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Effect of Suture Diameter and Material on Oral Soft-Tissue Tearing Behaviour: An In Vitro Study Relevant to
Alexander De Greef1,2, Kato Van Caesbroeck2, Hanne Langers2
1Private Practice, Merchtem, Belgium.
Aim:
To assess how suture diameter, material composition and tissue characteristics influence the tension-to-tearing behaviour of oral soft tissues, with the objective of optimising atraumatic suturing.
Materials And Methods:
This in vitro cadaver study evaluated 288 standardised porcine oral soft-tissue specimens (144 gingiva, 144 lining mucosa). Twelve different suture types including four distinct diameters (4-0, 5-0, 6-0, 7-0) and three different materials (polyvinylidene fluoride [PVF], polyamide [PA] and polyglycolic acid [PGA]) were tested using a calibrated Instron microtester. Maximum rupture force (N), failure mode and tissue thickness (mm) were recorded. Statistical analysis relied on three-way ANOVA, Tukey's post hoc testing and Pearson's correlation (α = 0.05).
Results:
The overall mean maximum rupture force was 5.03 ± 3.00 N. Rupture force increased with suture diameter (p = 0.0001) and differed between materials (p < 0.0001; PGA ≈ PVF > PA). Gingival specimens resisted higher loads than mucosal specimens (p = 0.003). Fine sutures (6-0, 7-0) failed mainly by thread rupture, while thicker sutures (4-0, 5-0) caused tissue tearing, supporting the concept of a mechanical safety buffer. PA (6-0) generally preserved tissue integrity, whereas PVF and PGA required 7-0 in delicate mucosa to ensure comparable tissue protection. Tissue thickness correlated positively with rupture force (r = 0.49, p < 0.001).
Conclusions:
Finer sutures (6-0 and 7-0) function as protective mechanical fuses, safeguarding delicate tissues during manipulation. PA 6-0 provides reliable protection, while 7-0 PVF and PGA are recommended for fragile mucosa manipulation. These findings provide a biomechanical framework for evidence-based suture selection in periodontal plastic surgery.
