Comparing the Efficacy of Triclosan Coated Sutures versus Chlorhexidine Coated Sutures in Preventing Surgical Site Infection after Removal of Impacted Mandibular Third Molar
Journal of Pharmaceutical Research International,
Page 138-148
DOI:
10.9734/jpri/2020/v32i1930720
Abstract
The aim of this present clinical trial study is evaluate the efficacy of triclosan coated sutures versus chlorhexidine coated sutures in preventing surgical site infection after removal of an impacted mandibular third molar. This prospective, single blind study included 30 patients divided into two groups with 15 patients each who had been referred to the Oral Surgery Clinic at Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Chennai for surgical removal of impacted mandibular third molar under local anaesthesia. The patients were randomly assigned to two groups: Group 1 were treated with (3-0) antimicrobial triclosan impregnated polyglactin sutures for closure and in group 2 with (3–0) antimicrobial chlorhexidine diacetate-impregnated polyglactin sutures. Evaluation in regard to infection rate, abnormal erythema, pain and trismus between two groups was done on the 7th day postoperatively. In this study we observed that no significant difference in rates of infection between the groups. Abnormal erythema and trismus showed better results in group 2(chlorhexidine group) on 7th day postoperatively whereas incidence of pain was higher in patients treated with chlorhexidine coated sutures on the 7th day postoperatively as compared to patients treated with triclosan coated sutures. However, P value was >0.05 which was considered statistically insignificant. Within the limitations of the present study, chlorhexidine diacetate-impregnated polyglactin sutures showed reduced infection rates,erythema and trismus as compared to triclosan impregnated polyglactin sutures in healthy patients undergoing surgical removal of third molar under local anesthesia.
Keywords:
- Triclosan impregnated polyglactin sutures
- chlorhexidine diacetate-impregnated polyglactin sutures
- infection
- erythema
- swelling
- pain
- trismus
- impacted mandibular third molar
How to Cite
Krishnan, S., Periasamy, S., & Murugaiyan, A. (2020). Comparing the Efficacy of Triclosan Coated Sutures versus Chlorhexidine Coated Sutures in Preventing Surgical Site Infection after Removal of Impacted Mandibular Third Molar. Journal of Pharmaceutical Research International, 32(19), 138-148. https://doi.org/10.9734/jpri/2020/v32i1930720
References
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Leaper DJ, Van Goor H, Reilly J. Surgical site infection–a European perspective of incidence and economic burden. Int Wound J; 2004.
Available:https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1742-4801.2004.00067.x
Carvalho RLR de, Campos CC, Franco LM de C, et al. Incidence and risk factors for surgical site infection in general surgeries. Rev Lat Am Enfermagem. 2017;25:2848.
Mody P, Ali I, Shetty V, et al. A comparative study to test the effectiveness of triclosan coated polyglactin 910 in reduction of surgical site infection in clean wounds. International Surgery Journal. 2019;6:1182.
Giglio JA, Rowland RW, Dalton HP, et al. Suture removal-induced bacteremia: a possible endocarditis risk. J Am Dent Assoc. 1992;123:65–6:69–70.
King RC, Crawford JJ, Small EW. Bacteremia following intraoral suture removal. Oral Surg Oral Med Oral Pathol. 1988;65:23–28.
Otten JE, Wiedmann-Al-Ahmad M, Jahnke H, et al., Bacterial colonization on different suture materials—A potential risk for intraoral dentoalveolar surgery. J Biomed Mater Res. 2005;74B:627–635.
Ford HR, Jones P, Gaines B, et al., Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL® Plus antibacterial suture (coated polyglactin 910 suture with triclosan) with Coated VICRYL® suture (coated polyglactin 910 suture). Surg Infect. 2005;6:313–321.
Lilly GE. Reaction of oral tissues to suture materials. Oral Surg Oral Med Oral Pathol. 1968;26:128–133.
Zeitler DL. Prophylactic antibiotics for third molar surgery: a dissenting opinion. J Oral Maxillofac Surg. 1995;53:61–64.
Bezerra TP, Studart-Soares EC, Scaparo HC, et al. Prophylaxis versus placebo treatment for infective and inflammatory complications of surgical third molar removal: A split-mouth, double-blind, controlled, clinical trial with amoxicillin (500 mg). Journal of Oral and Maxillofacial Surgery. 2011;69:333–339.
Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15:167–193.
Kruthi N, Rajasekhar G, Anuradha B, et al., Polyglactin 910 vs. triclosan coated polyglactin 910 in oral surgery: A comparative in vivo study. Dentistry. 2014;4:1.
Mohan S, Jayanth BS, Saralaya S, et al. Comparative Study on the Efficacy of Postsurgical Oral Prophylactic Antibiotic Versus Antimicrobial Suture Placement Alone in Preventing Surgical Site Infection After Removal of Impacted Mandibular Third Molar. Journal of Maxillofacial and Oral Surgery. Epub ahead of print; 2019. DOI: 10.1007/s12663-019-01267-0
Senthil Kumar MS, Ramani P, Rajendran V, et al. Inflammatory pseudotumour of the maxillary sinus: clinicopathological report. Oral Surg. 2019;12:255–259.
Wahab PUA, Madhulaxmi M, Senthilnathan P, et al., Scalpel Versus Diathermy in Wound Healing After Mucosal Incisions: A Split-Mouth Study. J Oral Maxillofac Surg. 2018;76:1160–1164.
J PC, Marimuthu T, C K, et al. Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study. Clin Implant Dent Relat Res. 2018;20:531–534.
Eapen BV, Baig MF, Avinash S. An Assessment of the Incidence of Prolonged Postoperative Bleeding After Dental Extraction Among Patients on Uninterrupted Low Dose Aspirin Therapy and to Evaluate the Need to Stop Such Medication Prior to Dental Extractions. J Maxillofac Oral Surg. 2017;16:48–52.
Marimuthu M, Andiappan M, Wahab A, et al. Canonical Wnt pathway gene expression and their clinical correlation in oral squamous cell carcinoma. Indian J Dent Res. 2018;29:291–297.
Jain M, Nazar N. Comparative Evaluation of the Efficacy of Intraligamentary and Supraperiosteal Injections in the Extraction of Maxillary Teeth: A Randomized Controlled Clinical Trial. J Contemp Dent Pract. 2018;19:1117–1121.
Abhinav RP, Selvarasu K, Maheswari GU, et al. The Patterns and Etiology of Maxillofacial Trauma in South India. Ann Maxillofac Surg. 2019;9:114–117.
Sweta VR, Abhinav RP, Ramesh A. Role of Virtual Reality in Pain Perception of Patients Following the Administration of Local Anesthesia. Ann Maxillofac Surg. 2019;9:110–113.
Abdul Wahab PU, Senthil Nathan P, Madhulaxmi M, et al. Risk Factors for Post-operative Infection Following Single Piece Osteotomy. J Maxillofac Oral Surg. 2017;16:328–332.
Ramadorai A, Ravi P, Narayanan V. Rhinocerebral Mucormycosis: A prospective analysis of an effective treatment protocol. Ann Maxillofac Surg. 2019;9:192–196.
Patil SB, Durairaj D, Suresh Kumar G, et al. Comparison of extended nasolabial flap versus buccal fat pad graft in the surgical management of oral submucous fibrosis: A prospective pilot study. J Maxillofac Oral Surg. 2017;16:312–321.
Mohan S, Jayanth BS, Saralaya S, et al. Comparative Study on the Efficacy of Postsurgical Oral Prophylactic Antibiotic Versus Antimicrobial Suture Placement Alone in Preventing Surgical Site Infection After Removal of Impacted Mandibular Third Molar. J Maxillofac Oral Surg. 2019:1–6.
Sivakumar P, Naseem I. Biosmart materials the future of dentistry: A review. Research Journal of Pharmacy and Technology. 2016;9:1737–1742.
Edlich RF, Panek PH, Rodeheaver GT, et al., Physical and chemical configuration of sutures in the development of surgical infection. Ann Surg. 1973;177: 679–688.
Barbolt TA. Chemistry and safety of triclosan, and its use as an antimicrobial coating on Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 suture with triclosan). Surg Infect. 2002;3(1):45–53.
Sala-Pérez S, López-Ramírez M, Quinteros-Borgarello M, et al. Antibacterial suture vs silk for the surgical removal of impacted lower third molars. A randomized clinical study. Med Oral Patol Oral Cir Bucal. 2016;21:95–102.
Bamber AI, Neal TJ. An assessment of triclosan susceptibility in methicillin-resistant and methicillin-sensitive Staphylococcus aureus. J Hosp Infect 1999; 41: 107–109.
Zafar AB, Butler RC, Reese DJ, et al. Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control. 1995;23:200–208.
Webster J, Faoagali JL, Cartwright D. Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan. J Paediatr Child Health. 1994;30:59–64.
Darouiche RO, Farmer J, Chaput C, et al. Anti-Infective Efficacy of Antiseptic-Coated Intramedullary Nails*†. The Journal of Bone & Joint Surgery. 1998;80:1336–1340.
Vorherr H, Ulrich JA, Messer RH, et al. Antimicrobial effect of chlorhexidine on bacteria of groin, perineum and vagina. J Reprod Med. 1980;24:153–157.
Fardai O, Turnbull RS. A review of the literature on use of chlorhexidine in dentistry. J Am Dent Assoc, Available:
https://jada.ada.org/article/S0002-8177(86)26020-1/abstract (1986).
Suido H, Offenbacher S, Arnold RR. A clinical study of bacterial contamination of chlorhexidine-coated filaments of an interdental brush. J Clin Dent. 1998;9:105–109.
Sanchez IR, Nusbaum KE, Swaim SF. Chlorhexidine Diacetate and Povidone‐iodine Cytotoxicity to Canine Embryonic Fibroblasts and Staphylococcus aureus. Veterinary; 1998.
Available:https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-950X.1988.tb00995.x
Gazivoda D, Pelemiš D, Vujašković G. A clinical study on the influence of suturing material on oral wound healing. Vojnosanit Pregl. 2015;72:765–769.
Venema S, Abbas F, van de Belt-Gritter B, et al. In vitro oral biofilm formation on triclosan-coated sutures in the absence and presence of additional antiplaque treatment. J Oral Maxillofac Surg. 2011;69:980–985.
Obermeier A, Schneider J, Harrasser N, et al. Correction: Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). PLoS One. 2018;13:0193284.
Deliverska EG, Petkova M. Complications after extraction of impacted third molars-literature review. Journal of IMAB--Annual Proceeding Scientific Papers. 2016;22:1202–1211.
Tae BS, Park JH, Kim JK, et al. Comparison of intraoperative handling and wound healing between (NEOSORB® plus) and coated polyglactin 910 suture (NEOSORB®): A prospective, single-blind, randomized controlled trial. BMC Surg. 2018;18: 45.
Leaper DJ, Van Goor H, Reilly J. Surgical site infection–a European perspective of incidence and economic burden. Int Wound J; 2004.
Available:https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1742-4801.2004.00067.x
Carvalho RLR de, Campos CC, Franco LM de C, et al. Incidence and risk factors for surgical site infection in general surgeries. Rev Lat Am Enfermagem. 2017;25:2848.
Mody P, Ali I, Shetty V, et al. A comparative study to test the effectiveness of triclosan coated polyglactin 910 in reduction of surgical site infection in clean wounds. International Surgery Journal. 2019;6:1182.
Giglio JA, Rowland RW, Dalton HP, et al. Suture removal-induced bacteremia: a possible endocarditis risk. J Am Dent Assoc. 1992;123:65–6:69–70.
King RC, Crawford JJ, Small EW. Bacteremia following intraoral suture removal. Oral Surg Oral Med Oral Pathol. 1988;65:23–28.
Otten JE, Wiedmann-Al-Ahmad M, Jahnke H, et al., Bacterial colonization on different suture materials—A potential risk for intraoral dentoalveolar surgery. J Biomed Mater Res. 2005;74B:627–635.
Ford HR, Jones P, Gaines B, et al., Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL® Plus antibacterial suture (coated polyglactin 910 suture with triclosan) with Coated VICRYL® suture (coated polyglactin 910 suture). Surg Infect. 2005;6:313–321.
Lilly GE. Reaction of oral tissues to suture materials. Oral Surg Oral Med Oral Pathol. 1968;26:128–133.
Zeitler DL. Prophylactic antibiotics for third molar surgery: a dissenting opinion. J Oral Maxillofac Surg. 1995;53:61–64.
Bezerra TP, Studart-Soares EC, Scaparo HC, et al. Prophylaxis versus placebo treatment for infective and inflammatory complications of surgical third molar removal: A split-mouth, double-blind, controlled, clinical trial with amoxicillin (500 mg). Journal of Oral and Maxillofacial Surgery. 2011;69:333–339.
Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15:167–193.
Kruthi N, Rajasekhar G, Anuradha B, et al., Polyglactin 910 vs. triclosan coated polyglactin 910 in oral surgery: A comparative in vivo study. Dentistry. 2014;4:1.
Mohan S, Jayanth BS, Saralaya S, et al. Comparative Study on the Efficacy of Postsurgical Oral Prophylactic Antibiotic Versus Antimicrobial Suture Placement Alone in Preventing Surgical Site Infection After Removal of Impacted Mandibular Third Molar. Journal of Maxillofacial and Oral Surgery. Epub ahead of print; 2019. DOI: 10.1007/s12663-019-01267-0
Senthil Kumar MS, Ramani P, Rajendran V, et al. Inflammatory pseudotumour of the maxillary sinus: clinicopathological report. Oral Surg. 2019;12:255–259.
Wahab PUA, Madhulaxmi M, Senthilnathan P, et al., Scalpel Versus Diathermy in Wound Healing After Mucosal Incisions: A Split-Mouth Study. J Oral Maxillofac Surg. 2018;76:1160–1164.
J PC, Marimuthu T, C K, et al. Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study. Clin Implant Dent Relat Res. 2018;20:531–534.
Eapen BV, Baig MF, Avinash S. An Assessment of the Incidence of Prolonged Postoperative Bleeding After Dental Extraction Among Patients on Uninterrupted Low Dose Aspirin Therapy and to Evaluate the Need to Stop Such Medication Prior to Dental Extractions. J Maxillofac Oral Surg. 2017;16:48–52.
Marimuthu M, Andiappan M, Wahab A, et al. Canonical Wnt pathway gene expression and their clinical correlation in oral squamous cell carcinoma. Indian J Dent Res. 2018;29:291–297.
Jain M, Nazar N. Comparative Evaluation of the Efficacy of Intraligamentary and Supraperiosteal Injections in the Extraction of Maxillary Teeth: A Randomized Controlled Clinical Trial. J Contemp Dent Pract. 2018;19:1117–1121.
Abhinav RP, Selvarasu K, Maheswari GU, et al. The Patterns and Etiology of Maxillofacial Trauma in South India. Ann Maxillofac Surg. 2019;9:114–117.
Sweta VR, Abhinav RP, Ramesh A. Role of Virtual Reality in Pain Perception of Patients Following the Administration of Local Anesthesia. Ann Maxillofac Surg. 2019;9:110–113.
Abdul Wahab PU, Senthil Nathan P, Madhulaxmi M, et al. Risk Factors for Post-operative Infection Following Single Piece Osteotomy. J Maxillofac Oral Surg. 2017;16:328–332.
Ramadorai A, Ravi P, Narayanan V. Rhinocerebral Mucormycosis: A prospective analysis of an effective treatment protocol. Ann Maxillofac Surg. 2019;9:192–196.
Patil SB, Durairaj D, Suresh Kumar G, et al. Comparison of extended nasolabial flap versus buccal fat pad graft in the surgical management of oral submucous fibrosis: A prospective pilot study. J Maxillofac Oral Surg. 2017;16:312–321.
Mohan S, Jayanth BS, Saralaya S, et al. Comparative Study on the Efficacy of Postsurgical Oral Prophylactic Antibiotic Versus Antimicrobial Suture Placement Alone in Preventing Surgical Site Infection After Removal of Impacted Mandibular Third Molar. J Maxillofac Oral Surg. 2019:1–6.
Sivakumar P, Naseem I. Biosmart materials the future of dentistry: A review. Research Journal of Pharmacy and Technology. 2016;9:1737–1742.
Edlich RF, Panek PH, Rodeheaver GT, et al., Physical and chemical configuration of sutures in the development of surgical infection. Ann Surg. 1973;177: 679–688.
Barbolt TA. Chemistry and safety of triclosan, and its use as an antimicrobial coating on Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 suture with triclosan). Surg Infect. 2002;3(1):45–53.
Sala-Pérez S, López-Ramírez M, Quinteros-Borgarello M, et al. Antibacterial suture vs silk for the surgical removal of impacted lower third molars. A randomized clinical study. Med Oral Patol Oral Cir Bucal. 2016;21:95–102.
Bamber AI, Neal TJ. An assessment of triclosan susceptibility in methicillin-resistant and methicillin-sensitive Staphylococcus aureus. J Hosp Infect 1999; 41: 107–109.
Zafar AB, Butler RC, Reese DJ, et al. Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control. 1995;23:200–208.
Webster J, Faoagali JL, Cartwright D. Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan. J Paediatr Child Health. 1994;30:59–64.
Darouiche RO, Farmer J, Chaput C, et al. Anti-Infective Efficacy of Antiseptic-Coated Intramedullary Nails*†. The Journal of Bone & Joint Surgery. 1998;80:1336–1340.
Vorherr H, Ulrich JA, Messer RH, et al. Antimicrobial effect of chlorhexidine on bacteria of groin, perineum and vagina. J Reprod Med. 1980;24:153–157.
Fardai O, Turnbull RS. A review of the literature on use of chlorhexidine in dentistry. J Am Dent Assoc, Available:
https://jada.ada.org/article/S0002-8177(86)26020-1/abstract (1986).
Suido H, Offenbacher S, Arnold RR. A clinical study of bacterial contamination of chlorhexidine-coated filaments of an interdental brush. J Clin Dent. 1998;9:105–109.
Sanchez IR, Nusbaum KE, Swaim SF. Chlorhexidine Diacetate and Povidone‐iodine Cytotoxicity to Canine Embryonic Fibroblasts and Staphylococcus aureus. Veterinary; 1998.
Available:https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-950X.1988.tb00995.x
Gazivoda D, Pelemiš D, Vujašković G. A clinical study on the influence of suturing material on oral wound healing. Vojnosanit Pregl. 2015;72:765–769.
Venema S, Abbas F, van de Belt-Gritter B, et al. In vitro oral biofilm formation on triclosan-coated sutures in the absence and presence of additional antiplaque treatment. J Oral Maxillofac Surg. 2011;69:980–985.
Obermeier A, Schneider J, Harrasser N, et al. Correction: Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). PLoS One. 2018;13:0193284.
Deliverska EG, Petkova M. Complications after extraction of impacted third molars-literature review. Journal of IMAB--Annual Proceeding Scientific Papers. 2016;22:1202–1211.
Tae BS, Park JH, Kim JK, et al. Comparison of intraoperative handling and wound healing between (NEOSORB® plus) and coated polyglactin 910 suture (NEOSORB®): A prospective, single-blind, randomized controlled trial. BMC Surg. 2018;18: 45.
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