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M o u t h w a s h e s a n d b a c t e r i a o n s u t u r e t h r e a d s Introduction Oral surgery interventions usually require sutures in order to facilitate wound healing and to prevent dehiscence. However, suture threads are inevitably colonized by microorganisms that could infect surrounding tissue and impair the wound-healing process.1–4 Many different kinds of surgical sutures (natural and synthetic) with different properties have been proposed over the years to overcome plaque stratifica- tion over threads. It is already known that bac- terial adherence to suture threads may delay and affect the wound-healing process. For this purpose, several antimicrobial agents have been tested to be incorporated in or to coat suture threads.5 Mouthwashes are highly rec- ommended for home care maintenance as an adjunctive measure to reduce bacterial coloni- zation of sutures and postoperative inflamma- tion.6 Nowadays, chlorhexidine is the gold standard in terms of antimicrobial activity because of its wide spectrum of actions. Chlor- hexidine has been commercially proposed in many different formulas.7 Even though its sev- eral advantages have been profusely demon- strated, some adverse effects, such as tooth staining,8, 9 tongue discoloration, and desqua- mation and soreness of the oral mucosa, should be considered.3, 10–12 Because of its nature, clini- cians must look at chlorhexidine as an anti- microbial agent to which bacteria could develop resistance, especially in the case of long-term use.13 Given those issues, researchers have been seeking alternatives to chlorhexidine in terms of antiseptic designs. In the present study, the authors tested a mouthwash con- taining zinc-substituted nanohydroxyapatite (Zn-nHAp) and zinc L-pyrrolidone carboxylate (Zn-PCA) in terms of microbial adherence to suture threads compared with a mouthwash containing chlorhexidine. Materials and methods S t u d y p r o t o c o l The present clinical case–control study was a multicenter study including the Tuscan Stomato- logic Institute, Versilia General Hospital, Lido di Camaiore, Italy, and the University of Bologna, Bologna, Italy. All of the participants were screened according to the following inclusion and exclusion criteria. Inclusion criteria: – aged 30 years and older; – received minimal surgical interventions (extraction, implant surgery, periodontal sur- gery) with sutures; and – compliance with the study protocol and will- ingness to adhere to the hygiene instructions. Exclusion criteria: – pregnancy; – antibiotics, nonsteroidal anti-inflammatory drugs, or steroids in the previous 3 months; – severe systemic disease that could compro- mise the conduct of the study; – untreated diabetes; – chronic or aggressive periodontitis or other severe oral pathologies; – smoking more than 5 cigarettes a day; and – alcohol or other drug abuse. At the end of the screening procedure, 26 patients were enrolled in the study and randomized into 2 maintenance groups according to the mouth- wash used: (a) a control group (the chlorhexidine group, or C-group, n = 13), in which the patients followed a postoperative home treatment for at least 7 days with a mouthwash containing 0.2% chlorhexidine (Dentosan, Johnson & Johnson, Rome, Italy); and a treatment group (the hydroxy- apatite group, or H-group, n = 13), in which the patients followed a postoperative home treat- ment for at least 7 days with a mouthwash con- taining Zn-nHAp/Zn-PCA (Biorepair, Coswell, Funo, Italy), with a 2.0% w/v concentration of Zn-nHAp and an overall concentration of Zn of 11.0% w/v. Nonabsorbable silk sutures (Sweden & Martina, Due Carrare, Italy) were removed after 10 days from the surgical sites of all of the patients. All sutures were placed and removed by the same skilled operator to eliminate inter- examiner variability. The collected samples were immediately transported to the laboratory and stored at -20 °C until microbiological analysis. All subject randomization was performed by means of a computer program generating random numbers. Oral and written information was given to each enrolled subject. All of the patients enrolled were informed about the study protocol and were asked to sign an informed written consent for participation. This study was carried out according to the ethical principles of the Declaration of Helsinki of 1975, as revised in 2013, for medical research involving human sub- jects. Figure 1 provides a flowchart summarizing the study protocol. Journal of Oral Science & Rehabilitation Volume 3 | Issue 4/2017 25