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
 Suture Armamentarium
• Needle Holder Suture scissors

Adson forceps Suture Needle

 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
o The sharp TIP is DOWNWARD.
• REVERSE CUTTING:
o More safe when working in delicate tissue.
• Cutting
o Sharp TIP is UPWARD.
Extra sharp tip in is more likely to tear the tissue.
o
 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
 Durability
• Resorbable Nonresorbable
o Natural Silk
• Plain gut Polyester
• Chromic gut Monofilament type
o Synthetic ‘nylon’
• Polyglycolic acid (PGA) Polytetrafluoroethylen
• Poliglecaprone 25 e (PTFE)

How do sutures resorb?

o Antigenic Reaction
o Acidic Environment
 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?
 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
 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.
 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.