Influence of suturing technique on marginal flap stability following coronally advanced flap: a cadaver study

The outcomes of periodontal soft tissue root coverage procedures can be influenced by a variety of different factors. Following coronally advanced flap (CAF), the impact of marginal flap stability (MFS) through the employment of specific suturing techniques has not yet been investigated. The purpose of this study was to compare the MFS of CAF following three different suture techniques.

Fifty-six CAF procedures were performed on seven fresh human cadaver heads. The MFS following simple interrupted, single sling or sling and tag (SAT) suture techniques were investigated through a specific tool involving a load cell-based recording device.

A highly statistically significant MFS was observed for sling and SAT sutures compared to the simple interrupted suture (p < 0.001). SAT suture technique was related to the greatest MFS (p < 0.001). The addition of sutures to the vertical releasing incision was able to provide a greater MFS compared to the suturing of the papillae alone (p < 0.001). No statistically significant difference was observed with regard to the suturing sequence between the two sling groups when the vertical incisions were sutured before or after the surgical papillae (p > 0.05). Linear regression model showed a positive correlation between thicker gingival tissue and MFS changes (p < 0.001).

Suturing technique highly affects the MFS following CAF on cadavers. Flap thickness was shown to be a positive predictor for flap stability.

Within the limitation of this study, the suturing of CAF with the SAT technique may provide higher MFS. However, clinical studies are necessary to validate these findings.