Comparison of Cyanoacrylate Tissue Adhesives to Polytetrafluoroethylene (PTFE) Sutures in the Donor Site of Connective Tissue Grafts- A Randomized Clinical Trial

A prospective, randomized clinical trial will be conducted to determine whether cyanoacrylate tissue adhesives or sutures are better tolerated by patients receiving soft tissue gum grafts.

Periodontal plastic surgery procedures have become an integral part of periodontal treatment by addressing esthetic and functional demands. Several therapeutic modalities such as free gingival graft, pedicle flaps, connective tissue grafts, grafts combining the two lateral modalities and guided tissue regeneration have been used for covering the denuded roots and augmenting the width and thickness of the keratinized gingiva. Among various surgical techniques, subepithelial connective tissue (SECT) grafts remain the most commonly used and most successful root coverage procedures. The esthetic and functional success of SECT graft techniques is highly predictable and reliable and they have given them a common place in the clinical practice. Subepithelial connective tissue graft procedures require harvesting tissue from a donor area, usually the palate. This addition of another surgical site extends the complexity of the procedure and increases patient discomfort.

Single interrupted or continuous interlocking sutures are suggested at the donor site. Suturing is the most common method of wound closure. Other biomaterials such as staples, adhesive tapes, adhesive glues and fibrin sealants have been used generally to hasten the pace of healing. Adhesives interact with different materials, merge and allow them to remain whole. Cyanoacrylates are bio-adhesives that were discovered by Ardis in 1949 and first used for surgery by Coover et al in 1959. When applied to two opposing, wet, living tissue surfaces, they have the ability to cement them in place. Their general chemical formula is CH2=C(CN)-COOR , where R can be substituted for any alkyl group, ranging from methyl to decyl. They polymerize rapidly within seconds in an exothermic reaction following contact with proteinaceous surfaces to form strong and flexible bonds. Methyl cyanoacrylate was the first glue developed, but tissue toxicity precluded its use. The process of causing histologic toxicity is thought to be related to the byproducts of degradation into cyanoacetate and formaldehyde. Further research showed that changing the type of alkyl chains in the compound to one with a longer molecular chain can reduce tissue toxicity. Cyanoacrylates are simple, inexpensive and practical adhesives. Cyanoacrylates have been used for achieving hemostasis at intraoral and extra-oral surgical sites treating ulcers, attaching grafts, managing cerebral spinal fluid leaks, stabilizing the bone fragments during plating, sealing sinus membrane perforations, and achieving peripheral nerve re-anastomosis; as periodontal dressings; and for a number of other dental applications. They are sloughed from the surface of the skin and mucosa 7 to 10 days after adhesive application. Butyl cyanoacrylate is a bacteriostatic, biodegradable, hemostatic cyanoacrylate with a long half-life and good tissue compatibility. It can adhere in moist environments and is available in a formulation appropriate to be used in the oral cavity. It has been proven to be effective in closure of uninfected intraoral incisions on edentulous areas in the mandible, in extractions and periapical surgery.

Few studies are focused on evaluating the wound healing and assessing patient-centered outcomes at the palate donor area after different harvesting techniques To the best of our knowledge, there is no study that compares different methods of wound closure at the donor site.

This prospective clinical trial aims at obtaining information to determine which technique from the patient's standpoint is superior.