Cyanoacrylate Adhesive With Low‐Level Laser Therapy for Sutureless Periodontal Flap Closure: A Pilot Randomized Controlled Trial

BACKGROUND AND OBJECTIVES: Conventional suturing in periodontal flap surgery may increase postoperative discomfort and requires additional visits for suture removal. Cyanoacrylate tissue adhesives and low-level laser therapy (LLLT) have individually shown benefits in wound healing and postoperative symptom reduction. This pilot randomized controlled trial evaluated the feasibility and preliminary clinical outcomes of a sutureless periodontal flap closure technique using cyanoacrylate adhesive with adjunctive LLLT compared with conventional suturing. METHODS: This prospective, parallel-group pilot randomized controlled trial was conducted over a 4-month period from October 2025 to January 2026, in the Department of Periodontics, Kothiwal Dental College and Research Centre, Moradabad, India. 20 systemically healthy adults (mean age 31.9 ± 3.6 years; 55% males) with Stage II or III, Grade B periodontitis requiring flap surgery were randomly allocated (1:1) to conventional silk sutures (control, n = 10) or cyanoacrylate adhesive with LLLT (intervention, n = 10). The primary outcome was postoperative pain measured using a 100-mm visual analog scale. Secondary outcomes included wound healing index, analgesic consumption, plaque index, probing pocket depth (PPD), clinical attachment level (CAL), and patient treatment preference. Statistical analysis was performed using mixed-effects models and generalized linear mixed models, with independent t-test or Mann-Whitney U test for between-group comparisons. Statistical significance was set at p < 0.05, and 95% confidence intervals were calculated. RESULTS: All participants completed the study with 100% follow-up and no adverse events. Baseline demographic characteristics were comparable between groups (p > 0.05). The intervention group demonstrated significantly lower analgesic consumption (mean difference 2.30 tablets; 95% confidence interval 1.18-3.42; p = 0.001) and higher patient preference scores (mean difference 1.50 points; 95% confidence interval 0.83-2.17; p = 0.001). Postoperative pain scores were consistently lower and early wound healing scores were higher in the intervention group across follow-up visits (p < 0.05). Both groups showed significant reductions in probing pocket depth and clinical attachment level at 6 weeks (p < 0.05), with no statistically significant between-group differences over time (p > 0.05). CONCLUSION: Cyanoacrylate adhesive with adjunctive low-level laser therapy appears feasible and may improve early postoperative outcomes following periodontal flap surgery. Larger randomized trials are required to confirm these findings. TRIAL REGISTRATION: The study was prospectively registered with the Clinical Trials Registry-India (CTRI/2025/09/095379) on September 24, 2025.