Beyond sutures: a focused review of contemporary concepts in periodontal wound closure

Wound closure is a critical part of periodontal and mucogingival surgery, as it directly affects tissue stability, healing, patient comfort, and esthetic outcomes. This focused review examines the current evidence on periodontal wound closure, with particular attention to suture materials, microsurgical suturing, tissue adhesives, and suture removal protocols. The available literature suggests that closure materials differ in their biologic and mechanical behavior, with monofilament and synthetic sutures generally demonstrating less bacterial retention and lower tissue reactivity than braided materials. Microsurgical suturing appears to offer advantages in soft tissue adaptation and esthetic refinement, although supporting evidence remains limited in certain regenerative procedures. Tissue adhesives, particularly cyanoacrylate-based formulations, may provide a useful alternative in selected cases, with studies reporting satisfactory healing and improved patient comfort, although the evidence remains limited. The studies also suggest that suture removal should be based on the specific surgical procedure and healing requirements rather than on a routine time-based rule. Overall, the evidence remains heterogeneous and often limited, supporting thoughtful material selection and procedure-specific clinical judgment rather than definitive recommendations.