Comparative Evaluation of N-Butyl-2- Cyanoacrylate Glue and Silk Suture on Healing After Periodontal Flap Surgical Procedure: A Single Blind Split Mouth Randomized Controlled Clinico-Histological And Microbiological Analysis

Abstract

Background: Wound closure after periodontal flap surgery plays a critical role in healing and infection control. N-Butyl-2-cyanoacrylate glue offers potential advantages over conventional sutures due to its haemostatic and bacteriostatic properties. Objective:  To compare the clinical, histological, and microbiological outcomes of N-Butyl-2-cyanoacrylate tissue adhesive versus 3-0 braided silk sutures for flap closure in patients undergoing periodontal surgery. Methods: A randomized split-mouth study was conducted on 11 systemically healthy patients with moderate to severe periodontitis. Each patient received periodontal flap surgery with flap closure using N-Butyl-2-cyanoacrylate on one side (test group) and 3-0 braided silk sutures on the contralateral side (control group). Clinical parameters assessed included Wound Healing Index (day 7), Gingival Index, Sulcus Bleeding Index, and Pocket Probing Depth (baseline and day 28). Histological evaluation of inflammatory response and microbiological analysis of subgingival plaque (total microbial count) were performed on day 7. Results: The test group demonstrated significantly better healing outcomes. Wound Healing Index scores were lower at glue sites, indicating improved tissue repair. Greater reductions in Gingival Index and Sulcus Bleeding Index were observed in the test group, signifying reduced inflammation and bleeding. Pocket probing depth decreased more substantially in the glue group. Histological analysis showed a milder inflammatory infiltrate at glue sites, while sutured sites exhibited moderate to severe inflammation. Microbial colony counts were significantly lower in the glue group. However, primary closure was more consistently achieved with sutures, as some glue sites exhibited partial closure due to lower tensile strength. Conclusion: N-Butyl-2-cyanoacrylate glue presents a promising alternative to silk sutures for periodontal flap closure, offering benefits including rapid haemostasis, reduced inflammation, ease of use, and antimicrobial effects. Despite slightly inferior mechanical strength, its clinical and biological advantages support its potential use in periodontal therapy. Further studies with larger sample sizes and extended follow-up are recommended.