EVALUATION OF THE EFFICACY OF COATED AND NON COATED SUTURES IN THE REDUCTION OF BACTERIAL LOAD: A SYSTEMATIC REVIEW

Abstract

Aim: To systematically evaluate the effectiveness of antimicrobial-coated sutures compared with non-coated sutures in reducing bacterial load and improving clinical outcomes following periodontal surgical procedures. Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD420251163080). Electronic databases (PubMed, ScienceDirect, Wiley Online Library, Cochrane Library, and Google Scholar) were searched for studies published between January 2000 and May 2025. Eligible studies included randomized controlled trials, controlled clinical trials, comparative observational studies, and well-designed in vitro investigations evaluating antimicrobial-coated versus non-coated sutures in periodontal surgery. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool for randomized trials and a modified Newcastle–Ottawa Scale for non-randomized and in vitro studies. All eligible studies were included in the qualitative synthesis; however, quantitative meta-analysis was restricted to randomized clinical trials reporting comparable microbiological outcomes. Pooled estimates were calculated using a random-effects model and expressed as standardized mean differences (SMDs) with 95% confidence intervals (CI). Results: Eleven studies met the inclusion criteria, comprising seven randomized clinical trials and four in vitro investigations. The studies evaluated a range of antimicrobial coatings, including triclosan, chlorhexidine, tetracycline, neem oil, and aloe vera. Qualitative synthesis demonstrated a consistent trend toward reduced bacterial colonization with antimicrobial-coated sutures, with several studies also reporting improved wound healing and postoperative comfort. Three randomized clinical trials involving 94 participants were eligible for quantitative synthesis. The pooled analysis demonstrated a moderate trend favoring antimicrobial-coated sutures (SMD = –0.68, 95% CI: –1.38 to 0.02); however, the overall effect was not statistically significant. Substantial heterogeneity was observed among the included clinical studies (I² = 72%). Conclusion: Antimicrobial-coated sutures demonstrate a consistent tendency to reduce bacterial colonization and may provide additional benefits in wound healing and postoperative comfort following periodontal surgery. Although the pooled clinical evidence suggests a favorable direction of effect, the available data remain inconclusive because the overall effect did not reach statistical significance and considerable heterogeneity existed among studies. Larger, well-designed randomized clinical trials employing standardized microbiological and clinical outcome measures are required to strengthen the evidence base.