{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:26:29Z","timestamp":1783445189779,"version":"3.54.6"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of this study was to compare the effectiveness of barbed versus smooth sutures for soft tissue closure of exposed jawbone sites in medication-related osteonecrosis of the jaw (MRONJ) patients. Exposed necrotic jawbone sites surgically managed by intraoral soft tissue closure were evaluated. Either barbed sutures (Stratafix\u2122 or V-Loc\u2122) together with Prolene\u00ae or Vicryl\u00ae sutures were used. We estimated the effect of barbed sutures (BS) with Prolene\u00ae compared to smooth sutures (Vicryl\u00ae) on the hazard rate of intraoral soft tissue dehiscence using a multivariate Cox regression model within a target trial framework, adjusting for relevant confounders. In total, 306 operations were performed in 188 sites. In the primary analysis 182 sites without prior surgery were included. Of these, 113 sites developed a dehiscence during follow-up. 84 sites were operated using BS and Prolene\u00ae. A total of 222 sites were operated with Vicryl\u00ae (control group). In the BS group, the median time to event (i.e., dehiscence) was 148 days (interquartile range (IQR), 42\u2013449 days) compared to 15 days (IQR, 12\u201352 days) in the control group. The hazard rate of developing intraoral dehiscence was 0.03 times (95%-confidence interval (CI): 0.01; 0.14, p &lt; 0.001) lower for BS patients compared to the control group. Within the limits of a retrospective study, BS showed a high success rate and are therefore recommended for soft tissue closure of exposed jawbone sites in MRONJ patients. Additional studies are warranted to further evaluate this novel application of BS.<\/jats:p>","DOI":"10.3390\/jcm10081677","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T04:21:08Z","timestamp":1618374068000},"page":"1677","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["New Perspective for Soft Tissue Closure in Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Barbed Sutures"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6913-5059","authenticated-orcid":false,"given":"Johannes","family":"Laimer","sequence":"first","affiliation":[{"name":"University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Hechenberger","sequence":"additional","affiliation":[{"name":"University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna Maria","family":"Lercher","sequence":"additional","affiliation":[{"name":"University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Born","sequence":"additional","affiliation":[{"name":"University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-0591","authenticated-orcid":false,"given":"Michael","family":"Schomaker","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall in Tirol, Austria"},{"name":"Centre for Infectious Disease Epidemiology and Research, University of Cape Town, 7550 Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0591-7067","authenticated-orcid":false,"given":"Sibylle","family":"Puntscher","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall in Tirol, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT\u2014University for Health Sciences, Medical Informatics and Technology, A-6060 Hall in Tirol, Austria"},{"name":"Center for Health Decision Science, Departments of Epidemiology and Health Policy &amp; Management, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA"},{"name":"Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7154-5735","authenticated-orcid":false,"given":"Emanuel","family":"Bruckmoser","sequence":"additional","affiliation":[{"name":"Private Practice for Oral and Maxillofacial Surgery, A-5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.joms.2014.04.031","article-title":"American Association of Oral and Maxillofacial Surgeons American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related Osteonecrosis of the Jaw\u20142014 Update","volume":"72","author":"Ruggiero","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s11657-020-00761-0","article-title":"Therapeutic Approach and Management Algorithms in Medication-Related Osteonecrosis of the Jaw (MONJ): Recommendations of a Multidisciplinary Group of Experts","volume":"15","author":"Chalem","year":"2020","journal-title":"Arch. Osteoporos"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/S0278-2391(03)00720-1","article-title":"Pamidronate (Aredia) and Zoledronate (Zometa) Induced Avascular Necrosis of the Jaws: A Growing Epidemic","volume":"61","author":"Marx","year":"2003","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.cden.2007.09.002","article-title":"Biophosphonate-Related Osteonecrosis of the Jaws","volume":"52","author":"Ruggiero","year":"2008","journal-title":"Dent. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.oooo.2012.08.439","article-title":"The Relationship of Denosumab Pharmacology and Osteonecrosis of the Jaws","volume":"114","author":"Malan","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_6","first-page":"c85","article-title":"Physiology and Pharmacology of Nonbisphosphonate Drugs Implicated in Osteonecrosis of the Jaw","volume":"78","author":"Troeltzsch","year":"2012","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1080\/08869634.2016.1211812","article-title":"Goodbye BRONJ\u2026 Hello MRONJ","volume":"34","author":"Weeda","year":"2016","journal-title":"Cranio"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Moraschini, V., Calasans-Maia, M.D., Louro, R.S., Arantes, E.B.R., and Jos\u00e9 de Albuquerque, C.-M. (2020). Weak Evidence for the Management of Medication-Related Osteonecrosis of the Jaw: An Overview of Systematic Reviews and Meta-Analyses. J. Oral Pathol. Med.","DOI":"10.1111\/jop.13083"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.oooo.2018.09.008","article-title":"Medication-Related Osteonecrosis of the Jaw: Definition and Best Practice for Prevention, Diagnosis, and Treatment","volume":"127","author":"Mendes","year":"2019","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_10","first-page":"e302","article-title":"Surgical Treatment vs. Conservative Treatment in Intravenous Bisphosphonate-Related Osteonecrosis of the Jaws. Systematic Review","volume":"9","author":"Figueiredo","year":"2017","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1007\/s00520-017-4003-2","article-title":"A Multicenter Case Registry Study on Medication-Related Osteonecrosis of the Jaw in Patients with Advanced Cancer","volume":"26","author":"Schiodt","year":"2018","journal-title":"Support Care Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.oraloncology.2011.02.024","article-title":"Long-Term Outcomes of Surgical Resection of the Jaws in Cancer Patients with Bisphosphonate-Related Osteonecrosis","volume":"47","author":"Bedogni","year":"2011","journal-title":"Oral Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10006-015-0538-x","article-title":"Surgical Management of Bisphosphonate-Related Osteonecrosis of the Jaws: Literature Review","volume":"20","author":"Silva","year":"2016","journal-title":"Oral Maxillofac Surg."},{"key":"ref_14","first-page":"2313","article-title":"Surgical Management of Bisphosphonate-Related Osteonecrosis of the Jaw in Oncologic Patients: A Challenging Problem","volume":"31","author":"Eckardt","year":"2011","journal-title":"Anticancer Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"12S","DOI":"10.1177\/1090820X13498505","article-title":"The History of Barbed Sutures","volume":"33","author":"Ruff","year":"2013","journal-title":"Aesthet Surg. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1002\/jbm.a.35683","article-title":"Suture Materials\u2014Current and Emerging Trends","volume":"104","author":"Dennis","year":"2016","journal-title":"J. Biomed. Mater. Res. A"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.jbiomech.2009.11.012","article-title":"Finite Element Analysis of Barbed Sutures in Skin and Tendon Tissues","volume":"43","author":"Ingle","year":"2010","journal-title":"J. Biomech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.cps.2015.06.003","article-title":"Clinical Applications of Barbed Suture in Aesthetic Breast Surgery","volume":"42","author":"Mitchell","year":"2015","journal-title":"Clin. Plast Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1177\/0194599814551541","article-title":"Correction of Protruding Ears (Weerda Grade I Deformity) Using Knotless Bidirectional Barbed Absorbable Sutures","volume":"151","year":"2014","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"72S","DOI":"10.1177\/1090820X13499915","article-title":"The Application of Barbed Sutures in Body Contouring Surgery","volume":"33","author":"Shermak","year":"2013","journal-title":"Aesthet Surg. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1473-2165.2010.00495.x","article-title":"Barbed Sutures \u201cLunch Time\u201d Lifting: Evidence-Based Efficacy","volume":"9","author":"Atiyeh","year":"2010","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_22","first-page":"5","article-title":"Reduction of Face and Neck Laxity with Anchored, Barbed Polypropylene Sutures (Contour Threads)","volume":"11","author":"Horne","year":"2006","journal-title":"Skin Therapy Lett."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s11325-020-02088-z","article-title":"Different Barbed Pharyngoplasty Techniques for Retropalatal Collapse in Obstructive Sleep Apnea Patients: A Systematic Review","volume":"24","author":"Moffa","year":"2020","journal-title":"Sleep Breath"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1007\/s00402-018-2979-9","article-title":"The Efficacy and Safety of Knotless Barbed Sutures in Total Joint Arthroplasty: A Meta-Analysis of Randomized-Controlled Trials","volume":"138","author":"Han","year":"2018","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"19764","DOI":"10.1038\/srep19764","article-title":"Barbed versus Traditional Sutures for Wound Closure in Knee Arthroplasty: A Systematic Review and Meta-Analysis","volume":"6","author":"Zhang","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"666e","DOI":"10.1097\/PRS.0000000000002573","article-title":"Biomechanical Analysis of Barbed Suture in Flexor Tendon Repair versus Conventional Method: Systematic Review and Meta-Analysis","volume":"138","author":"Shin","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s11552-014-9669-z","article-title":"Barbed Sutures and Tendon Repair\u2014A Review","volume":"10","author":"Shah","year":"2015","journal-title":"Hand (N. Y.)"},{"key":"ref_28","first-page":"185","article-title":"Barbed Sutures in Minimally Invasive Gynecologic Surgery","volume":"28","author":"Mikhail","year":"2016","journal-title":"Surg. Technol. Int."},{"key":"ref_29","first-page":"161","article-title":"An Update on the Use of Barbed Suture in Minimally Invasive Gynecological Surgery (MIGS)","volume":"28","author":"Kondrup","year":"2016","journal-title":"Surg. Technol. Int."},{"key":"ref_30","first-page":"39","article-title":"Robotic-Assisted Radical Prostatectomy with the Use of Barbed Sutures","volume":"30","author":"Porreca","year":"2017","journal-title":"Surg. Technol. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.kjms.2016.12.005","article-title":"Efficacy and Safety of Barbed Suture in Minimally Invasive Radical Prostatectomy: A Systematic Review and Meta-Analysis","volume":"33","author":"Lin","year":"2017","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_32","first-page":"65","article-title":"Barbed Sutures in General and Digestive Surgery. Review","volume":"94","year":"2016","journal-title":"Cir. Esp."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1093\/aje\/kwz100","article-title":"Effect Estimates in Randomized Trials and Observational Studies: Comparing Apples With Apples","volume":"188","author":"Lodi","year":"2019","journal-title":"Am. J. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1093\/aje\/kwz194","article-title":"Re: \u201cEffect estimates in randomized trials and observational studies: Comparing apples with apples\u201d","volume":"189","author":"Schomaker","year":"2020","journal-title":"Am. J. Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"616","DOI":"10.2105\/AJPH.2018.304337","article-title":"The C-Word: Scientific Euphemisms Do Not Improve Causal Inference From Observational Data","volume":"108","year":"2018","journal-title":"Am. J. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7","DOI":"10.2202\/1557-4679.1203","article-title":"An Introduction to Causal Inference","volume":"6","author":"Pearl","year":"2010","journal-title":"Int. J. Biostat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.jcms.2018.03.005","article-title":"Double-Layer Closure Techniques after Bone Surgery of Medication-Related Osteonecrosis of the Jaw\u2014A Single Center Cohort Study","volume":"46","author":"Ristow","year":"2018","journal-title":"J. Craniomaxillofac Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jcms.2020.07.012","article-title":"Surgical Treatment of Advanced Medication-Related Osteonecrosis of the Jaws: Comparison of Soft Tissue Closure Techniques and Evaluation of Side Effects","volume":"48","author":"Ahrenbog","year":"2020","journal-title":"J. Craniomaxillofac Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1136\/jech.2004.029496","article-title":"Estimating Causal Effects from Epidemiological Data","volume":"60","author":"Robins","year":"2006","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not Available","volume":"183","author":"Robins","year":"2016","journal-title":"Am. J. Epidemiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/8\/1677\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:47:46Z","timestamp":1760161666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/8\/1677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,14]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["jcm10081677"],"URL":"https:\/\/doi.org\/10.3390\/jcm10081677","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,14]]}}}