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Case Report Role of Fibrin Fibronectin Sealing System (tissucol ) In Periodontal Flap Surgery - A Comparative Case Report

Dr Krishna Kripal*, Dr Prasanna H R** Abstract


Traditionally, sutures are used to close flaps associated with periodontal and implant procedures. When implants are placed in the esthetic zone or when periodontal plastic surgical procedures are performed, fibrin sealants (tissucol) may be a viable alternative to closing flaps with sutures. This article describes the use of fibrin sealants in dentistry along with case reports of patients treated with sealants . Keywords : (tissucol) fibrin, fibronectin, sutureless periodontal surgery, periodontal flap. *Professor, Department of Periodontology, Rajarajeswari Dental College and Hospital, Ramohalli Cross, Bangalore-560 060. **Reader, Department of Periodontology, SRM Kattankullathur, Dental College and Hospital, Chennai.

Fibrin sealants have been used as an alternative to close flaps. (tissucol) is Fibrin Fibronectin Sealing System (FFSS). It is available as two component system. The first component contains highly co? fibrinogen, factor XIII, fibronectin, and traces of other plasma proteins. The second component contains thrombin, calcium chloride, antifibrinolytic agents such as aprotinin. Mixing of two components promotes clotting with the formation and crosslinking of fibrin. Animal studies have showed that FFSS has osteoconductive potential and significantly produced more new bone when used with bone graft material like tricalcium phosphate. The split mouth clinical trials done to see the effect of treating deep wide buccal gingival recession with guided tissue regeneration after root conditioning with tetracyclinehydrochloride (HCl) and FFSS give good results. Fibrin-sealing system is effective as a means of fixing tissues after periodontal surgery, as fibrin glue is easier and quicker to use. Sutures cause inflammation around themselves, while glue enhances early wound healing. We report here a comparative case report of patients in whom flap surgeries were carried out. In the first patient, flap was closed using tissucol sutures were used in the second. This was carried out to evaluate the usefulness and consequence of (tissucol) as an alternative to sutures.

Methodology:
The fibrin sealant kit contains four separate vials: 1. 2. 3. 4. Sealer protein concentrate (human) vapor heated, freeze dried; Fibrinolysis inhibitor solution (bovine); Thrombin (human) vapor heated freeze dried; and Calcium chloride solution.

Correspondence: Dr Krishna Kripal, Professor RajaRajeswari Dental College and Hospital, Kumbalgodu, Mysore Road, Bangalore - 560074.

Freeze dried sealer protein concentrate and thrombin are reconstituted in fibrinolysis inhibitor solution and calcium chloride solution using fibrinotherm heating and stirring device, a standard incubator or a water bath. Solutions are then combined by using duploject and 0.1 ml of the solution was applied per tooth and per side. (0.2 ml in case of flap procedure and on lingual aspects). To avoid risk of allergic, anaphylactic and/or thromboembolic events, which may be life threatening, fibrin sealant should not be applied intravascularly or into the tissues. Fibrin sealant is not indicated for the treatment of massive and brisk arterial or venous bleeding. It is also contraindicated in individuals who are hypersensitive to bovine protein.

Results
The tissucol proved to be more convenient and easy for use by the dentist. The patient treated with glue had an early recovery as compared to the patient treated with traditional sutures

Discussion
Although the tissucol proved to be more convenient and easy for use, the overall convenience in using fibrin sealing system should be evaluated on the basis of its cost and benefits. Synthetic adhesives (cyanoacrylates) have been discarded because of toxicity, stiffness, and lack of acceptance among clinicians. Use of resorbable sutures is sometimes known to cause strong

Journal of Health Sciences and Research, Volume 3, Number 1, April - 2011

Original Article

inflammatory responses. It appeared that the essential precursor for connective tissue attachment was occurrence of fibrin linkage with the root surface and this became replaced by collagen to establish new connective tissue attachment to a denuded root surface. The fibrin glue seemed effective in bringing about early wound healing. Fibrin family of related proteins found in blood plasma and on the surface of fibroblasts is a chemo attractant for fibroblasts and enhances the interaction and adherence of fibroblast to root surfaces. Fibronectin may serve to anchor a blood clot to surrounding collagen owing to its property of being covalently linked to fibrin and clotting factor XIIIa. Conventional sutures provide only a marginal fixation, while the fibrin sealing system seals the tissues on its whole surface. The use of fibrin glue saves remarkable amount of time and makes it easier to fix the tissues in difficult, inaccessible areas and esthetical areas. Fibrin sealing system also saves cost of preparing, sterilizing, and storing instruments as well as cost of suture themselves. Suture removal, which is important in traditional treatment is not required with this system and hence is more convenient for the patients.

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Conclusion
The fibrin sealing system is effective as a means of fixing tissues after periodontal surgery. The fibrin glue is easier and quicker to use than sutures.

References
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Journal of Health Sciences and Research, Volume 3, Number 1, April - 2011