Cyanoacrylate Adhesive in Free Gingival Graft Healing: A Digital and Microcirculatory Randomized Clinical Trial

This study aimed to evaluate the efficacy of n-butyl cyanoacrylate (CA) in stabilizing free gingival grafts (FGGs) without sutures at the recipient site and accelerating postoperative healing at the donor site. Additionally, perfusion dynamics and graft shrinkage were assessed using laser Doppler flowmetry (LDF) and digital impression techniques.

This randomized controlled clinical trial included 40 systemically healthy, non-smoking patients with insufficient keratinized tissue in the mandibular region. Patients were randomly assigned to the test group (FGG stabilized with CA) or the control group (FGG secured with sutures). Periodontal parameters, intraoperative durations, LDF values at recipient and donor sites, graft shrinkage (digital impression), and postoperative pain (VAS scores) were recorded.

Graft shrinkage was significantly lower in the CA group (37.23%) than in the control group (45.15%) (p < 0.001). The test group exhibited significantly higher LDF values at the donor site on days 4 and 7, suggesting enhanced perfusion and early vascularization (p = 0.002, p < 0.001). Postoperative pain (VAS scores) was significantly lower in the CA group until day 6 (p < 0.05). Furthermore, FGG stabilization time was three times shorter in the CA group than in the control group (p < 0.001). By day 30, perfusion values equalized between groups, indicating that CA did not negatively impact long-term tissue healing.

N-butyl cyanoacrylate provides a rapid, reliable, and minimally traumatic alternative to sutures for FGG stabilization. Its use may reduce graft shrinkage, enhance early vascularization, minimize postoperative pain, and shorten surgical time. These findings support CA as a promising wound dressing and stabilizer in periodontal plastic surgery. However, further randomized clinical trials with larger sample sizes are needed to evaluate its long-term effects.