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FlapsandSuturingforRoutineExodontia
Dr. Karl Koerner
FlapsUsefulforGeneralDentists
Cervical(severgingivalfibersbutnoreflection)Mini(formostsingleextractions)Envelope (formultipleextractions)
TriangularSemilunar
Straightor“surgical”highspeed.
Cervicalreflection.
Flap#1.Cervical.Fiberscutwitha15cblade(or11or12)oreventhetipofaLuxator.NoPEneededunlessyouusea700intothePDL.
Flap#2.MiniflapMadewithaPE,exposingenoughbonetoplaceforcep beaktobone.Suturepapillaewhendone.
Flap#3.Envelope.1)Buccalplateboneremovalnotadvisedasshowninprinthere.2)Cryertoobig.shouldhavebeenthe“miniCryer”.
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Triangularflap,asoftenusedtoremovedeeperimpactedthirdmolars.
Eitherhandpiece canbeusedfororalsurgery-- aslongasthehighspeed isa”surgical”one.
Flap#4.Triangular.Angledrelease- onetoothaway fromtheoneworkedon.
Whathappenswhenyou“slip”withaLuxatororelevator?
Facialartery
SlippedIntoMBF
Preventsslipping.
Triangularflap
Flap#5.Trapezoidal.Atrapezoidalflapwouldinvolvea2nd releaseontheotherside.(Notcommonlydone.Oneexamplecouldbewithsinuslateralwindowflaps.)
SuturingIdeasUsefulinGenenal Practice
RegularInterrupted
“X”Suture(sometimescalledfigure-of-eight)
HorizontalMattress
CrossHorizontalMattress
Continuous-lock
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References.Startingwithalongertailasanoptionthatis
madeshorterbeforetheknotistied.
Dr.Silverstein’sRuleof3s.
• Needlepenetrates3mmfromtheedgeofthewoundoratthebaseofapapilla.• Suturesalonganincisionare3mmfromeachother.• Whentheassistantcutsthethread,itiscut3mmfromtheknot.• Surgeon’sknotis3timesaroundtheneedleholder(firstoneisdouble).Eachtime,thedirectionchanges.
RegularinterruptedSuture(1st type).
Suturingareleasingincision.Needleentersfromthe“loose”side.Ifthefixedsidetears(lesslikelywitha½circleneedleeventhougha3/8circleisgenerallybetterforexodontia)thenyoucanhelpbyliftingupthefixedsideslightly.Knotonthe“fixed”side.
Needlegoesfromflaptofixedside.
Onlyifthefixedsideistearing,dothis. Knotonthefixedside.
ReverseInterruptedSuture(3rd type).Doesn’tsnagthemembranewithagraft.Knotonthetop.
Advantages:Betterforbonegraftswith
membranes.
Lingual
Knotontop.
Buccal
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Somenotes:
• 3/8circleneedleisbetterforexodontia.• Longerstretchtothelingual.
• Reversecuttingislesstraumatictotissuethana“cutting”needle.• Hemostatsshouldneverbeusedtotiesutures,onlyneedleholders(drivers).• Chromicgutiscommonforexodontia.Tensilestrengthfor5daysandresorbable.• Plaingutkeepsstrengthforonly1-2days.• 3.0or4.0arecommonlyused.
“X”Suture.TheXisontopofthesofttissueallowingforbetterhemostasis.
Advantages:Fastandeasy.
Buccal
HorizontalMattress.Easytoplace.
Advantages:Cansometimesactinplaceoftwointerruptedsutures,especiallyforasmallersocket.
Cocero,N,etal.BleedingrateduringoralsurgeryOforalanticoagulanttherapypatientswithassociatedsystemicpathologicentities:Aprospectivestudyofmorethan500extractions.JOralMaxiiolfac Surg.72:858-867,2014.
Examplesofusingahorizontalmattressforexodontia.
CrossHorizontalMattress.CanrestonahemostaticagentORonamembrane.
Advantages:Helpskeepaproductaddedtothesocketinplace.Mayneedinterrupteds onmesialanddistal.
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Manydentalsuturevideos.
The End
