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Suturing techniques involved in dental surgery

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This was my presentation during Oral Surgery rotation at the University of Detroit Mercy School of Dentistry (UDMSD)

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Suturing techniques involved in dental surgery

  1. 1. Suturing in Dental Surgery Hasanain Alani, 18’ July 21, 2016
  2. 2. Overview • Objectives • Review of suturing materials • Techniques used in Oral Surgery
  3. 3. 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-orally o Achieve functional and esthetic results o Decreasing the potential for postoperative infections occurance
  4. 4. Suture Armamentarium • Needle Holder Suture scissors Adson forceps Suture Needle
  5. 5. 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. • Cutting o Sharp TIP is UPWARD. o Extra sharp tip in is more likely to tear the tissue.
  6. 6. Suture Materials: Thread • Properties o Tensile strength o Biocompatibility o Ease of tying o Least tissue irritation and reaction o Diameter and size o Coefficient of friction • Classification o Origin o Structure o Duration
  7. 7. Durability • Resorbable o Natural • Plain gut • Chromic gut o Synthetic • Polyglycolic acid (PGA) • Poliglecaprone 25 How do sutures resorb? o Antigenic Reaction o Acidic Environment Nonresorbable Silk Polyester Monofilament type ‘nylon’ Polytetrafluoroethylen e (PTFE)
  8. 8. Silk Sutures • This is the most universally used material in dentistry • Advantages: o Inexpensive o Easy to handle and tie • Disadvantages: o It must be removed o It is multifilament • When Should we avoid using silk? And what are the alternatives?
  9. 9. 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)
  10. 10. 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.
  11. 11. 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.
  12. 12. Techniques • Interrupted Suture • Simple Continuous Suture • External Horizontal Mattress Suture • External Vertical Mattress Suture • Figure-of-eight Suture • Criss-cross Suture
  13. 13. 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.
  14. 14. 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.
  15. 15. 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.
  16. 16. 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.
  17. 17. 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.
  18. 18. 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.
  19. 19. 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.
  20. 20. 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.