Traditionally, silk has been the mostly used suture material for dental and several other surgical procedures . Even though silk is inexpensive and easy to handle as compared to other nonabsorbable suture materials [19, 22]; the authors believe that it should not be considered as a “material of choice” for oral surgical interventions. Studies on oral tissue reactions to sutures have revealed constant inflammatory reactions, which are most prominent with silk and cotton and minimal with others including nylon, polyester, ePTFE, polyglecaprone 25 and PGA [3, 5, 7–19]. A histological study  compared the oral tissue reactions to various suture materials. The results showed the presence of a large number of neutrophilic polymorphonuclear leukocytes in the premises of silk sutures which were less intense in oral tissues farther from silk sutures . Another finding was that fibroblasts and new capillaries formed at a slower pace in the oral tissues in the vicinity of silk sutures compared to tissues farther from the silk sutures. This may be a justification for the delayed healing and severe tissue reactions associated with silk sutures.
Another factor that may instigate tissue reactions is the capability of bacteria to adhere to various suture materials. In their in vitro study, Katz et al.  investigated the capability of bacteria to adhere to various types of sutures to cause tissue reactions. The results showed that bacterial adherence to braided silk sutures was five- to eightfolds higher as compared to nylon to which the least numbers of bacteria adhered . In another study , colonization on various intraoral suture materials from patients microbial having undergone dentoalveolar surgery was investigated. The results showed a larger numbers of bacteria on silk as compared to polyglecaprone 25 . In an experimental study, Leknes et al.  investigated the inflammatory responses in oral tissues sutured with silk and ePTFE by recording the presence or absence of bacterial plaque along the suture track. The results showed that bacterial plaque was present in 10 out of the 11 silk and 4 out of the 11 ePTFE suture channels . These studies may act as possible explanations to the minimum tissue reactions evoked in nylon and polyglecaprone 25 as compared to braided silk sutures. Thus, the different rates of bacterial adherence to various suture materials support the hypothesis that bacterial adherence to sutures plays a significant role in the induction of tissue reactions. Since sutures are immediately contaminated as soon as they contact the oral cavity, it is recommended that sutures should be opened just before being passed through the gingival tissues in order to minimize complications such as stitch abscesses .
It is still evident that various suture materials used in oral surgical interventions present varying degrees of tissue reactions depending on several factors including surface properties and bacterial adherence properties. The present information emphasizes on the need for careful suture selection of suturing materials for oral surgical interventions.
The following case shows the advanced healing process where Biotex® was used.
The table below shows the histological findings in different types of suture.
For more information or to order online to go: