MeSH Key Words: cyanoacrylates/therapeutic use; periodontal dressings; tissue adhesives.
Extensive research is available from the early 1960s on dental uses of cyanoacrylate materials. Several forms of cyanoacrylate have been studied for possible use in humans. Alpha and ethyl forms were found incompatible for use in humans. Particular interest has focused on the use of n-butyl cyanoacrylate, which is biocompatible in humans. This material is an effective tissue adhesive which displays hemostatic properties and a bacteriostatic action.

N-butyl cyanoacrylate has several advantages over conventional suture materials in soft-tissue surgery: it saves time, is hemostatic and bacteriostatic, and doesn't need to be removed during post-operative follow-up. Patients must wear eye protection when cyanoacrylates are being applied, as they may cause irreversible retinal damage.

Case One

click to enlarge Fig 1(a): Preoperative view of graft recipient site.

In my practice, I use cyanoacrylate to facilitate the free gingival graft surgical procedure (Fig. 1(a)).

Following preparation of the recipient site, the donor tissue is obtained from the palate. Cyanoacrylate is then applied as a dressing over the donor site. The material is useful here because of it hemostatic and bacteriostatic properties and because it acts as a protective barrier during the healing phase. (Fig.1(b)).

click to enlarge Fig 1(b): Donor site with cyanoacrylate dressing in-situ.

Following accurate positioning of the donor tissue in the recipient site, I apply digital pressure for approximately four minutes. Using a special applicator, I then apply cyanoacrylate at the coronal border of the recipient site/donor tissue interface, to aid fixation (Fig.1(c)).

click to enlarge Fig 1(c): Cyanoacrylate anchoring the donor tissue in place.

A further periodontal dressing may be placed over the recipient site at the clinician's discretion. Post-operative care instructions are given to the patient and appropriate follow-up appointments are arranged. (Fig. 1(d)). The cyanoacrylate material I prefer to use for this technique is Periacryl (Blacklock Medical Products, Delta, BC). I prefer it because of it distinctive color, consistency of flow, ease of application and the

click to enlarge Fig 1(d): Preoperative view of graft recipient site.

consistent post-operative results it produces. It is also relatively inexpensive.

Case Two
Practitioners may have the occasion to perform a soft tissue biopsy and

click to enlarge Fig 2(a): Preoperative view of biopsy site.

submit the sample for histologic examination and diagnosis (Fig. 2(a)). The use of sutures for wound closure may be very difficult or impractical in certain situations. Periodontal dressings may be difficult to apply and retain. Bleeding may also be difficult to control.

In my practice, following the soft-tissue biopsy, I apply a thin layer of cyanoacrylate to the biopsy site. The material is effective as a surgical

click to enlarge Fig 2(b): Cyanoacrylate applied to biopsy site.

dressing during the early healing phase. (Fig 2(b)). Appropriate post-operative care instructions are given and the patient is asked to return for follow-up (Fig. 2(c)).

I have found cyanoacrylate to be useful in several other periodontal surgery applications. These include post-gingivectomy, gingivoplasty and tooth extraction; securing apically positioned flaps; and following ridge preservation procedures using osseous graft materials.

click to enlarge Fig 2(c): Healed biopsy site at follow up.

Dr. Grisdale is in private practice and is affiliated with the continuing dental education department at UBC.

Reprint requests to: Dr. Jim Grisdale, 805-805 West Broadway, Vancouver, BC V5Z 1K1.

The author has no declared financial interest in any company manufacturing the types of products mentioned in this article.