Comparative study between using a tissue adhesive (N-BCA & OCA) and surgical sutures in free gingival graft surgery: A randomized controlled clinical trial.

Background: The success of periodontal surgery depends on the appropriate coaptation of the incised edges, the elimination of empty spaces and the reduction of the amount of blood coagulum. In free gingival graft (FFG) surgery, the stabilization of the graft, hemostasis and cleansing the site remain a necessity.

Objectives: The aim of the present study was to compare the use of the tissue adhesive N-butyl cyanoacrylate + octyl cyanoacrylate (N-BCA + OCA; Iceberg-glue®) and surgical sutures to evaluate the stabilization and fixation of FGG, which is indicated to increase the width of the keratinized attached gingiva.

Material And Methods: A total of 24 cases - 12 patients aged 18-45 years with gingival recession and the absence of the keratinized gingiva underwent FGG surgery at 2 parallel sites at the same time. A long piece of FGG was taken from the palate, from the area adjacent to a canine to a second molar, and divided into 2 equal pieces. The bed of the graft was prepared at each side with a 15C blade. One piece was applied to each bed, one graft was sutured using 0/5 nylon sutures and the other one was stabilized using the tissue adhesive.

Results: The data analysis showed that the postoperative pain ended after 3 days at the tissue adhesive site, but it continued up to 4 days at the suture site. The healing index was significantly better after 2 months at the tissue adhesive site. Graft shrinkage was significantly lower after 3 months at the tissue adhesive site, whereas there was no significant difference in graft shrinkage between the 2 methods at 6 months after the surgery.

Conclusions: The Iceberg-glue tissue adhesive proved to be a reliable alternative material to sutures in stabilizing the free gingival graft at the recipient site. It reduced postoperative pain and improved the healing of the recipient site.