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Comparative Assessment of Microbial Colonization and Tissue Reaction Among Three Suture Materials: A Randomized
José Manuel Alarcón Cordovilla1, María Victoria Olmedo-Gaya2, María Teresa Arias-Moliz3,4
1Independent Researcher, 18071 Granada, Spain.
Antibiotics (Basel, Switzerland)
|December 30, 2025
Summary
Monofilament sutures like nylon showed better outcomes in third molar extraction than silk sutures, with less bacterial colonization and inflammation. Silk sutures performed poorly, leading to increased bacterial load and inflammatory response.
Area of Science:
- Oral and Maxillofacial Surgery
- Biomaterials Science
- Microbiology
Background:
- Surgical extractions of impacted mandibular third molars often involve suture placement.
- The choice of suture material can influence post-operative outcomes, including bacterial colonization, immune response, and clinical healing.
- Evaluating different suture materials is crucial for optimizing surgical procedures and patient recovery.
Purpose of the Study:
- To compare multifilament silk, monofilament nylon, and expanded polytetrafluoroethylene (PTFE) monofilament sutures.
- To assess bacterial colonization, cytotoxicity, immune response, and clinical parameters in impacted mandibular third molar extractions.
Main Methods:
- A randomized controlled clinical trial involving 21 patients undergoing surgical extraction of impacted mandibular third molars.
- Sutures were placed using silk, nylon, and PTFE monofilament materials in a bayonet-shaped flap.
- Microbiological analysis (bacterial cell counting, qPCR), in vitro cytotoxicity (WST-1 assay), histological analysis of inflammatory response, and clinical parameter recording were performed.
Main Results:
- Monofilament sutures (nylon and PTFE) exhibited significantly lower bacterial colonization and DNA copies compared to silk sutures.
- No cytotoxic effects were observed for any suture material in vitro.
- Silk sutures elicited a more pronounced inflammatory response characterized by lymphocyte-like cells.
- Pain and swelling were highest at 48 hours post-surgery, correlating significantly.
- Nylon sutures demonstrated superior handling and less slack compared to PTFE and silk.
Conclusions:
- Silk sutures showed the least favorable microbiological and histological performance, with higher bacterial load and inflammation.
- Monofilament sutures, particularly nylon, offered better clinical outcomes, including reduced bacterial colonization and milder inflammatory response.
- While silk provided better handling than PTFE, its increased slack may compromise wound stability. Nylon offered a balance of good handling and minimal slack.
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