NAN 561

Material used in suturing in oral surgery

By: Mai Riyadh

ID:201717034
Dr.Ibtihag Mohamed Nour
 Definitions:

Suture material is an artificial fibre used to keep wound together until

they hold sufficiently well by themselves by natural fibre (collagen),
which is synthesized and woven into a stronger scar
Goals:

1. Provide an adequate tension of wound closure without dead space but loose enough to obviate
tissue ischemia and necrosis
2. Maintain hemostasis.
3. Permit primary intention healing.
4. Provide support for tissue margins until they have healed and the support is no longer needed.
5. Reduce postoperative pain.
6. Prevent bone exposure resulting in delayed healing and unnecessary resorption

 Requisites for suture material :

1. High uniform tensile strength, permitting use of ner sizes.

2. High tensile strength retention in vivo, holding the wound securely throughout the critical healing
period, followed by rapid absorption.
3. Sterile.
4. Pliable for ease of handling and knot security.
5. Freedom from irritating substances or impurities for optimum tissue acceptance.
6. Predictable performance.
7. Prevent or limit bacterial adhesion and proliferation.
8. Uniform diameter.
9. No carcinogenic.
10.Biologically inactive.

With the possible exception of coated Vicryl, none of the sutures available today meet these
criteria.

fi

 Principal of suture selection:

The selection of a suture material by a surgeon must be based on a sound

knowledge of the:

1. Healing characteristics of the tissues, which are to approximated.

2. The physical and biological properties of the suture materials.
3. The condition of the wound to be closed.

The ideal suture:

1. It can be utilized in any operation.

2. It can be handled easily and comfortably.
3. Minimal tissue reaction.
4. High breaking strength.
5. High knot security.
6. It does not cut, tear or shrink the tissue.
7. It is non-allergenic, non-carcinogenic
8. It is absorbed predictably with no tissue reaction

The physical configuration:

1. Mono-filamentous or multi-filamentous.

2. Twisted or braided.

• Absorbable Sutures
Popular in periodontal and implant surgeries, less postoperative
inflammation, more patient’s comfort and it is available in
two forms natural or synthetic.

• Non-absorbable Sutures
. Materials suitably resistant to the action of living mammalian tissues.Treated
for capillarity (the passage of tissue fluid along the strand permitting
infection) .patient’s discomfort and available in two form natural and synthetic.

 RESOURCES

● Vital signs are an important objective indication of the

patient's overall physical condition.
● The accuracy of obtaining and recording vital sign
measurements is critical for the diagnosis and treatment of
the patient.
 • Selection Sutures material

A variety of suture materials and suture/needle combinations Selection of suture material

are available. choice of suture for a particular procedure is based on the known
physical and biologic characteristics of the suture material and the healing properties
of the sutured tissues. The selection of suture material is based on: The condition of the
wound, the tissues to be repaired, the tensile strength of the suture material, knot-
holding characteristics of the suture material, and the reaction of surrounding tissues

 Sutures Needles
Surgical needles are designed to lead suture material through Suture Needles tissue
with minimal injury. Needles can be:

a. Straight (limited use in oral surgery) or curved (Figure 3).

b. Swaged or eyed. Made up of either SS or carbon steel.

 surgical needle has 3 parts:

The needle point, The needle body & the swaged (press-fit) end The most
commonly used are the 3/8 & ½ circle needles

The common shapes:

1-Round Needle :
o Less traumatic than the other two, requires more force

2-Reverse Cutting
The sharp Cross-sectional TIP is DOWNWARD
More safe when working in delicate tissue

3-Cutting Needle:
• Sharp Cross-sectional TIP is UPWARD.
• Extra sharp tip in is more likely to tear the tissue
 Sutures instruments

Some of the suturing instruments like scissors, tissue

forceps and needle holder .

The Most Used Suturing Techniques in Oral Cavity

• Simple Interrupted Suture

• Simple Continuous Suture
• Horizontal Mattress Suture
• Vertical Mattress Suture
• Figure-of-eight Suture

 Simple Interrupted Sutures

Indications:
Single tooth extraction, 3rd molar extraction flap, Biopsy, Implants, Minor oral surgery,
…..etc
Advantages:
• It is the most commonly used technique,
• Preferred in urgent situations
• It is easy to remove
• Failure of one is inconsequential of the other sutures
Disadvantages:
• It does not bring all surfaces into contact o Less supportive for healing of the flap margins

 Simple Continuous Sutures

Indications:
Bone graft, Removal of mandibular tori, Tuberosity reduction & where esthetics
are not important
Advantages:
• It is very easy to produce or perform
• Offers a more water tight closure

Disadvantages:
• If you cut one part of it, you lost all of it.

 Horizontal Mattress Sutures

The strongest type of sutures, very far away from margin (8 mm from edge)

Indications:
• Large distances between tissues
• Bone grafts & implants
• Closure of extraction socket in Bleeding situations
Advantages:
• Good for hemostasis,
• Less prominent scarring
Disadvantages:
• It leaves a gap between flaps
• It is difficult to remove

 Vertical Mattress Sutures

The far far, near near technique

Indications:
• Where the wound edges tend to evert
• Areas of Tension in Extra oral & non esthetic areas
Advantages:
• Greater closure strength of wound margins
• 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

Indications:
• Bleeding socket closure ( Very useful )
• Adaptation of gingival papilla around the tooth
• Bone graft placement in socket

Advantages:
• Rapid method to close the socket
Disadvantages:
• Due to its orientation, it is difficult to remove
• It leaves a significant amount of suture threads inside the socket

References:
1- Miguel GS Andrade, Ruben Weissman, Sílvia RA Reis (2005) Tissue
Reaction and Surface Morphology of Absorbable Sutures after In Vivo
Exposure. Journal of Material Science: Material Medicine 17(10): 949-
961.

2-Contemporary Oral & maxillofacial surgery 6th

Edition by James Hupp, Edward Ellis III &
Myron Tucker