Evaluation of mechanical properties of three commonly used suture materials for clinical oral applications: an in vitro study

Shahabe  Saquib Abullais; Nabeeh Abdullah Al-Qahtani; Talib Amin Naqash; Abdul Ahad  Khan; Suraj Arora; Shaeesta  Bhavikatti

doi:10.2298/VSP200114079A

Shahabe Saquib Abullais King Khalid University, College of Dentistry, Periodontics and Community Dental Sciences, Research Center for Advanced Materials Sciences
Nabeeh Abdullah Al-Qahtani King Khalid University, College of Dentistry, Periodontics and Community Dental Sciences, Research Center for Advanced Materials Sciences
Talib Amin Naqash King Khalid University, College of Dentistry, Department of Oral and Maxillofacial Surgery
Abdul Ahad Khan King Khalid University, College of Dentistry, Department of Oral and Maxillofacial Surgery
Suraj Arora King Khalid University, College of Dentistry, Restorative Dental Sciences
Shaeesta Bhavikatti King Khalid University, College of Dentistry, Periodontics and Community Dental Sciences

DOI: https://doi.org/10.2298/VSP200114079A

Keywords: materials testing;, polymers;, polypropylenes;, saliva, artificial;, silk;, sutures;, tensile strength

Abstract

Background/Aim. Appropriate selection of suture materials is a crucial step in oral, maxillofacial and periodontal surgery for uneventful healing. We have scarcity of comprehensive studies comparing mechanical properties of commonly used suture material in oral surgery. The present in vitro study sought to evaluate the effect of saliva on the strength, elongation and stiffness of the commonly used suture material over a period of two weeks. Methods. Three suture materials, silk (SL), polyglactin 910 (PG) and polypropylene (PP), were used in 4–0 gauge. A total of 120 suture samples (40 from each material) were used for the investigation. Artificial saliva was mixed with human serum in 1:1 ratio and maintained at pH of 7.4 to 8.1 to simulate oral environment. All samples were tested at pre-immersion (baseline), as well as on the 3rd, 7th and 14th day in the post-immersion period. A universal testing machine was used to test the selected mechanical properties. The collected data were subjected to statistical analysis. Results. The distribution of mean baseline strength and percentage elongation was significantly higher in the PP group (p < 0.001), whereas stiffness score was the highest in the SL group (p < 0.001). Inter-group comparison revealed that the PP group had maximum tensile strength compared to the PG and SL groups at all time points. When percentage elongation was compared, the PP and PG groups showed the highest values on the 7th and 14th day, respectively. The PP group exhibited the highest stiffness values compared to the SL and PG groups on the 7th and 14th day in the post-immersion period (p < 0.001). Intra-group comparison showed that all suture materials had significant difference in mechanical properties when pre-immersion values were compared to the 14th day post-immersion values (p < 0.001). Conclusion. PP sutures are the strongest and have the highest tensile strength and elongation property. PP seems to sustain its tensile strength better than SL and PG at the end of the 14th day. Controlled clinical studies are necessary to verify this finding in an in vivo setting.

References

Naleway SE, Lear W, Kruzic JJ, Maughan CB. Mechanical prop-erties of suture materials in general and cutaneous surgery. J Biomed Mater Res B Appl Biomater 2015; 103(4): 735‒42.

Vasantha A, Satheesh K, Hoopes W, Lucaci P, Williams, K, Rapley J. Comparing suture strengths for clinical applications: a novel in vitro study. J Periodontol 2009; 80(4): 618‒24.

Burkhart SS, Wirth MA, Simonich M, Salem D, Lanctot D, Atha-nasiou K. Knot security in simple sliding knots and its relation-ship to rotator cuff repair: How secure must the knot be? Ar-throscopy 2000; 16(2): 202‒7.

Arce J, Palacios A, Alvitez-Temoche D, Mendoza-Azpur G, Romero-Tapia P, Mayta-Tovalino F. Tensile Strength of Novel Nonab-sorbable PTFE (Teflon(R) versus Other Suture Materials: An In Vitro Study. Int J Dent 2019; 2019: 7419708.

Hiatt WH, Stallard RE, Butler E, Badgett B. Repair following mucoperiosteal flap surgery with full gingival retention. J Per-iodontol 1968; 39(1): 11‒6.

Burkhardt R, Lang NP. Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques. J Clin Periodontol 2005; 32(3): 287‒93.

Chu CC. Mechanical-properties of suture materials–An important characterization. Ann Surg 1981; 193(3): 365‒71.

von Fraunhofer JA, Storey RJ, Masterson BJ. Tensile properties of suture materials. Biomaterials 1988; 9(4): 324‒7.

Racey G, Wallace W, Cavalaris C, Marguard J. Comparison of a polyglycolic-polylactic acid suture to black silk and plain cat-gut in human oral tissues. J Oral Surg.1978; 36(10): 766‒70.

Ferguson RE Jr, Schuler K, Thornton BP, Vasconez HC, Rinker B. The effect of saliva and oral intake on the tensile properties of sutures: an experimental study. Ann Plast Surg 2007; 58(3): 268‒72.

Alsarhan M, Alnofaie H, Ateeq R, Almahdy A. The Effect of Chlorhexidine and Listerine® Mouthwashes on the Tensile Strength of Selected Absorbable Sutures: An In Vitro Study. BioMed Res Int 2018; 2018: 8531706.

Banche G, Roana J, Mandras N, Amasio M, Gallesio C, Allizond V, et al. Microbial adherence on various intraoral suture materials in patients undergoing dental surgery. J Oral Maxillofac Surg 2007; 65(8): 1503‒7.

Gal JY, Fovet Y, Adib-Yadzi M. About a synthetic saliva for in vitro studies. Talanta 2001; 53(6): 1103‒15.

Vasanthan A, Satheesh K, Hoopes W, Lucaci P, Williams K, Rapley J. Comparing suture strengths for clinical applications: a novel in vitro study. J Periodontol 2009; 80(4): 618‒24.

Lai SY, Becker DG, Edlich RF. Sutures and needles. 2009. Available from: http: www.eMedicine.com [accessed 2010 Oc-tober].

Pillai C, Sharma CP. Review paper: absorbable polymeric sur-gical sutures. Chemistry, production, properties, biodegrada-bility, and performance. J Biomater Appl 2010; 25: 291‒366.

von Fraunhofer JA, Storey RS, Stone IK, Masterson BJ. Tensile strength of suture materials. J Biomed Mater Res 1985; 19(5): 595‒600.

Edlich RF, Panek PH, Rodeheaver GT, Turnbull VG, Kurtz LD, Edgerton MT. Physical and chemical configuration of sutures in the development of surgical infection. Ann Surg 1973; 177(6): 679–688.

Moy R L, Lee A, Zalka A. Commonly used suture materials in skin surgery. Am Fam Physician 1991; 44(6): 2123‒8.

Ketchum LD. Suture materials and suture techniques used in tendon repair. Hand Clin 1985; 1(1): 43‒53.

Karabulut R, Sonmez K, Turkyilmaz Z, Bagbanci B, Basaklar AC, Kale N. An in vitro and in vivo evaluation of tensile strength and durability of seven suture materials in various pH and dif-ferent conditions: an experimental study in rats. Indian. J Surg 2010; 72(5): 386‒90.

McCaul LK, Bagg J, Jenkins WM. Rate of loss of irradiated pol-yglactin 910 (vicryl rapide) from the mouth: A prospective study. Br J Oral Maxillofac Surg 2000; 38(4): 328‒30.

Siervo S. Suturing Techniques in Oral Surgery. 1st ed. Berlin, Germany: Quintessence Publication Co. 2008.

Chu CC, and Moncrief G. An in vitro evaluation of the stability of mechanical properties of surgical suture materials in various pH conditions. Ann Surg 1983; 198(2): 223‒8.

Mohammed A, Hourya A, Rawan A, Ahmed A. The Effect of Chlorhexidine and Listerine® Mouthwashes on the Tensile Strength of Selected Absorbable Sutures: An In Vitro Study. BioMed Res Int 2018; 2018: 8531706.

Alshehri MA, Baskaradoss JK, Geevarghese A, Ramakrishnaiah R, Tatakis DN. Effects of myrrh on the strength of suture mate-rials: an in vitro study. Dent Mater J 2015; 34(2): 148–153.

Arcuri C, Cecchetti F, Dri M, Muzzi F, Bartuli FN. Suture in oral surgery. A comparative study. Minerva Stomatol 2006; 55(1‒2): 17‒31.

Debus ES, Geiger D, Sailer M, Ederer J, Thiede A. Physical, bio-logical and handling characteristics of surgical suture material: a comparison of four different multifilament absorbable su-tures. Eur Surg Res 1997; 29(1): 52‒61.

Rashid RM, Sartori M, White LE, Villa MT, Yoo SS, Alam M. Breaking strength of barbed polypropylene sutures: rater-blinded, controlled comparison with nonbarbed sutures of various calibers. Arch Dermatol 2007; 143(7): 869‒72.

Yaltirik M, Dedeoglu K, Bilgic B, Koray M, Ersev H, Issever H, et al. Comparison of four different suture materials in soft tis-sues of rats. Oral Dis 2003; 9(6): 284‒6.

Hochberg J, Meyer KM, Marion MD. Suture choice and other methods of skin closure. Surg Clin North Am 2009; 89(3): 627‒41.

Altman GH, Diaz F, Jakuba C, Calabro T, Horan RL, Chen J, et al. Silk-based biomaterials. Biomaterials 2003; 24(3): 401‒16.