How well do antibacterial sutures control microbial colonization after oral surgery?

Data sources: A literature search was conducted through PubMed and Scopus databases to identify articles published from January 2013 to May 2023, using appropriate search terms. There were no language restrictions. Additionally, reference lists of the included studies and key peer-reviewed journals in oral surgery were manually searched for further relevant studies.

Study selection: Selection criteria targeted human clinical studies, including cohort studies, randomized clinical trials (RCTs), quasi-experimental studies, case reports, and case series that investigated the antimicrobial activity of antibacterial-coated sutures in oral surgery. Studies were excluded if they were in vitro, ex vivo, or animal studies, as well as if they were non-research or pre-print articles. Two authors independently selected studies, resolving disagreements through discussion or a third expert reviewer.

Data extraction and synthesis: Two reviewers independently extracted data, including author, year, country, study design, sample size, population, intervention, control, surgery type, suture removal time, methodology, main results, and additional information. Discrepancies were resolved through discussion or with input from a third reviewer. This study followed the PRISMA-ScR guidelines for scoping reviews.

Results: Out of 150 identified articles, 129 abstracts were reviewed after removing duplicates, and 10 full-text articles were screened, resulting in the inclusion of 5 studies published between 2014 and 2019. Three were RCTs, with one using a split-mouth design, involving 10 to 40 patients aged 18 to 60 years, primarily healthy. The sutures were mostly braided and coated with triclosan or chlorhexidine, while control groups used various non-coated sutures. Suture removal times ranged from 3 to 8 days. Postoperative rinses were advised in two studies, with one study not administering antibiotics and unclear antibiotic use in others. Three studies reported significantly reduced bacterial counts with antimicrobial-coated sutures compared to non-coated ones, while two studies found no significant differences. Triclosan-coated sutures generally showed greater antimicrobial activity, though results varied.

Conclusion: Antibacterial-coated sutures in oral surgery showed reduced bacterial retention compared to non-coated sutures. However, methodological variability, small sample sizes, and confounding factors limit the generalizability and reliability of these findings. High-quality RCTs with larger sample sizes are needed for more definitive conclusions. While antibacterial-coated sutures show promise in reducing microbial colonization and potentially improving surgical outcomes, their cost-effectiveness relative to non-coated sutures should be evaluated in larger clinical trials.