28 in the suture arm and 74 in the adhesive glue arm. While cosmetic and functional results of adhesive glue use were not inferior to suturing, the use of adhesive glue was associated with a shorter procedure, less need for local anesthetic, less pain, and greater satisfaction. Our results suggest a novel approach for the repair of common postpartum first degree lacerations. The use of adhesive glue achieves cosmetic and functional results equal to traditional suturing and offers some immediate advantages for the patient. While further clinical trials are needed to validate our results, it is important to inform obstetrician of the possible use of adhesive glue in these very common clinical scenarios. This trial is registered with NCT00746707.

Demineralization of the contacting surfaces in autologous onlay bone grafts improves bone formation and bone consolidation

BACKGROUND

Autologous bone grafts are usually well consolidated after 4 to 5 months but can be incompletely interlocked with the native bone. This study investigated the effect of acid demineralization of the graft-bed interface on graft consolidation.

METHODS

Onlay bone grafts were performed on the calvaria of 36 guinea pigs. Half of the animals had the graft-bed contacting surfaces demineralized with 50% citric acid (pH 1.0) for 3 minutes (test group). The other half received no demineralization (control group). The bone grafts were immobilized by a resorbable membrane glued to the recipient bed with cyanoacrylate. After 7, 30, and 90 days, specimens (n = 6) were obtained for light microscopy. Data from qualitative analysis and computerized histomorphometry were statistically processed at a significance level of 5%.

RESULTS

Osteogenesis was not seen at the interface after 7 days. After 30 days, the test group showed 34.39% ± 13.4% of the interface area filled with mineralized tissue, compared to 17.14% ± 8.6% in the control group (P = 0.026). After 90 days, the mean percentages of mineralized tissue at the interface in the test and control specimens were 54.00% ± 11.23% and 38.65% ± 7.76% (P = 0.041), respectively. Within groups, a higher percentage of the area filled with mineralized tissue was seen at 90 days compared to 30 days (P = 0.004 for control and 0.041 for test).

CONCLUSIONS

Demineralization of the contacting surfaces between autologous bone graft and bone bed improved new bone formation and bone consolidation. These data need to be confirmed in humans.

Nonoperative closure of persistent gastrocutaneous fistulas in children with 2-octylcyanoacrylate

A persistent gastrocutaneous fistula (pGCF) is an all-too-common complication following removal of a gastrostomy tube (GT) in a child and is associated with significant morbidity. The most common initial methods to manage pGCF include local would care and occlusion techniques. Failure of this approach is followed by surgical excision of the fistula tract and closure of the gastrostomy under general anesthesia. We report the first use of a tissue adhesive, 2-octylcyanoacrylate (2OC) (Dermabond; Ethicon, Sommerville, NJ) as a non-surgical method to close pGCF in children.

METHODS

The families of children presenting to the pediatric surgical division for management of a pGCF were offered the option of 2OC closure. Children not receiving or who failed to achieve closure with 2OC therapy underwent surgery for excision of the pGCF with primary closure of the stomach and soft tissues.

RESULTS

Seven children underwent 2OC therapy. 57% (4 of 7) of the children had complete closure of the pGCF with 2OC therapy. Three children underwent operative closure without complication.

CONCLUSIONS

The tissue adhesive 2OC can successfully close a pGCF in children after GT removal. This therapy is cost-effective, non-invasive, does not require general anesthesia, and can be performed in an outpatient setting.

The patient with recurrent oral ulceration

This paper discusses the range of recurrent oral ulceration which affects the oral mucosa. Types of ulceration covered in this paper include traumatic, infective, aphthous, ulceration related to the oral dermatoses, drug-induced, ulceration as a manifestation of systemic disease and ulceration indicating malignancy. Aspects of the aetiology, diagnosis and management of common oral recurrent ulcerative conditions are reviewed from a clinical perspective as an aid to practising dentists.

Effects of camel thorn distillate on recurrent oral aphthous lesions

BACKGROUND

Near 20 % of people suffer from recurrent oral aphthous ulcers. These painful ulcers are found on the oral mucosa. We conducted this study to evaluate the effect of the camel thorn distillate on this condition.

PATIENTS AND METHODS

93 patients with recurrent aphthous ulcers were selected and divided into two groups. One group was given a placebo (n = 44) and the other was given camel thorn distillate (n = 49). The diameter of the lesions and the severity of the pain were measured 3, 5, 7, 10 and 14 days after initiation of therapy. The lesion diameters and pain scores of the two groups were compared using the t-test.

RESULTS

Complete resolution time ranged from 3 to 7 days (mean = 4.02) in the group treated with camel thorn distillate, whereas in the control group, complete resolution time ranged from 7 to 14 days (mean = 8.9, p < 0.001).

CONCLUSIONS

The efficacy of camel thorn distillate is comparable to that of other drugs used to treat oral aphthous ulcers. Its therapeutic effect may be due to the flavanones (alhagitin and alhagidin) that are present in this plant.

The efficacy of the bioadhesive patches containing licorice extract in the management of recurrent aphthous stomatitis

This study evaluated the efficacy of licorice bioadhesive hydrogel patches to control the pain and reduce the healing time of recurrent aphthous ulcer.This study was carried out in three episodes of ulcers: in the first episode of ulcer, all 15 patients were asked to record their baseline individual pain level by a visual analog scale. In the second and third episodes, comparative and consecutive subjective and objective evaluations of the bioadhesive were done. The effects of the following variables were investigated: (1) VAS pain score for 5 consecutive days, (2) profile of aphthous ulcers on days 3 and 5, (3) time to complete relief of pain and healing of the ulcers, (4) diameter of the lesions and necrotic zone.A significant reduction in VAS was recorded following application of the licorice patches on days 2, 3, 4 and 5 compared with the no-treatment group (p < 0.001). Licorice patches caused a significant reduction in the diameter of the inflammatory halo and necrotic center compared with the placebo group (p = 0.03).According to the results of this study, licorice bioadhesive can be effective in the reduction of pain and of the inflammatory halo and necrotic center of aphthous ulcers.

Efficacy of a mucoadhesive patch compared with an oral solution for treatment of aphthous stomatitis

OBJECTIVE

The purpose of this study was to evaluate the efficacy and tolerability of a mucoadhesive patch compared with a pain-relieving oral solution for the treatment of aphthous stomatitis.

METHODS

Patients with active aphthous stomatitis were randomly treated either once a day with a mucoadhesive patch containing citrus oil and magnesium salts (n = 26) or three times a day with an oral solution containing benzocaine and compound benzoin tincture (n = 22). All patients were instructed to apply the medication until pain had resolved, and completed a questionnaire detailing multiple clinical parameters followed by an evaluation of the treatment.

RESULTS

The mucoadhesive patch was found to be more effective than the oral solution in terms of healing time (mean +/- SD: 36.0 +/- 22.8 hours vs 134.7 +/- 57.7, p < 0.001) and pain intensity after 12 and 24 hours (3.7 +/- 2.8 vs 6.3 +/- 2.6, p = 0.003, and 2.3 +/- 2.7 vs 5.7 +/- 2.5, p < 0.001, respectively). Local adverse effects 1 hour after treatment were significantly (p < 0.01) less frequent among the mucoadhesive patch patients compared with the oral solution patients.

CONCLUSIONS

The mucoadhesive patch was found to be significantly more effective and better tolerated than the oral solution in the treatment of aphthous stomatitis.

Mucosal disease series. Number VI. Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is a common condition which is characterized by multiple recurrent small, round or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors typically presenting first in childhood or adolescence. RAS occurs worldwide although it appears most common in the developed world. The aetiology of RAS is not entirely clear. Despite many studies trying to identify a causal microorganism, RAS does not appear to be infectious. A genetic predisposition is present, as shown by strong associations with genotypes of IL-1beta; IL-6 in RAS patients, and a positive family history in about one-third of patients with RAS. Haematinic deficiency is found in up to 20% of patients. Cessation of smoking may precipitate or exacerbate RAS in some cases. Ulcers similar to RAS may be seen in human immunodeficiency virus disease and some other immune defects, and drugs, especially non-steroidal anti-inflammatory drugs and nicorandil may produce lesions clinically similar to RAS. Topical corticosteroids can often control RAS. However, the treatment of RAS remains unsatisfactory, as most therapies only reduce the severity of the ulceration and do not stop recurrence.

Fermeture cutanée par colle à base d'octylcyanoacrylate (Dermabond®) en chirurgie cervicofaciale programmée : étude longitudinale prospective

OBJECTIVES

A prospective non-randomised evaluation of the octyl-2-cyanoacrylate (Dermabond) for skin closure in head and neck surgery.

MATERIALS AND METHODS

An inception cohort of 52 patients managed by six otorhinolaryngologists head and neck surgeons at a single institution (university teaching and tertiary referral center) during the months of May-July 2004. The length of the skin incision varied from 3 to 30 cm (mean: 7 cm). Morbidity evaluation, longitudinal analysis of the evolution of the scar, and analysis of the degree of satisfaction.

RESULTS

Postoperative death was not encountered. The overall morbidity rate was 3.8% (2/52). There was no instances of wound dehiscence's. A subcutaneous abscess was noted in one patient. From an aesthetic point of view, the scar appearance was considered to be slightly retracted during the first postoperative month and to be very good 2 to 4 months from initial surgery. Only one patient developed a minimal cheloid scar. Among the 47 patients who expressed an opinion postoperatively regarding the use of the octyl-2-cyanoacrylate (Dermabond) for skin closure, the degree of satisfaction was very high due to the ability to take an early shower (40 patients) followed by the lack of skin sutures (5 patients) and the lack of any allergic skin reaction (2 patients).

CONCLUSION

At our department, the octyl-2-cyanoacrylate (Dermabond) for skin closure at the time of head and neck surgery is becoming more and more utilized due to the completion of a solid and aesthetic suture, the ability to take an early shower and the high degree of satisfaction expressed by the patients.

Cyanoacrylates for Skin Closure

Cyanoacrylates (CAs) were not widely adopted for medical use until recently because of lingering concerns regarding the initial tissue toxicities of the short-chain CAs. The medium-chain CAs, primarily butyl-cyanoacrylate, have been widely used in Europe and Canada for several decades and have gone a long way in dispelling any lingering concerns about tissue toxicity. The newer, longer chain CA, octyl-2-cyanoacrylate (2-OCA), now has been approved for multiple uses in the United States and has achieved widespread acceptance by the medical and lay communities. The current authors believe that this is probably only the beginning of the use of 2-OCA and other CAs in cutaneous medicine. This article discusses the use of CAs in their original cutaneous use as glues for the repair of lacerations and incisions and in their more recent use as dressings for the treatment of abrasions and wounds.

Adhesive tablet effective for treating canker sores in humans

A new mucoadhesive tablet, which releases natural active agents for pain reduction and rapid healing of canker sores, has been prepared and characterized. Adhesive tablets were prepared by compression molding of mixed powders of crosslinked polyacrylic acid and hydroxypropyl cellulose, absorbed with citrus oil and magnesium salt. The rate of tablet erosion and the rates of citrus oil and magnesium release were determined as well as the adhesiveness of the tablet using bovine gingival tissue and an Instron tensiometer. A clinical trial was conducted on 248 volunteers who had canker sores. Tablets adhere well to the mucosal tissue and gradually erode for 8 h releasing the citrus oil in a zero-order pattern whereas the magnesium is released during a period of 2 h. Both experimental and plain tablets were effective in reducing pain and decreasing healing time (p < 0.05) without adverse side effects. However, the tablets loaded with active agents were more effective.

A review of the literature on octylcyanoacrylate tissue adhesive

BACKGROUND

Octylcyanoacrylate is a medical grade topical tissue adhesive that has been approved for closing surgical incisions and traumatic lacerations. We reviewed animal and human studies that evaluated its use for a variety of surgical indications and specialties. We also performed a meta-analysis of all clinical trials using octylcyanoacrylate.

DATA SOURCES

Animal and human studies published in peer-reviewed articles as well as published abstracts. A search of Medline was performed using the MESH terms: tissue adhesives, cyanoacrylates, and octylcyanoacrylate.

CONCLUSIONS

The current review and metanalysis demonstrate that octylcyanoacrylate can be used successfully in a wide variety of clinical and surgical settings for multiple types of wounds covering most of the surface of the human body. Prior knowledge of the limitations and technical aspects specific to wound closure with octylcyanoacrylate as well as appropriate wound selection and preparation will help ensure optimal results.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis remains a commonly occurring cause of oral pain and ulceration. Although the ulcerations of RAS are multifactorial and of unknown cause, recognition of the role of patient and environmental factors may be helpful in developing recommendations for treatment and prevention of future ulcers.