suturing techniques involved in dental surgery
TRANSCRIPT
What is Suturing?• The primary objective is to position
and secure surgical flaps to promote optimal healing.
• When performed properly, healing by primary intention occurs.
• Performed intra- and extra-orallyoAchieve functional and esthetic
resultsoDecreasing the potential for
postoperative infections occurance
Suture Materials: Needle
A surgical needle has 3 parts: the needle point, the needle body, and the swaged (press-fit) end The most commonly used are the 3/8 and ½ circle needles.
The common shapes:• ROUND
o Less traumatic than the other two, requires more force
• REVERSE CUTTING: o The sharp TIP is DOWNWARD. o More safe when working in delicate tissue.
• Cuttingo Sharp TIP is UPWARD. o Extra sharp tip in is more likely to tear the tissue.
Suture Materials: Thread
• Propertieso Tensile strengtho Biocompatibilityo Ease of tyingo Least tissue irritation and reactiono Diameter and sizeo Coefficient of friction
• Classificationo Origino Structureo Duration
Durability• Resorbable
o Natural• Plain gut• Chromic gut
o Synthetic• Polyglycolic acid (PGA)• Poliglecaprone 25
How do sutures resorb?o Antigenic Reactiono Acidic Environment
NonresorbableSilkPolyester
Monofilament type ‘nylon’Polytetrafluoroethylene (PTFE)
Silk Sutures• This is the most universally used material in
dentistry
• Advantages:o Inexpensiveo Easy to handle and tie
• Disadvantages:o It must be removedo It is multifilament
• When Should we avoid using silk? And what are the alternatives?
Example• Patient diagnosed with bulimia presented to
OS clinic for #30 extraction, and it was determined that the flap edges need to be positioned by sutures.
• What is the minimum coaptation time for tissue flaps?
• Synthetic vs Organic thread?
• Fast Absorbing Polyglycolic Acid (PGA-FA)
Diameter• Thread materials range in diameter from 1
to 10, and the higher number corresponds to the thinner, more delicate thread.
• periodontal plastic surgery: 5–0 for soft tissue grafts, 4-0 mucoperiosteal grafts and implants surgery.
Knots• Art of suturing!• An appropriate type of
know should be used for the specific suture material
• Slip knot: used with silk, chromic or plain gut suture
• Surgeon’s knot: used with synthetic resorbable and other nonresorbable synthetic suture materials to prevent untimely knot untying.
Techniques• Interrupted Suture• Simple Continuous Suture• External Horizontal Mattress Suture• External Vertical Mattress Suture• Figure-of-eight Suture• Criss-cross Suture
Interrupted Suture• Do the pass technique, two loops
around the needle holder, then grab the tail and do the knot.
• Indications: Single tooth extraction, third molar extraction flap, biopsies, implants, ..etc.
• Advantages: It is the most commonly used technique, preferred in urgent situations and it is easy to remove. Failure of one is inconsequential of the others.
• Disadvantages: It does not bring all surfaces into contact and less supportive for healing of the flap margins.
Simple Continuous Suture
• Start it with simple interrupted suture• Then you cut the tail off and leave that last
piece loose then you can do your loops.
• Indications: Bone graft, removal of mandibular tori, tuberosity reduction and where esthetics are not important
• Advantages: It is very easy to produce and offers a more water tight closure
• Disadvantages: if you cut one part of it, you lost all of it.
Horizontal Mattress Suture
• The strongest type of sutures, very far away (8 mm from the edge)
• Indications: large distances between tissues, bone grafts and implants, and closure of extraction socket.
• Advantages: Good for hemostasis, less prominent scarring.
• Disadvantages: Leave a gap between flaps and it is difficult to remove.
Vertical Mattress Suture
• The far far, near near technique.
• Indications: where the wound edges tend to evert
• Advantages: greater closure strength and better distribution of wound tension
• Disadvantages: Scar formation and the formation of edge necrosis.
Figure of 8 sutures• Pattern goes 1-2-3-4-1
• Indication: Extraction socket closure, adaptation of ginigival papilla around the tooth, and bone graft placement in socket
• Advantages: Rapid closure• Disadvantages: Due to its orientation, it is difficult to
remove and it leaves a significant amount of suture threads inside the socket.
General Principles• 1- Grasp the needle 2/3 front, and 1/3 behind
the needle driver.• 2- The needle should pass perpendicular to the
tissue• 3- The needle should pass at an equal depth
and distance on both sides of the wound• 4- Pass from the thinner to the thicker tissue• 5- The suture should never be closed under
tension (no blanch).• 6- The knot should be placed at 2-3 mm from
the incision• 7- Suture should pass over the dental papilla,
not the empty socket.
Conclusion• Due to the daily surgical procedures carried
by dentists, a greater knowledge of suturing armamentarium and materials and is needed.
• The success of technique-sensitive surgeries depends on the clinician’s knowledge and skills to close the wound and achieve optimal healing
• The innovations in suturing materials decrease the potential for postoperative infections.
Refrences• 1- Silverstein, Lee H., Gregori M. Kurtzman,
and Peter C. Shatz. "Suturing for optimal soft-tissue management." Journal of Oral Implantology 35.2 (2009): 82-90.
• 2- Chu, Chih-Chang, J. Anthony Von Fraunhofer, and Howard P. Greisler, eds.Wound closure biomaterials and devices. CRC Press, 1996.
• 3- Int J Periodontics Restorative Dent. 1998 Oct;18(5):474-87. Oral tissue reactions to suture materials.Selvig KA(1), Biagiotti GR, Leknes KN, Wikesjö UM.