Clinical Outcomes of Different Suture Materials in Periodontal Surgery

A Systematic Review

Authors

  • Shilpi Asthana Subharti Dental College
  • Sameer Ahmed
  • Mehvish Saleem
  • Mayur Kaushik

DOI:

https://doi.org/10.5195/d3000.2026.1557

Keywords:

Periodontal surgery, Suture materials, Wound healing, Flap approximation, Bacterial colonization

Abstract

To systematically evaluate the available clinical evidence regarding the effects of different suture materials on wound healing and flap approximation following periodontal surgical procedures and to assess their influence on bacterial colonization, tissue response, mechanical properties, postoperative pain, and other clinical outcomes. A systematic review was conducted using PubMed/MEDLINE, Scopus, EBSCOhost, and Ovid. Human comparative clinical studies evaluating different suture materials used in periodontal flap surgery were included according to predefined eligibility criteria. Data regarding wound healing, flap approximation, bacterial colonization, plaque accumulation, histological tissue response, tensile strength, handling characteristics, postoperative pain, and other clinical outcomes were extracted. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized controlled trials and the ROBINS-I tool for non-randomized comparative studies. Inter-reviewer agreement during study selection was assessed using Fleiss' kappa statistic. Seven comparative clinical studies were included, comprising four randomized controlled trials and three non-randomized comparative studies. Inter-reviewer agreement was almost perfect (κ = 0.85). Two randomized controlled trials demonstrated low overall risk of bias, whereas two had some concerns; among the non-randomized studies, one had serious and two had moderate overall risk of bias. Braided silk consistently demonstrated greater bacterial colonization and plaque accumulation and was associated with a greater inflammatory tissue response and less favourable clinical outcomes than monofilament materials. Nylon demonstrated favourable histological tissue compatibility and lower bacterial adhesion. ePTFE demonstrated greater tensile-strength sustainability than polyamide and favourable handling, flap approximation, and early healing compared with black silk. Poliglecaprone 25 also demonstrated favourable wound healing, flap approximation, and reduced bacterial adhesion compared with silk. Triclosan- and chlorhexidine-coated absorbable sutures reduced bacterial colonization and plaque accumulation compared with conventional absorbable sutures. Triclosan-coated polyglactin 910 demonstrated the most consistent antimicrobial benefit and was associated with improved wound healing and reduced postoperative pain in one randomized trial; however, these clinical advantages were not consistently observed across all studies. Considerable heterogeneity in suture materials, surgical techniques, outcome measures, and follow-up periods limited direct comparison across studies. The available evidence suggests that monofilament and selected antibacterial-coated sutures may provide more favourable microbiological and clinical outcomes than conventional braided silk following periodontal flap surgery. ePTFE and poliglecaprone 25 demonstrated favourable clinical performance, while triclosan-coated polyglactin 910 showed consistent reductions in bacterial colonization with promising clinical benefits. However, the limited number of studies, methodological heterogeneity, and variable risk of bias preclude definitive recommendations regarding the superiority of any single suture material. Further adequately powered randomized controlled trials using standardized clinical, microbiological, mechanical, and histological outcomes are required to establish evidence-based recommendations for suture selection in periodontal surgery.

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Published

2026-09-16

Issue

Vol. 14 No. 2 (2026)

Section

Mechanisms of Oral Disease

License

Copyright (c) 2026 Shilpi Asthana, Sameer Ahmed, Mehvish Saleem, Mayur Kaushik

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