Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

A Comparative Study of N-Butyl Cyanoacrylate and

Conventional Silk Sutures in the Closure of Intra Oral
Incisions After Modified Corticotomy/Peizocision
Dr. Prasanna Kumar P (Professor and Head) Dr. Swathi Priya V V
Department Oral and Maxillofacial Surgery, Dept.of Oral & Maxillofacial Surgery,
Rama Dental College & Research center, Coorg Institute of Dental Sciences
Kanpur, Uttar Pradesh. Virajpet, Karnataka.

Dr. Vinodh Thangaswamy (Professor) Dr. Jambu Keshwar Kumar B (Associate professor)
Department Of Oral and Maxillofacial Surgery Department Of Oral and Maxillofacial Surgery,
Coorg Institute of Dental Sciences, Coorg Institute of Dental Sciences,
Virajpet Karnataka. Virajpet Karnataka.

Dr. Joon Sunil

Dept. of Oral & Maxillofacial Surgery,
Coorg Institute of Dental Sciences,
Virajpet, Karnataka.

Abstract:-  Results
The results were statistically significant and showed
 Background superior results in surgical glue group when compared
Wound closure is assisted by the usage of with silk suture group for postoperative parameters.
appropriate suturing techniques and suture material in
intra oral and general surgical procedures and aimed at  Conclusion
maintaining form, function and aesthetics of surgical Cyanoacrylate is a better alternative for wound
site. Wound closure can be done by suture materials, closures in minor oral surgical procedures as tissue glue
staples and tissue adhesives. Purpose of this study is to was found to be haemostatic in nature, helpful in
clinically compare the efficacy between tissue adhesive reduction of post operative pain and patients need to
and standard suturing for wound closure after the visit again for suture removal was not required.
piezocision. Moreover, this procedure was found to be comfortable
for the surgeon. Future studies are required to evaluate
 Aims & Objectives long term results of intraoral usage to further its
Aim of the study was to compare the efficacy application. Research is needed for development of
between tissue adhesive and standard suturing for better tissue adhesives for usage in intraoral wounds.
wound closure after piezocision. The Objectives were to
assess the surgical outcome of cyanoacrylate glue and Keywords:- Peizocision, Cyanoacrylate Glue, Silk Suture,
conventional suture, and to compare surgical outcome of Intraoral Wound Closure, Piezosurgery.
the both and also to establish an alternative to the
conventional suture with emphasis on cost to benefit I. INTRODUCTION
ratio.
Wound healing is a challenging clinical problem and
 Materials and Methods correct, efficient wound management is essential to
In this prospective, non-blinded study we have positively influence the wound healing course and reduce
included 8 healthy consenting individuals of age group potential complication. The response of tissue to injury
16-30 years who were indicated to undergo forms the foundation of surgical practice. Wound healing is
peizocision/Modified corticotomy. Patients were divided a complex & dynamic process. A thorough knowledge of
into 2 groups. Group A in whom the wound closure was basics of physiology of wound healing is a must to
done with cyanoacrylate glue and Group B received implement the principles of wound closure.1
interrupted routine conventional silk suture after wound
closure. The primary goals of wound closure are to stop
bleeding, prevent infection, speed healing and achieving a
functionally & aesthetically pleasing scar.2

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The need for proper wound closure is of paramount whom incision closure was done with interrupted routine 3-
importance after any intra oral surgery. Various wound 0 black braided conventional Silk suture.
closure techniques have been discussed in literature using
traditional, synthetic absorbable & non-absorbable sutures, Healthy patients who required orthodontic treatment
surgical staples & tissue adhesives. Cyanoacrylates are (accelerated orthodontic tooth movement) and patients with
among the most commonly used tissue adhesives like no history of periodontal infections/ bone loss in the
methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate, n-butyl required surgical site were included in the study. The
cyanoacrylate and 2-octyl cyanoacrylate. exclusion criteria were patients with history of smoking,
allergic to drugs or anesthetic agents used in surgical
There are presently four types of tissue adhesives: protocol, poor oral hygiene, patients lost to follow up,
fibrin sealants, collagen-based sealants, synthetic polymer- patients on oral contraceptives, patients under radiotherapy
based materials, and protein-based sealants. Utilization of or chemotherapy, diabetic patient, patients on
tissue adhesives can be divided in to three categories: immunosuppressants, patients having a pacemaker or any
haemostasis, tissue sealing and local delivery of exogenous other active implants, patients undergoing pregnancy.
substances6.
All patients were advised to undergo routine
The emergence of Piezocision has influenced the haemogram before the procedure. Patients were prepared in
efficiency, duration, cost and convenience of accelerated a standard aseptic manner and taken up for the procedure
orthodontics dramatically. Piezocision is the flapless method under proper aseptic condition where in the patient is
of corticotomy using piezosurgery8 (Osteotomy using painted with 5% betadine intraorally and extraorally and
Piezo). It is believed that the rapid tooth movement after draped. Patient was anaesthetized with 2% lignocaine with
corticotomy (surgical procedure whereby only the cortical 1:80,000 adrenaline in infiltration manner on both labial &
bone is cut, perforated or mechanically altered) surgery is lingual sides of the required Piezocision region.Vertical
due to elimination of the resistance of the cortical layer of incisions measuring 1cm in length were made using No:15
bone and due to reparative process induced after the injury. 9 BP blade on the buccal aspect of the extracted teeth region
where rapid orthodontic space closure was anticipated,
This technique combines micro incisions limited to the interproximal buccal incisions are made in the attached
buccal gingiva that allows the use of a piezoelectric knife to gingiva or alveolar mucosa. The incisions are small enough
give osseous cuts to the buccal cortex and initiate the RAP to accommodate the diameter of the BS 1 insert of the
without involving palatal or lingual cortex.12 Presently in piezotome. These incisions are started 2–3 mm below the
oral and maxillofacial surgery, adhesives have a minimal base of the interproximal papillae, keeping in mind that the
role, but this is changing rapidly. Thus, in view of the soft tissues and the underlying periosteum need to be cut to
above-mentioned features, the purpose of this study is to create an opening that will allow for the insertion of the BS
compare between tissue adhesive and standard suturing for 1 insert. Once the soft tissue incisions are completed, the
wound closure after peizocision. piezotome is used to create the bone injury that will start the
RAP (Regional accelerated phenomenon). This is done by
 Aims & Oblectives inserting the head of the BS1 insert in the gingival openings
The aim of this study was to compare and contrast the and decorticate the alveolar bone. The depth of the cut is
effects on healing of intraoral wounds when closure was 3mm and care has to be taken so that the surrounding roots
carried out by n-Butyl cyanoacrylate and conventional silk are not injured. Following the procedure, the cyanoacrylate
suture. glass ampoule inside the jacket was crushed and applied
along the surface on to the incision for the wound closure in
The objective was to assess the surgical outcome of group A, where as in group B 3-0 black braided silk sutures
cyanoacrylate glue, the surgical outcome of conventional was used in simple interrupted manner to close the wound.
suture and also to compare the surgical outcome of both. Patients were prescribed similar analgesics for 3 days and
antibiotic for 5 days postoperatively. All procedures in the
II. METHODOLOGY study were performed under the standard guidelines for the
respective procedure. The patients were evaluated on
In this prospective non-blinded comparative study immediate post-operative, 1st, 3rd and 7th post-operative day
between 3-0 black braided silk suture and n-butyl-2 after the surgery.
cyanoacrylate glue. We have included 8 consenting
individuals of age group 16-30 years who are undergoing Variables were taken as immediate post-operative
orthodontic treatment at Coorg institute of dental sciences. bleeding, pain, wound dehiscence, wound healing & patients
Under standard aseptic conditions, the selective tunnelling comfort on immediate post-operative day, 1st, 3rd & 7th post-
(peizocision) procedure was carried out under local operative day.
anaesthesia.
 Postoperative Bleeding was Recorded as (Visual
The intraoral wounds were divided into 2 groups Analog Scale)13
which consisted of 8 patients: Group A and Group B. Group
A with individual in whom incision closure was done with  No bleeding
N-Butyl-2-Cyanoacrylate glue. Group B with individual in  Oozing

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Accidental low bleeding poor comfort, 4-7 as fair and 8-10 as good and the
 Continuous low bleeding subjective review was taken on 7th day.
 Massive bleeding.
Patients who fell under poor comfort were categorized
 Absence of Pain was Noted as 0 and 10 Expressed as as 1, patients falling under fair were categorized as 2 and
Maximum Pain13 patients falling under good were categorized as 3.
Scoring criteria given as

 0= absence of pain.
 1= pain assessment less than 5;
 2= pain assessment greater than 5.

Patients were given a subjective pain scale ranging

from 0 to 10(visual analogue Scale-Wong baker scale).
Rescue analgesics required beyond the third postoperative
day would be recorded in both the groups.

 It is Defined as Wound Rupture Along the Surgical

Fig 1 3-0 Black Braided Silk Suture
Incision 13.

 0=absence of wound rupture.

 1=presence of wound rupture.

 Wound Healing
Scoring criteria was given as 13,

 Score 1- Healing is not satisfactory

 Score 2 - Healed adequately
 Score 3- Healing is satisfactory
Fig 2 N-Butyl-2 Cyanoacrylate Glue
Every patient was asked to compare and rate the
postoperative comfort on the silk suture site as well as
cyanoacrylate glue site. The scoring was given as 0-3 as

III. RESULTS

The patients were followed up on immediate after postoperative, 1st day, 3rd day, 7th for postoperative day for signs and
symptoms of bleeding, pain, wound dehiscence and wound healing, time taken for the wound closure and post operative comfort
of the patient.The age of the patients included in our study were between 16-30 years.

 Postoperative Bleeding
Comparison of postoperative bleeding in both group A and group B between immediate postoperative day,1st postoperative
day, 3rd postoperative day & 7th postoperative day is shown in table below.

Table 1 Comparison of postoperative bleeding in both group A and group B

Timeline
Scores Chi square value Sig.
Immediate 1st day 3rd day 7th day
Glue 0 10(100) 10(100) 10(100) 10(100)
3.077 0.380(NS)
group 1 0(0) 0(0) 0(0) 1(10)
0 6(60) 10(0) 10(100) 7(70)
Suture
25.920 0.000(HS)
group 1 4(40) 0(0) 0(0) 3(30)

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
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Table 2 Comparison of Postoperative Bleeding in Both Group A And Group B
Hemostasis 0 1 Chi square value Sig.
Immediate Glue group 10(100) 0(0) 5 0.043(S)
Suture B 6(60) 4(40)
1st day Glue group 10(100) 0(0) - -
Suture group 10(100) 0(0)
3rd day Glue group 10(100) 0(0) - -
Suture group 10(100) 0(0)
7th day Glue group 10(0) 0(0) 1.250 0.291(NS)
Suture group 7(70) 3(30)

Bleeding was absent on immediate postoperative,1st postoperative day & 3rd postoperative day. On the 7th postoperative day
in cyanoacrylate group, where as in suture group bleeding was present in 4 out of 10 wounds during immediate postoperative
phase, 0 out of 10 wounds during 1st and 3rd postoperative day. 3 out of 10 wounds had mild ooze on the day of suture removal (7th
follow up day) in the silk suture group.

 Pain
Pain was assessed by Visual analogue scale (WONG-BAKER SCALE), In Glue group the pain was absent in immediate
postoperative and 1st postoperative day. On 3rd postoperative day 4 wounds out of 10 had a mildly annoying pain with a score of
<5. By the 7th postoperative day 2 out of 10 wounds had mild pain with a score of <5.

In Suture group the pain was absent in all 10 wounds during immediate postoperative day. On 1 st post-operative day 4 out of
10 had mild annoying pain on 3rd post-operative day, 2 out of 10 had mild pain and by the end of 7 th follow up day 1 out of 10
sutures wounds had nagging uncomfortable pain with a score of <5.

 Wound Dehiscence

Table 3 Comparison of wound dehiscence between Group A and Group B

Scores Immediate Post op 1st day 3rd day 7th day Chi square value Sig.
Glue group
0 10(100) 10(100) 10(100) 9(90) 0.380(NS)
3.077
1 0(0) 0(0) 0(0) 1(10)
0 10(100) 10(100) 10(100) 8(80)
Suture group 6.316 0.097(NS)
1 0(0) 0(0) 0(0) 2(20)
Wound dehiscence 0 1 Chi square value Sig.
Glue group 10(100) 0(0)
Immediate Suture - -
10(100) 0(0)
group
Glue group 10(100) 0(0)
1st day Suture - -
10(100) 0(0)
group
Glue group 10(100) 0(0)
3rd day Suture - -
10(100) 0(0)
group
Glue group 9(90) 1(10)
7th day Suture 0.392 0.50(NS)
8(80) 2(20)
group

 Comparison of Wound Dehiscence Between Group A And Group B

Wound dehiscence was absent during immediate, 1st, & 3rd day post-operative follow up days and on 7th day post-operative
day 9 out of 10 wounds had no wound dehiscence in the cyanoacrylate Group. In the Suture group there was no wound dehiscence
on immediate ,1st & 3rdpost operative follow up day. On 7th post-operative day 2 out of 10 wounds had wound dehiscence.

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ISSN No:-2456-2165
 Wound Healing

Table 4 Comparison of wound healing between Group A and Group B

Glue Group Suture Group Chi Square Value Sig.
1 0(0) 2(20)
Wound healing
2 0(00) 8(80) 20.000 0.000(HS)
7th day
3 10(100) 0(0)

By the end of 7th day wound healing was assessed in the wounds of both the groups. Healing was satisfactory in 10 out of
10 wounds in Cyanoacrylate group. Healing was not satisfactory in 2 out of 10 wounds and was adequate in 8 out of 10 wounds in
Silk suture group.

Table 5 Intra Operative Assessment of Duration of Procedure

Time taken for wound closure in seconds Mean Standard deviation t Sig.
Group A 156.8000 4.63801
-67.705 0.000(HS)
Group B 318.6000 5.96657

The mean time taken for the wound closure in Glue group is 156 seconds and for Suture group it is 318 seconds with a
standard deviation of 4.6 in Glue group and 5.9 in Suture group.

 Postoperative Comfort
All the patients were asked to assess how comfortable the wound closure was by the end of 7 th day, All the wounds in the
Suture group were falling under fair comfort where as patients wounds in the Glue group were falling under Good comfort. The
postoperative comfort is described in the table below.

Table 6 Postoperative comfort of both Group A & B

Glue group Suture group Chi square value Sig.
1 0(0) 0(0)
Post op comfort 7th day 2 0(0) 10(100) 20.000 0.000(HS)
3 10(100) 0(0)

IV. DISCUSSION own advantages and shortcomings. A never-ending search

for a material to overcome the shortcomings of the wound
The healing wound is an over expression of an closure techniques led to the discovery of various new
intricate and tightly choreographed sequence of cellular and biomaterials like staples, adhesive tapes, adhesive glue and
biochemical responses directed towards restoring tissue fibrin sealant42
integrity and functional capacity following injury. Although
healing culminates uneventfully in most instances, a variety Cosmetic appearance and primary healing is often the
of intrinsic and extrinsic factors can impede or facilitate the final parameter by which outcomes in wound repair are
process.17 Ideal wound healing largely depends upon use of judged. Optimal wound healing will be best obtained when
proper surgical techniques and wound care. Good wound wound edges are well apposed with proper eversion. Wound
healing can be achieved by accurate incision, delicate tissue closure techniques have evolved from the earliest
handling, precise wound approximation, good working development of suturing materials to resources that include
properties of wound closure material and aseptic techniques synthetic absorbable sutures, staples, and adhesive
to prevent pathogenic microbes from entering the body. compounds16
Various other factors responsible for proper wound healing
are person’s systemic health, nutritional status, immune Braided silk is the most common and widely used
response and presence or absence of infection at the surgical suture material for closure of oral wounds31 since 131 -211
site.40 BC, first introduced by Galen of Pergamon to repair
damaged tendons in gladiators. Various studies of closure of
Soft tissue wound generally heals in three ways that is oral wounds have been documented, reporting advantages
by primary intention, secondary intention and tertiary such as careful closure, low dehiscence rate, resilient tensile
intention. Healing by primary intention is preferable as there strength and optimum handling properties. However,
is less scarring and the healing is rapid.4 disadvantages like prolonged duration of surgery and
anesthesia, maximal tissue reactivity (Posthelwaite1974),
The primary steps in the management of surgical risk of needle-stick injury, undesirable trauma to intact
wounds are to attain adequate hemostasis and tissue tissue on either side of the wound, permanent suture tracts,
approximation. Through ages surgeons have used various pain and anxiety during removal have been reported. 43
materials to close incisions. They are metal clips, adhesive
tapes and various suture materials. Every material has its

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Another significant disadvantage reported is the cyanoacrylate glue should be considered. Hence this study
phenomenon of ‘wicking’, which makes it a site for was undertaken to compare the efficacy between tissue
retention and ingress of bacteria into the tissues and thus a adhesive and standard suturing for wound closure after
reservoir of secondary infection. So in order to overcome peizocision.
these difficulties, a need for an alternative was always felt. 44
In this prospective, comparative study we have
The ever striving search for an alternative procedure included 8 consenting individuals of age group 16-30 years
and materials has led to the discovery and development of who were indicated to undergo Peizocision / modified
tissue adhesives45 to overcome the disadvantages of suture corticotomy. Two groups (A & B) consisting of 10 wounds
and provide sufficient good wound healing. each were considered. Group A (Glue group) where the
wound closure was done with cyanoacrylate glue and Group
Surgeons have been using tissue sealants and B (Suture group) the wound closure was done with
adhesives since the early nineteenth century. There are conventional silk suture for wound closure after peizocision.
presently four types of tissue adhesives: fibrin sealants,
collagen based sealants, synthetic polymer-based materials The study objectives were to assess the surgical
and protein-based sealants. The creation of natural glues, outcome of cyanoacrylate glue and conventional suture with
surgical staples and tapes to substitute sutures has regards to the postoperative bleeding, severity of pain,
supplemented the armamentarium of wound closure wound healing, wound dehiscence, time taken for wound
techniques. The use of tissue adhesive has long appealed to closure and postoperative comfort / quality of life of the
surgeons and they have been extensively studied for diverse patient and also to establish an alternative to the
applications such as wound closure on extraction sockets, conventional silk suture. The severity of pain, bleeding,
face, sinus perforations in sinus lift, mucogingival flaps, wound healing and wound dehiscence are the indicator of a
biopsy, and other sites in general surgery like axilla, lungs, patient’s comfort during the postoperative period.
hearts, scalp wounds, circumcision and perineum, trocar
sites, cleft lip repair, face lifts, blepharoplasty, brow lifts and Piezosurgery is a minimally invasive and selectively
other cosmetic surgeries.29 cutting instrument that inert to surrounding soft tissues and
important structures such as nerves, vessels and mucosa. It
Cyanoacrylates were first described in 1949 and their was developed by Italian oral surgeon Tomaso Vercellotti in
first reported use as clinical adhesives was 10 years later by 1988 to overcome the limits of traditional instrumentation in
Coover36. Members of the cyanoacrylate family include oral bone surgery by modifying and improving conventional
methyl, ethyl, propyl, butyl, hexyl, heptyl and octyl ultrasound technology. Piezocision is the flapless method of
cyanoacrylates15. In 1960s, the combination of fibrin and corticotomy using piezosurgery (Osteotomy using Piezo). It
thrombin as fibrin sealants were developed and used is believed that the rapid tooth movement after corticotomy
extensively with donor preserved and autologous donated (surgical procedure whereby only the cortical bone is cut,
plasma as the source of coagulation components. In 1977 perforated or mechanically altered) surgery is due to
however, the US Food and Drug Administration (FDA) elimination of the resistance of the cortical layer of bone and
revoked the license for commercial use of fibrin sealants due to reparative process induced after the injury.
from donor preserved human plasma.
Regarding bleeding, the surgical glue group was found
Since1980 n butyl 2-cyanoacrylate has been approved to be significantly superior. During immediate postoperative
as alternative for skin closure at low tension areas. Its toxic phase, there was no bleeding in all 10 wounds (100%) of
effects and carcinogenicity were also studied and shown to group A and in 6 wounds (60%) of group B and this was
be harmless23,28,3 found to be significant with p value<0.043. By the end of 7th
day mild ooze was found in the 30% of the wounds among
Mehta et al reported that the use of n-butyl-2- silk sutured group B on removing the sutures which was
cyanoacrylate adhesives in the surgical treatment of eventually controlled by pressure application. Whereas, the
fractures seems very promising and he stated that n-butyl-2- ooze was absent in 100 % of the wounds among the glue
cyanoacrylate was nontoxic, non-mutagenic and non- group A on the 7th follow up day. Our results are similar to
carcinogenic. In some studies27 by using agar overlay tissue Mehdi Ghoreishian et al, Sneha Setiya et al, Ajit D. Joshi et
cultures it has been shown that fibroblast cell death around a al. The slow biodegradation nature of cyanoacrylate into
disc of n-butyl-2-cyanoacrylate progressed at a slow rate formaldehyde and cyanoacetate makes the material less
indicating its moderate toxicity on fibroblasts in vitro. histotoxic22. Hence, resulting in fewer toxic by-products
Clinical and electron microscopic examination in this study released into the tissues per unit time. This slower release
has not revealed any evidence of that sort. allows for more efficient tissue clearance of these toxic by-
products, with less ensuing tissue toxicity. The rate of
Presently in oral and maxillofacial surgery, adhesives degradation is inversely proportional to the side-chain length
have a minimal role, but this is changing rapidly. Despite and correlated directly with the degree of local inflammation
the improvement in chemistry of cyanoacrylates, there have and tissue toxicity. Hence, resulting in fewer toxic by-
been a number of clinical studies in literature regarding the products released into the tissues per unit time. This slower
intraoral use of cyanoacrylates. Hence taking the various release allows for more efficient tissue clearance of these
advantages into consideration, a need to study the use of toxic by-products, with less ensuing tissue toxicity. The rate

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of degradation is inversely proportional to the side -chain healing are patient’s systemic health condition, nutritional
length and correlated directly with the degree of local status, immune response and presence or absence of
inflammation and tissue toxicity. Higher homologues infection at the surgical site.
hypothesis is that the ester forms a macrofilm causing
mechanical blockage to slow blood flow, providing a Wound dehiscence was absent during immediate, 1st,
surface agent to activate the clotting cascade35. This could & 3 day post-operative follow up days and on 7th day post-
rd

be explained as cyanoacrylate has been found to be an operative day 9 out of 10 wounds had no wound dehiscence
excellent haemostatic agent. Bleeding is generally in the cyanoacrylate Group. In the Suture group there was
adequately retarded within fifteen seconds after application no wound dehiscence on immediate ,1st & 3rdpost operative
and a second dose is seldom required20 follow up day. On 7th post-operative day 2 out of 10 wounds
had wound dehiscence with a p value of <0.50.
Pain after any surgery is expected to be one of the
inevitable morbidity. The postsurgical pain begins when the By the end of 7th follow up day wound healing was
effect of the local anaesthesia subsides and reaches peak assessed in both the group A & B. Healing was satisfactory
levels in 6 to 12 hours. among 10 out of 10 wounds in Group A (Cyanoacrylate
glue). Healing was adequate in 8 out of 10 wounds & was
Pain was assessed by Visual analogue scale (WONG- not satisfactory in 2 out of 10 wounds in Group B (Silk
BAKER SCALE), In Glue group the pain was absent in suture group), with a p value of <0.000 which was highly
immediate postoperative and 1st postoperative day. On 3rd significant.
postoperative day 4 wounds out of 10 had a mildly annoying
pain with a score of <5. By the 7th postoperative day 2 out Our study showed satisfactory healing which is similar
of 10 wounds had mild pain with a score of <5 with a p to the study conducted by Mehdi Ghoreishian et al 6, Sneha
value of 0.035 which is non-significant. Setiya et al 33,Ajit D. Joshi et al 28.A study done by RJ
Mortan et al 4 on 50 scalp wounds which were treated with
In Suture group the pain was absent in all 10 wounds adhesive. At review, only one wound had failed to achieve
during immediate postoperative day. On 1st post-operative complete healing. Patient acceptability was high and the
day 4 out of 10 had mild annoying pain on 3rd post-operative procedure rapidly gained popularity amongst the clinical
day 2 out of 10 had mild pain and by the end of 7th follow staff. They concluded that adhesive should be considered as
up day 1 out of 10 sutures wounds had nagging an alternative to suturing small scalp wounds.
uncomfortable pain with a score of <5. This was found to be
highly significant with p value of<0.109. The time taken for the wound closure is very crucial
parameter to be considered. Our study also recorded the
Immediate postoperative,1st ,3rd & 7th day time taken for wound closure in both the groups. The mean
postoperative results were significant in Group A could be time taken for the wound closure in Group A is 156 seconds
because of the analgesics effect. More number of patients of and for Group B it was 318 seconds with a standard
group B had mild pain even after the cessation of analgesics. deviation of 4.6 in Group A and 5.9 in Group B. The results
Subsequently none of the patients reported with any pain were similar to a study conducted by phani himaja et al39,
after the 7 days follow up. where they compared the cyanoacrylate tissue adhesive and
silk sutures in intra oral wound closure and concluded that
Our results are similar to Mehdi Ghoreishian et al6 the glue group takes lesser time for wound closure than
Sneha Setiya et al33and Ajit D. Joshi et al28 Kulkarni et closure by the silk sutures and lesser time to achieve
al19found reduced post-operative pain after the use of haemostasis.
cyanoacrylate in periodontal flap surgery. V Rajkumar et al
27
concluded that tissue adhesives cause less pain as The postoperative patients comfort was also assessed
compared to sutures. This may be due to less tissue handling in this study All the patients were asked to assess whether
and less tissue inflammation in the study group. Similarly, and how comfortable they were on both the tissue adhesive
the results of our study showed marked significant site and sutured site during the 7th follow up day. All the
difference in the severity of pain in both the groups for wounds in the sutured group were falling under fair comfort
immediate postoperative, 1st, 3rd and 7th day postoperative where as patients wounds in the glue group were falling
follow up for pain evaluation. under Good comfort with a p value of < 0.000 . The
subjective response indicated that those patients in whom
In the present study we have also assessed wound wound closure done with cyanoacrylate glue i.e., group A
dehiscence and wound healing. Optimal wound healing will were more comfortable than in whom wound closure done
be best obtained when wound edges are well apposed with with conventional silk suture technique i.e., group B.
proper eversion. Ideal wound healing largely depends upon
use of proper surgical techniques and wound care. Good Cyanoacrylate tissue adhesives form a strong bond
wound healing can be achieved by accurate incision, across tissue-wound edges by secondary intermolecular
delicate tissue handling, precise wound approximation, good forces such as hydrogen bonding aided by mechanical
working properties of wound closure materials and aseptic interlocking of irregular and porous surfaces22 enabling
techniques to prevent pathogenic microbes from entering the normal healing to occur below the seal. These adhesives
body. Various other factors responsible for proper wound have been shown to save time and provide a flexible water

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resistant protective coating that will seal wounds from water V. CONCLUSION
exposure and contamination. They can be used safely in
small wounds, but also in larger wounds where Closure of soft tissue wounds of maxillofacial region
subcutaneous sutures are needed and a watertight sealant is are primarily achieved by mechanical devices, such as
appropriate. sutures and staples. Tissue adhesive for wound closure is an
emerging technology with innovative concepts and cutting-
Favourable characteristics of cyanoacrylates are that it edge applications. Presently in oral and maxillofacial
offers several advantages over other methods of wound surgery, adhesives have a minimal role, but this is changing
closure and tissue fixation like their ability to rapidly forma rapidly.
flexible hydrogen bond, act as an occlusive protective
dressing, decrease inflammation and reduce follow-up care Conventionally, ideal wound closure is achieved by
and medical costs. suture material but because of namely prolonged duration of
surgery and anaesthesia, tissue reactivity, risk of needle
One of the more alluring features of cyanoacrylates is stick, undesirable trauma to the intact tissue on either side of
their ease of application. For example, repair of lacerations wound, permanent suture tracts, early removal or suture
and surgical incisions require significantly less time when snapping results in dehiscence, anxiety and pain during
using these polymers. Cyanoacrylate surgical sealant has removal and inadequate aesthetics effect resulted in the
some characteristics that make it particularly useful and evolution of alternative procedures for wound closure, that
reliable for the surgeon. It can be stored at room temperature is tissue adhesive. The best tissue adhesive material is N-
can be easily and rapidly prepared in the applicator device, Butyl 2-cyanoacrylate, which is easy to apply, reduce the
and is easy to apply 38. anxiety of the patient. It also acts as a haemostatic agent and
antimicrobial agent.
Our study showed patients had less pain, good
haemostasis, satisfactory wound healing and atraumatic Older cyanoacrylates like methyl-and ethyl-
wound closure, less time taken for the wound closure and cyanoacrylates are not biodegradable and can induce
better postoperative patient comfort in the n-butyl-2- significant inflammatory response, they are also
cyanoacrylate group as compared to suture group and our hydrophobic in nature. These properties did not permit the
results have same findings as Mehdi Ghoreishian et al 6 usage of such adhesives in intraoral wounds. With the
Sneha Setiya 33 et al 26 and Ajit D 28. Joshi et al. Although advent of n-butyl cyanoacrylate, closures of moisture
patients didn’t have opportunity to experience both wound contaminated wounds like intraoral wounds are possible. It
closure techniques in order to explain relative comfort, their has also been found that moisture promotes polymerization
subjective response indicated that those patients in whom reaction. N-butyl-2-cyanoacrylate has biodegradable
wound closure done with cyanoacrylate glue i.e., group A properties and induces lesser tissue inflammation compared
were more comfortable than in whom wound closure done to older adhesive system.
with conventional silk suture technique i.e., group B.
Our study clinically compared n-butyl 2-cyanoacrylate
This study clinically compared N-butyl-2- with silk suture for closure of intraoral wounds. Parameters
cyanoacrylate with silk suture for closure of intraoral like bleeding, pain, wound dehiscence, and wound healing,
wounds. Postoperative parameters like bleeding and pain, time taken for wound closure and patient’s post operative
haemostasis, better postoperative comfort, time taken for comfort were evaluated subjectively.
wound closure and wound healing had superior results for
surgical glue group patients. The ease of application, less In this prospective, comparative study we have
time consumption, no food lodgement & irritation 28 to the included 8 healthy consenting individuals of age group 16-
patient compared to conventional sutures and better patient 30 years who were indicated to undergo peizocision. Intra
acceptability makes cyanoacrylate more advantageous over oral wounds were divided into 2 groups consisting of 10
silk sutures. Hence, it can be concluded that cyanoacrylate is each. Group A the wound closure was done with
a better alternative for intraoral minor surgical procedures as cyanoacrylate glue and Group B it was done using routine
tissue glue, as it was found to be haemostatic in nature, was conventional silk suture.
helpful in reduction of pain and patients need to visit again
for suture removal was not required. Moreover, this Postoperative parameters like bleeding and pain,
procedure was found to be comfortable for the surgeon. Patient comfort/quality of life after procedure and
intraoperative parameters like time taken for wound closure
The cost of tissue adhesive was the limitation of this had superior results for glue group A patients. The evaluated
study. Future studies are required to evaluate long term wound dehiscence and wound healing were found to have
results of intraoral usage to further its application. Research superior results in the same glue group A.
is needed for development of better tissue adhesives for
usage in intraoral wounds. Ease of application, less time consumption, no food
lodgement & irritation to the patient compared to
conventional sutures and better patient acceptability makes
cyanoacrylate more advantageous over silk sutures. Hence,
it can be concluded that cyanoacrylate is a better alternative

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
for intraoral minor surgical procedures as tissue glue, as it [12]. Fischer TJ. Orthodontic treatment acceleration with
was found to be haemostatic in nature, was helpful in corticotomy-assisted exposure of palatally impacted
reduction of pain and patients need to visit again for suture canines: a preliminary study. The Angle Orthodontist.
removal was not required. Moreover, this procedure was 2007 May;77(3):417-20
found to be comfortable for the surgeon. [13]. Setiya S, Halli R, Shah A, Chhabaria G, Singh T.
Comparative evaluation of efficacy of tissue glue and
The small sample size, possibility of complications sutures after surgical removal of impacted mandibular
other than pain, wound dehiscence, shorter period of follow third molars–A prospective controlled clinical study.
up, absence of an objective measurement technique and the JOMSMP. 2015 Mar 1;27(2):183-8.
cost of tissue adhesive were limitations of the study. Future [14]. Vaaka PH, Patlolla BR, Donga SK, Ganapathi AK,
studies are required to evaluate long term results of intraoral Kurapati V. Cyanoacrylate: an alternative to silk
usage to further its application. Research is needed for sutures: a comparative clinical study. Journal of Dr.
development of better tissue adhesives for usage in intraoral NTR University of Health Sciences. 2018 Apr 1;
wounds. 7(2):108.
[15]. Samuel PR, Roberts AC, Nigam A. The use of
REFERENCES Indermil (n-butyl cyanoacrylate) in
otorhinolaryngology and head and neck surgery. A
[1]. Chhabra S, Chhabra N, Kaur A, Gupta N. Wound preliminary report on the first 33 patients. The
healing concepts in clinical practice of OMFS. Journal of Laryngology & Otology. 1997
Journal of maxillofacial and oral surgery. 2017 Jun;111(6):536-40.
Dec;16(4):403-23. 2016 Mar 5:10.1007/s12663-016- [16]. Giray CB, Atasever A, Durgun B, Araz K. Clinical
0880-z and electron microscope comparison of silk sutures
[2]. Breitenbach KL, Bergera JJ. Principles and and n‐butyl‐2‐cyanoacrylate in human musosa. Aust
techniques of primary wound closure. Primary care. Dent J 1997; 42(4):255-8.
1986 Sep 1;13(3):411-31. [17]. Shermak MA, Wong L, Inoue N, Chao E and Manson
[3]. Singer AJ, Quinn JV, Hollander JE (2008) The PN. Butyl-Z-cyanoacrylate fixation of mandibular
cyanoacrylate topical skin adhesives. Am J Emerg osteotomies. PlastReconstrSurg 1998; 102(2):319-24.
Med 26: 490- 496 [18]. Osmond MH, Quinn JV, Sutcliffe T, Jarmuske M,
[4]. Morton RJ, Gibson MF, Sloan JP. The use of Klassen TP. A randomized, clinical trial comparing
histoacryl tissue adhesive for the primary closure of butylcyanoacrylate with octylcyanoacrylate in the
scalp wounds. Emergency Medicine Journal. 1988 management of selected pediatric facial lacerations.
Jun 1;5(2):110-152. AcadEmerg Med 1999;6(3):17 1-7.
[5]. Brett TR, Maxey TS.A prospectus on tissue [19]. Amiel GE, Sukhotnik I, Kawar B, Siplovich L. Use
adhesives, Am J Surg2001 ;(182):4OS- 44. of N-butyl-2-cyanoacrylate in elective surgical
[6]. Ghoreishian M, Gheisari R, Fayazi M. Tissue incisions—longterm outcomes. J Am Col Surg. 1999
adhesive and suturing for closure of the surgical Jul 1;189(1):21-5.
wound after removal of impacted mandibular third [20]. Charter A. Wound glue: a comparative study of tissue
molars: a comparative study. OOOOE. 2009 Jul 1; adhesive. AccdEmerg Nur 2000 ;(8):223-227
108(1):e14-6. [21]. Pérez M, Fernández I, Márquez D, Bretaña RM. Use
[7]. Sametet al.Biochemical and histopathological of N‐butyl‐2‐cyanoacrylate in oralsurgery: Biological
findings of N-Butyl-2- Cyanoacrylate in oral surgery: and clinical evaluation. Artif Organs. 2000 Mar
an experimental study Oral Surg Oral Med Oral 1;24(3):241-3.
Pathol Oral Radio Endo 2006; 102: e14-el7 [22]. Mourougayan V. Sutureless skin closure for cleft lip
[8]. Ileri Z, Akin M, Erdur EA, Dagi HT, Findik D. repair. The Cleft palatecraniofacial journal. 2006
Bacteremia after piezocision. American Journal of Nov; 43(6):656-8.
Orthodontics and Dentofacial Orthopedics. 2014 Oct [23]. Choi BH, Kim BY, Huh JY, Lee SH, Zhu SJ, Jung
1;146(4):430-6. JH, Li J. Cyanoacrylate adhesive for closing sinus
[9]. Dibart S, Yee C, Surmenian J, Sebaoun JD, Baloul S, membrane perforations during sinus lifts. Journal of
Goguet-Surmenian E, Kantarci A. Tissue response Cranio-Maxillofacial Surgery. 2006 Dec 1;34(8):505-
during Piezocision-assisted tooth movement: a 9.
histological study in rats. European journal of [24]. Knott PD, Zins JE, Banbury J, Djohan R, Yetman RJ,
orthodontics. 2013 Nov 19;36(4):457-64. Papay F. A comparison of dermabond tissue adhesive
[10]. İşeri H, Kişnişci R, Bzizi N, Tüz H. Rapid canine and sutures in the primary repair of the congenital
retraction and orthodontic treatment with cleft lip. Annals of plastic surgery. 2007 Feb 1;
dentoalveolar distraction osteogenesis. American 58(2):121-5
journal of orthodontics and dentofacial orthopedics. [25]. Kulkarni S, Dodwad V, Chava V. Healing of
2005 May 1;127(5):533-41. periodontal flaps when closed with silk sutures and
[11]. AlGhamdi AS. Corticotomy facilitated orthodontics: N-butyl cyanoacrylate: a clinical and histological
Review of a technique. The Saudi dental journal. study. Indian J Dent Res. 2007 Apr 1; 18(2):72.
2010 Jan 1;22(1):1-5.

IJISRT23FEB1167 www.ijisrt.com 1672

Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
[26]. Perin LF, Helene Jr A, Fraga MF. Sutureless closure [40]. Al-Belasy FA and Amer MZ. Hemostatic effect of n-
of the upper eyelids in blepharoplasty: use of octyl-2- butyl-2- Cyanoacrylate (Histoacryl) glue in Warfarin-
cyanoacrylate. Aesthetic surgery journal. 2009 Mar treated patients undergoing oral surgery. J Oral
1;29(2):87-92. MaxillofacSurg 2003; 61(12):]404-9.
[27]. Kumar VR, Rai AB, Priyayadav. Comparative [41]. Fabio CA, Jomet PL, Fenoll AB, Murcia.Effects of
evaluation of n-butyl cyanoacrylate and silk sutures scalpel (with and withouttissue adhesive) and
in intra oral wound closure-A clinical study. J. Adv cryosurgery on wound healing in rat tongues. Oral
Dental Research. 2010 Oct; 1(1):37-42. Surg Oral Med Oral Pathol 2005; 100zE58-63.
[28]. Joshi AD, Saluja H, Mahindra U, Halli R. A [42]. ToriumiM et a1. Histotoxicity of cyanoacrylate tissue
comparative study: efficacy of tissue glue and sutures adhesives. Arch Otolaryngol Head and Neck Surg
after impacted mandibular third molar removal. J. 1990; 116:546-5.
Maxillofac. Oral Surg.. 2011 Dec 1;10(4):310-5. [43]. Lumsden AB, Eugene Heyman R. Prospective
[29]. Vastani A, Maria A. Healing of intraoral wounds randomized study evaluating an absorbable
closed using silk sutures and isoamyl 2-cyanoacrylate cyanoacrylate for use in vascular reconstructions. J
glue: A comparative clinical and histologic study. J VascSurg 2006; 44: 1002-9.
oral maxillofac surg. 2013 Feb 1;71(2):241- [44]. Buckley MJ, Beckman EJ. Adhesive use in oral and
[30]. Kumar MS, Natta S, Shankar G, Reddy SH, maxillofacial surgery. Oral and Maxillofacial Surgery
Visalakshi D, Seshiah GV. Comparison between silk Clinics. 2010 Feb 1; 22(1):195-9.
sutures and cyanoacrylate adhesive in human [45]. Gassner R. Wound closure materials. Oral
mucosa-a clinical and histological study. Journal of Maxillofacial SurgClin N Am 2002 14: 95- 104.
international oral health: JIOH. 2013 Oct;5(5):95.
[31]. Parmar CS, Kumar KD. Evaluation and Comparison
of Healing of Periodontal Flaps when Closed with
Silk Sutures and N-Butyl Cyanoacrylate: A Clinico–
Histological Study. Adv Hum Biol 2013; 3(1):7-14.
[32]. Keser EI, Dibart S. Sequential piezocision: a novel
approach to accelerated orthodontic treatment.
American Journal of Orthodontics and Dentofacial
Orthopedics. 2013 Dec 1;144(6):879-89.
[33]. Setiya S, Halli R, Shah A, Chhabaria G, Singh T.
Comparative evaluation of efficacy of tissue glue and
sutures after surgical removal of impacted mandibular
third molars–A prospective controlled clinical study.
JOMSMP. 2015 Mar 1;27(2):183-8.
[34]. Milano F, Dibart S, Montesani L, Guerra L.
Computer-guided surgery using the piezocision
technique. International Journal of Periodontics &
Restorative Dentistry. 2014 Jul 1;34(4).
[35]. Sagar P, Prasad K, Lalitha RM, Ranganath K.
Cyanoacrylate for intraoral wound closure: a
possibility? International journal of biomaterials.
2015
[36]. El-rewainy MA, Osman SM, Hassan NE. The Use of
N-Butyl Cyanoacrylate Adhesive In The Closure Of
Muco-Periosteal Flap After The Surgical Extraction
Of Impacted Mandibular Third Molar. Alexandria
Dental Journal. 2015;40(2)
[37]. Pavan Kumar B, Venkatesh V, Haripriya Chari,
YashwanthYadavIs tissue glue an alternative
tosutures in impacted third molarsurgeries Indian J
Dent Adv 2017; 9(1): 8-14.
[38]. James D. Efficacy of cyanoacrylate and black braided
silk for the closure of incision after surgical removal
of impacted third molars: A Systematic Review.
Annals of Applied Bio-Sciences. 2017 Oct 29;
4(4):R38-46.
[39]. Vaaka PH, Patlolla BR, Donga SK, Ganapathi AK,
Kurapati V. Cyanoacrylate: an alternative to silk
sutures: a comparative clinical study. Journal of Dr.
NTR University of Health Sciences. 2018 Apr 1;
7(2):108.

IJISRT23FEB1167 www.ijisrt.com 1673