title: Tissue reactions to sutures in the presence and absence of anti-infective therapy.
abstract: BACKGROUND
  In the oral cavity, sutures are placed within tissues of high vascularity in a moist environment with infectious potential. The objective of this study was to evaluate tissue reactions at silk and expanded polytetrafluoroethylene (ePTFE) sutures in the presence and absence of anti-infective therapy (AT).
  
  
  METHODS
  Thirty-six sutures were placed within the mandibular keratinized gingiva in six Beagle dogs. Each animal received one braided silk (4-0) and one ePTFE (CV-5) suture in contra-lateral jaw quadrants at 14, 7, and 3 days prior to biopsy. Three animals received daily AT including topical 2% chlorhexidine solution and a systemic broad-spectrum antibiotic. Biopsy specimens allowed histometric analysis of tissue reactions along the central part of the suture loop including the area of perisutural epithelium, ratio inflammatory cells (ICs)/epithelial cells and IC/fibroblasts, and presence/absence of bacterial plaque in the suture track.
  
  
  RESULTS
  A perisutural epithelial sheath was forming within 3 days. The cross-sectional area of the epithelium increased with time for both suture materials (p=0.003) but was particularly pronounced for the silk sutures in the absence of AT. Clusters of IC were present in the perisutural connective tissue and epithelium. Over time, a more prominent increase in IC/fibroblasts was evident for the silk sutures in the absence of AT. The pooled material revealed a significantly higher IC/fibroblast ratio for silk compared with ePTFE sutures (p=0.017). Bacterial plaque influx was detected in 6/9 silk and 0/9 ePTFE suture channels in the presence, and 6/6 and 3/6 suture channels, respectively, in the absence of AT.
  
  
  CONCLUSIONS
  AT may reduce biofilm formation and inflammation along the suture track. Braided silk, however, elicits more severe tissue reactions than ePTFE regardless of infection control.
authors.affiliation: Department of Periodontology, Temple University School of Dentistry, 3223 North Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Knut N
authors.initials: KN
authors.lastname: Leknes
authors.forename: Knut A
authors.initials: KA
authors.lastname: Selvig
authors.forename: Olav E
authors.initials: OE
authors.lastname: Bøe
authors.forename: Ulf M E
authors.initials: UM
authors.lastname: Wikesjö
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D004285:Dogs; D005549:Foreign-Body Reaction / Q000473:pathology*; D005881:Gingiva / Q000382:microbiology / Q000473:pathology; D007249:Inflammation / Q000517:prevention & control; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D047011:Silk / Q000009:adverse effects*; D013537:Sutures / Q000382:microbiology; D014945:Wound Healing
chemical_list: D000890:Anti-Infective Agents; D047011:Silk; D011138:Polytetrafluoroethylene; D002710:Chlorhexidine