Comparison of clinical effectiveness of tissue adhesives with sutures for wound closure in periodontal flap surgeries– A Systematic Review and Meta-analysis

Jeevitha M¹Gurumoorthy Kaarthikeyan^1*Prabhu Natarajan^2*

• ¹Saveetha Dental College And Hospitals, Chennai, India
• ²College of Dentistry, Ajman University, Ajman, United Arab Emirates

Background: Traditional sutures, while efficient, can result in problems like infection and scarring. Tissue adhesives, on the other hand, have the potential to provide advantages such as shorter application times and less pain after surgery. Understanding the comparative outcomes of various procedures can have a substantial impact on clinical periodontal surgery. This systematic review and meta-analysis (PROSPERO CRD42023444615) is designed to synthesize existing research and provide insights into optimizing wound closure procedures for better patient outcomes. The aim of the present systematic review and meta-analysis is to compare the efficacy of tissue adhesives with sutures on wound healing in periodontal flap surgeries. Materials and Methods: By adhering to PRISMA 2020 standards, the review outlined systematic processes for identifying and selecting relevant studies, which involved an extensive search across databases such as PubMed, Cochrane, EMBASE, Scopus, and Web of Science, as well as Google Scholar and various trial registries. The inclusion criteria focused on all prospective human trials conducted between January 2013 and June 2023, allowing for a diverse range of study designs, including randomized controlled trials, clinical trials, non-randomized trials, and split-mouth trials. Ultimately, 10 studies were included for qualitative synthesis and 8 for quantitative analysis, with data on degree of wound closure/healing aggregated from studies that shared similar follow-up periods and forest plots were created appropriately allowing for a clearer interpretation of the comparative outcomes between tissue adhesives and sutures. Results: The assessment of the included studies revealed that most demonstrated a low risk of bias in their methodologies, indicating reliable and robust research practices. However, the forest plot analysis indicated no significant mean difference in degree of wound healing between tissue adhesives and sutures, despite a high level of heterogeneity (I² = 94%), suggesting variability in the results among the studies. The funnel plot showed the presence of publication bias with high standard error. Conclusion: Wound healing with tissue adhesives seems to be better or comparable to that of sutures in periodontal flap surgeries in terms of cosmetic outcome and patient satisfaction. Further randomized trials with larger samples should be undertaken for its use in periodontal flap surgery.