Comparative evaluation of two antibacterial-coated resorbable sutures versus noncoated resorbable sutures in periodontal flap surgery: A clinico-microbiological study

Antimicrobial Activity of Antibacterial Sutures in Oral Surgery: A Scoping Review

OBJECTIVE

The aim of this scoping review was to explore and synthesise the current evidence on the antimicrobial activity of antibacterial suture materials used in oral surgery.

METHODS

The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A bibliographic search was carried out in the PubMed and Scopus databases to retrieve all human clinical studies that investigated the antimicrobial efficacy of antibacterial-coated sutures used in oral surgery. Included studies were screened and extracted independently by 2 examiners. Data were tabulated and qualitatively described.

RESULTS

The search initially returned 150 articles and resulted in 5 included studies after the duplicates' removal and the full-text screening. Selected studies were published from 2014 to 2019. Three studies (60%) were randomised clinical trials, whilst the remaining studies did not report information on randomisation. The antimicrobial agents for coated sutures included triclosan and chlorhexidine. In almost all the studies, antibacterial-coated sutures exhibited lower bacterial retention compared to those without coating.

CONCLUSIONS

Within limitations, the antimicrobial-coated sutures employed in oral surgery exhibited good results in terms of their microbicidal activity when compared with sutures that were not coated. Considering the high variability and confounding factors identified in the included studies, more high-quality research is needed to confirm these results. Antimicrobial-coated sutures could represent a promising and clinically valid strategy to reduce microbial colonisation in oral surgery. The reduced bacterial adherence is likely to improve the clinical success of the surgical procedures. Yet, the cost-benefit ratio of antimicrobial-coated sutures should be assessed in larger clinical trials to confirm their efficacy over conventional noncoated sutures.

Analysis of Study Designs and Primary Outcome Measures in Clinical Trials of Investigational Suture Materials

BACKGROUND

Clinical trials are a prerequisite for any investigational suture materials before a market approval application. The appropriate study designs and primary outcome measures are key to the validity and reliability of clinical trial results. This study aimed to characterize the study designs and primary outcome measures being applied in clinical trials of investigational suture materials.

METHODS

The systematic searches on PubMed, EMBASE, Web of Sciences, Scopus, and Cochrane databases were conducted to gather relevant studies published between January-2019 and May-2021. Data on general characteristics, suture intervention, study design, and primary outcome measures were extracted and analyzed.

RESULTS

Of 46 included studies, the majority of them were conducted with a randomized-controlled (93.5%), single-blind (50.0%), two-arm (84.8%), and parallel (76.1%) design with a 1:1 allocation ratio (95.7%). Through correlation network and heatmap analysis, the moderate-to-very strong correlations between some types of investigational suture materials and primary outcome measures were found including barbed vs non-barbed suture and suturing time, antibacterial-coated vs non-coated suture and wound infection, mono- vs multi-filament suture and wound healing index/markers, and different sizes of suture materials and scar assessment.

CONCLUSIONS

Our analysis provides guidance, with several key considerations, for designing a clinical trial evaluating investigational suture materials.

Comparative evaluation of the efficacy of a novel tetracycline-coated suture with triclosan-coated and noncoated sutures on bacterial load reduction: A prospective in vitro study

Background

Surgical site infection (SSI) is one of the common postoperative complications observed after various periodontal surgeries, and sutures play a vital role in its causation. Thus, the aim of this study is to evaluate and compare the efficacy of a novel tetracycline-coated suture with triclosan-coated and nonantibacterial-coated sutures on bacterial load reduction to prevent SSI by measuring the zone of inhibition.

Materials and Methods

Twenty systemically healthy individuals with moderate chronic periodontitis were included in this study. Fresh unstimulated saliva was collected from each patient and inoculated on three different blood agar plates. Sutures were divided into three groups (Group A: Tetracycline-coated suture, Group B: Triclosan-coated suture, Group C [control group]: Nonantibacterial-coated suture). The antibacterial efficacy of each suture was evaluated by performing agar diffusion test. The zone of inhibition around each suture was calculated, and statistical analysis was performed for the same using Kruskall-Wallis ANOVA test and Mann-Whitney U-test.

Results

On intergroup comparison, there was a statistically highly significant difference seen for the zone of inhibition between the groups (P < 0.01) with the highest values in Group A (14.45 mm), followed by Group B (1.4 mm) and least in Group C (0 mm).

Conclusion

Tetracycline-coated suture is more efficacious than triclosan-coated suture to reduce bacterial load and further prevent SSIs. However, in vivo clinical trial is must to prove the same.

Bacterial Adherence Around Sutures of Different Material at Grafted Site: A Microbiological Analysis

Closure of the surgical incision has been the primary function of sutures since their introduction. However, whatever the type, they are known to carry bacteria, which can be a source of infection. Five types of surgical sutures, Gut, Silk, Vicryl, PTFE, and Polyamide, were selected and tested on their ability to carry aerobic and anaerobic bacteria and were rated on the basis of forming colony-forming units (CFUs). Aerobic bacteria grown around gut sutures showed minimum CFUs (≈30 × 10⁴/suture). Though very less anaerobic bacteria growth was seen among all tested suture materials, it was maximum around Vicryl and polyamide sutures. Every suture material is capable, albeit not equally, of holding bacterial biofilm formation, which can be a source of surgical site infection.