Cyanoacrylate Adhesive Versus Sutures for Free Gingival Graft Fixation: A Systematic Review and Meta‐Analysis of Clinical Outcomes

OBJECTIVE: To compare clinical outcomes of cyanoacrylate adhesive (GLU) and sutures (SUT) for the fixation of free gingival grafts (FGG) around natural teeth. MATERIALS AND METHODS: A systematic search of MEDLINE, Embase, Cochrane Library, Scopus, and Google Scholar was conducted up to March 2025. Randomized controlled trials (RCTs) comparing GLU and SUT as fixation methods for FGG were included in a meta-analysis. Potential moderators, including publication year, follow-up duration, sample size, baseline clinical parameters, and study-level covariates, were investigated. RESULTS: Ten RCTs were included. No significant differences were observed between GLU and SUT for recession reduction (mean difference [MD] = 0.49 mm; 95% CI: -0.53 to 1.50; p = 0.08), keratinized tissue (KT) height gain (MD = 0.01 mm; 95% CI: -1.58 to 1.59; p = 0.99), or graft shrinkage (MD = 0.26; 95% CI: -0.13 to 0.66; p = 0.15). A statistically significant but clinically negligible difference favored GLU for probing depth reduction (MD = 0.063 mm; 95% CI: 0.007 to 0.118; p = 0.044). Meta-regression identified smoking, tissue thickness, graft dimension, and follow-up duration as moderators of treatment outcomes. CONCLUSION: No significant differences were observed between GLU and SUT in clinical outcomes following FGG procedures around natural teeth.