SUTURING INSTRUMENTS

During extraction, soft tissues may Suturing Kit

be intentionally or inadvertently
Needle Holder
compromised
Scissors
Suturing is common after extraction
of multiple teeth or surgical Tissue Forceps
extraction
Suture Needle
Or where good wound closure or
haemostasis is critical Suture Material
Image Source: Adobe Stock
NEEDLE HOLDER

Locking handle with short, blunt beak

15-cm needle holder is recommended for

intraoral sutures 

Features:

Finger-ring handle design, for easy Image Source: Hupp et al., 2019
manoeuvrability in oral cavity

Ratchet, to allow instrument to keep a fixed

suture needle position without application of
force

Cross-hatched working surface, to allow holding

of suture needle across range of angulations
Image Source: Delphachitra et al., 2021
NEEDLE HOLDER ERROR

Error is using artery forceps instead to avoid

additional cost of purchasing a needle holder

Dangerous, as artery forceps do not provide

sufficient grip or control of suture needle

Beaks of needle holder are shorter and stronger

than beaks of a hemostat

Face of shorter beak of needle holder is cross-

hatched to permit a positive grasp of suture
needle

Hemostat has parallel grooves on face of beaks,

thereby decreasing control over needle

Image Source: Hupp et al., 2019

HOLDING NEEDLE HOLDER

Control locking handles properly and must

hold in proper fashion

Thumb and ring finger inserted through

rings

Index finger is held along length of needle

holder to steady and direct it

Index finger should not be put through

finger ring as dramatic decrease in control

Image Source: Hupp et al., 2019

TISSUE FORCEPS

Grasping soft tissue to incise it or pass a suture

needle

Adson

In posterior part of mouth, Adson forceps may be

too short

Longer forceps that have a similar shape are the

Gillies forceps

Gillies
Image Source: Hupp et al., 2019
Ideal for oral cavity given their straight profile,
small size, narrow jaws, and cross-serrated tips

Have teeth that can hold and grip smooth and

often lubricated periodontal tissues
SCISSORS

No particular scissor designed for suture cutting in

oral cavity

Scissor should have sufficient handle length to

access posterior oral cavity

Short blades to avoid inadvertent damage to oral

tissues, and slight curve in blade to facilitate
visualisation 

Commonly used are Dean scissors

Slightly curved handles and serrated blades make

cutting easier
Image Source: Hupp et al., 2019
KEY COMPONENTS OF A SUTURE NEEDLE

Needle tip

Body

Swage

Suture material

HOLDING NEEDLE

Needle tip must not be held with needle holders as this

will blunt suture 

Body of needle is where suture should be held,

approximately 2/3rds of distance from needle tip

Swage area is where material has been fastened to

Image Source: Unknown Textbook
needle = weak area so avoid holding in this location 
NEEDLE CLASSIFICATION

Curvature

• 3/8 circle commonly used in oral cavity 

Length

• A wide variety of lengths available

• 19 mm is a common length intraorally

Needle Tip

• Reverse cutting is preferred

Image Source: Ethicon Inc, 1993

CONVENTIONAL CUTTING

Cutting point is inside needle and other two points

of triangle are on outside surface of curvature of
needle and are blunt

Advantage - easier to place in thicker tissue, but

higher risk of suture tearing 

REVERSE CUTTING

Cutting point is on outside of curve of needle and

other two points of triangle are on inside curve of
needle and are blunt

Advantage - less likely to cut out, but needle more Image Source: Ethicon Inc, 1993
difficult to use as blade is on outside of needle and
any stray movement will cut into tissue
SUTURE MATERIAL

Wide variety of materials

Largely dependent on surgeon preference

Each characteristic has significant effect

on intraoperative handling and
postoperative healing

CLASSIFICATION:

Type of material (synthetic versus natural)

Ability to be resorbed by the tissues

Structure (monofilament versus braided)

Table Source: Delphachitra et al. 2019
ABSORBABLE
NON-ABSORBABLE
Avoids need for removal, mechanism by proteolytic
Where aesthetics is a primary concern e.g.
enzyme digestion
skin to minimise scarring, extra-oral such as
Mild inflammatory reaction, intraorally minimum or no vermillion
scarring, softer, more flexible
When longer retention is essential e.g.
Natural placing a drain which is to be removed within
a week
Cat-gut and Chromic cat- gut
Natural
Composed of purified connective tissue (mostly collagen)
• Silk (consisting of a protein called fibroin)
Derived from the submucosal layer of sheep intestines
Synthetic
Synthetic
•Nylon/Polyamide (Ethilon)
Polyglactin 910 eg. Vicryl • Polyglycolic acid eg. Dexon 
• Polypropylene (Prolene)
VARIATIONS IN SUTURE MATERIALS

Chemically Altered

Change reabsorption rate e.g Vicryl takes 28 days, Vicryl Rapid takes 14
days

Treated with chromate ions (e.g. Chromic gut),  delays reabsorption rate,
decreases tissue reaction 

Dying to change colour

Enhances visibility in blood filled environment (e.g. Vicryl and Dexon)

Undyed materials are used where aesthetics are a concern

Antibacterial Agents

Added to coatings and labelled “PLUS” e.g. Vicryl Plus

Image Source: Ethicon
BRAIDED VS. MONOFILAMENTS

Braided e.g vicryl and silk

Gives strength (used for absorbable material)

Increases risk of bacterial adhesion to outer surface

Increased infection and inflammatory response

Result in more scarring, therefore not desirable on skin surfaces

More tissue reaction, easier to handle, less knots needed

Monofilaments e.g nylon and prolene

Minimal tissue trauma, more knots needed

Image Source: Ethicon Inc
Minimal tissue reaction, ideal properties for skin
 0:00

SUTURE SIZE

Refers to diameter of suture material

Numbers followed by a 0 indicates

progressively smaller size • e.g. 2-0,
3-0, 4-0, 5-0, 6-0, etc.

Most commonly used intraoral sizes

are 3-0 or 4-0

Based on an old fashioned method,

metric equavalent available but not Image Source: Ethicon Inc
used