A Comparative Evaluation of Human Gingival Tissue Response to Silk & M-Polytetrafluoroethylene Sutures – A Clinico-Histological Study

Abstract

BACKGROUND Sutures require specific physical characteristics and properties such as good tensile strength, dimensional stability, lack of memory, knot security and sufficient flexibility to avoid damage to the oral mucosa. The strength and adherence of the sutured tissue increases over time. Tissue reaction characteristics involve varying degree of inflammatory reactions. Therefore, the purpose of this study was to assess clinically and histologically human gingival tissue reaction to silk & m- polytetrafluoroethylene (m-PTFE) sutures in periodontal surgical procedures. METHODS The present study is a prospective clinical randomised split mouth study. A total of 15 patients of both sexes were included in the study. All the patients were provided with thorough scaling and root planing before the commencement of the study. The patients were re-evaluated at 4 weeks and sutures were placed in the surgical area where there was a need for excision of gingival tissue as a part of routine periodontal surgery. After placement of sutures, the change of bite, change of slack, clinical changes in plaque index, modified gingival index & sulcus bleeding index and the histological changes in mean thickness of the peri sutural epithelial sleeve, proportion of inflammatory cells to peri sutural epithelial cells, diameter of the connective tissue inflammatory infiltrate (measured in mm) from the periphery of the epithelialization of the sutures from the insertion day (day 0) to the day of scheduled surgery (day 7) were recorded. RESULTS Silk sutures presented an increase in the change of bite and change of slack of the suture loop than m-PTFE. Diameter of the connective tissue infiltrate was greater around the multifilament suture (SILK) as compared to the monofilament suture (mPTFE) though the difference was not statistically significant. (P-value = 0.321). Monofilament suture (m-PTFE) showed the least amount of inflammatory infiltrate around the suture track. The proportion of inflammatory cells to epithelial cells was statistically not significant between the two suture materials (P-value = 0.82). CONCLUSIONS Though the clinical and histological parameters are statistically non-significant, mpolytetrafluoroethylene has shown better results compared to silk. Silk sutures cause a more extensive inflammatory tissue reaction in an environment characterized by moisture and infectious potential compared to m-PTFE sutures. KEY WORDS PTFE, Inflammatory Response, Sutures, Gingiva