Clinical context: Overcoming the limitations of conventional suturing

The closure of mucosal incisions is a fundamental procedure in oral surgery to preserve aesthetics, function and accelerate healing. Although silk suture remains the historical "gold standard", it imposes significant clinical constraints: risk of accidental iatrogenic needlestick injuries (hepatitis, HIV), bacterial plaque accumulation and inflammatory tissue reactions, which are particularly critical in immunocompromised or diabetic patients.

Objective and hypotheses of the study

This prospective clinical study, conducted on 50 patients aged 18 to 35 years requiring minor oral surgery (notably the extraction of third molars), aims to compare the efficacy of 3-0 silk with isoamyl 2-cyanoacrylate (IAC). The objective is to evaluate whether this tissue adhesive, recognised for its haemostatic and bacteriostatic properties, constitutes a viable alternative to conventional sutures.

The authors test the hypothesis that IAC reduces operative time while providing wound stability and postoperative comfort comparable, if not superior, to manual suturing. The analysed parameters include closure time, pain (VAS scale), bleeding, facial oedema, trismus and healing complications such as dehiscence or infection.

Experimental protocol and methodology

This prospective clinical study was conducted on a sample of 50 patients, aged 18 to 35 years, requiring minor oral surgery (mainly the extraction of third molars) under local anaesthesia (2% lignocaine with 1:80,000 adrenaline). Inclusion criteria targeted healthy patients whose incision margins could be approximated without tension. Patients on anticoagulants, immunocompromised, or presenting with a local pathology at the surgical site were excluded.

The participants were randomly allocated by drawing lots (coin-toss method) into two groups of 25 individuals:

• Group I: Closure with conventional 3-0 silk sutures (Trusilk).
• Group II: Closure with tissue adhesive (isoamyl 2-cyanoacrylate - IAC, Amycrylate), applied as two drops after isolation of the site and precise approximation of the edges.

The protocol evaluated incisions of 1 to 3 cm in length. Clinical follow-up was performed on the 1st, 2nd and 7th postoperative days according to the following parameters:

• Pain and inflammation: Assessment via the visual analogue scale (VAS 0-10) and measurement of facial oedema using the Gabka and Matsumura method (sum of the tragus-pogonion, tragus-labial commissure and external canthus-gonion distances).
• Function and healing: Measurement of trismus (graduated metal scale), time required for closure, presence of bleeding (scale 0-4), wound dehiscence, infection and local ulceration.

Statistical analysis was performed with SPSS v25.0 software, using independent t-tests for means and the Chi-square test for categorical variables, with a significance level set at p < 0.05.

Results: Comparable efficacy, marked time savings

The prospective study conducted on 50 patients (age range 18-35 years) evaluated the clinical performance of isoamyl 2-cyanoacrylate (IAC) compared to 3-0 silk sutures during minor oral surgeries. The data demonstrate therapeutic parity across several major criteria, while highlighting kinetic specificities unique to the tissue adhesive.

The main technical advantage of IAC lies in the reduction of the operative time required for the closure of the incision margins (1 to 3 cm in length). On a biological level, the authors report that IAC exhibits intrinsic haemostatic and bacteriostatic properties, absent in conventional silk.

However, the analysis of pain scores via the visual analogue scale (VAS) reveals a divergence at 7 days post-operatively: patients in the IAC group reported statistically greater sensitivity than those in the suture group. Regarding structural healing, no notable difference was observed in terms of dehiscence or local infection, confirming that IAC provides tissue approximation as reliable as the surgical gold standard.

Conclusion

Isoamyl 2-cyanoacrylate is positioned as an effective alternative to 3-0 silk, combining speed of execution and aseptic protection of the surgical site.

Clinical analysis: adhesive versus silk suture

This prospective study demonstrates that isoamyl 2-cyanoacrylate (IAC) represents a credible alternative to 3-0 silk for the closure of mucosal incisions. Clinically, the major advantage of IAC lies in the optimisation of operating time: the application of a few drops is significantly faster than placing sutures. In terms of primary healing, the study reveals no statistically significant difference regarding dehiscence, thus validating the efficacy of the adhesive in maintaining tension-free approximation of the wound edges.

However, a point of vigilance emerges: the pain score at D7 is significantly higher in the IAC group. This result suggests a possible local irritation related to the rigidity of the polymer or its progressive degradation, whereas silk, although more prone to plaque accumulation, seems better tolerated at one week post-operatively. The immediate haemostatic effect of the IAC remains a significant collateral benefit for the patient's immediate comfort.

The limitations of this study lie in the modest sample size (n=50) and the patient profile, exclusively young (18-35 years) and in good systemic health. Furthermore, the results are restricted to tension-free repositioned flaps, which does not allow extrapolating the use of IAC to more complex reconstructive surgeries. For the practitioner, IAC therefore appears to be an effective solution to simplify minor oral surgery procedures, subject to medium-term follow-up of tissue sensitivity.

Summary of results

This clinical study conducted on 50 patients demonstrates that isoamyl 2-cyanoacrylate (IAC) enables significantly faster incision closure than 3-0 silk. Although the overall clinical efficacy is comparable in terms of dehiscence, the IAC group presented a statistically higher pain score on the 7th day (p < 0.05) compared to the conventional suture.

In practical terms, for the practitioner:

• Optimise your clinical time: The use of IAC drastically reduces flap closure time, a major advantage for practice productivity during minor oral surgeries.
• Secure your environment: Tissue adhesive eliminates any risk of accidental needlestick injuries, enhancing the protection of the surgical team against transmissible pathogens.
• Adapt postoperative communication: Although IAC is effective, anticipate and warn the patient of a possible increased sensitivity around the 7th day compared to a traditional suture.

Technical glossary of the study

Isoamyl 2-cyanoacrylate (IAC): Synthetic tissue adhesive with a long molecular chain, clinically approved for wound closure. It is distinguished by its haemostatic and bacteriostatic properties and its ability to adhere in a moist environment.

Wound dehiscence: Spontaneous rupture or opening of previously approximated incision margins, assessed in this study by visual inspection and palpation on the first, second and seventh postoperative days.

Trismus: Pathological limitation of mouth opening following surgical trauma. In this protocol, it is quantified by the distance between the incisal edges of the upper and lower central incisors.

Pogonion: Most anterior anthropometric point of the mandibular symphysis. It serves here as a landmark to measure facial oedema according to the Gabka and Matsumura method (tragus-pogonion distance).

Visual Analogue Scale (VAS): Subjective pain measurement tool graded from 0 (no pain) to 10 (excruciating pain), used to compare the sensory experience between the suture group and the adhesive group.

Bacteriostatic: Ability of an agent or material to inhibit the growth and reproduction of bacteria. This property is attributed to IAC in the study, contributing to the protection of the surgical site.

Associated product: SERAFAST 5/0 DS-15 absorbable (Serag & Wiessner) — available in the Delynov surgical catalogue.

Information intended for healthcare professionals. This content may contain errors or truncated summaries. We recommend always verifying with the original source article. Delynov disclaims all liability regarding the use of this information. This document is not intended for patients or the general public.