A Review of Dental Suturing for Optimal Soft-Tissue Management

CE 1Figure 5—Diagramof apically repositionedvertical mattresssuture technique.Figure 6—Diagramof vertical sling mattresssuture technique,which is usedfor predictable interdentalclosure followingan interdental/interimplantboneregenerative procedure.Figure 7—Clinical photograph illustrating a sling suture in themaxillary anterior region following the placement of a connectivetissue graft over a dental implant to soft tissue root convexity.silk, there are other nonabsorbable sutures thatcan be used in these situations, such as nylon,p o l y e s t e r, polyethylene, polypropylene, orexpanded polytetrafluoroethylene (e-PTFE).Polyester sutures are comprised of multifilamentsthat are braided into a single strand.This suture is made of a polyethylene polymerand does not weaken when moistened and hasa lot of tensile strength. The polyester suturesare usually coated with a biologically inert n o n-absorbable compound, which aids the suture inpassing more easily through tissues. This coating,h o w e v e r, does present a problem in that it alsomakes knot security an issue because the materialwill easily untie if not secured with a surgeon’sk n o t . 4 The e-PTFE suture material is a nonabsorbablemonofilament that has high tensilestrength, good handling properties, and goodknot security, but is expensive compared with allthe other nonresorbable suture materials. 1NeedlesAside from the thread type, the otherimportant component of a suture is the needle.The surgical needle is comprised of 3 parts: theneedle point, the needle bod y, and the swaged(press-fit) end. Suture needles usually are classifiedaccording to their curvature, radius, andshape. The most commonly used suture needlesin dentistry are the 3/8 and 1/2 circle needles. 3 , 4The 3/8 needle allows the clinician to pass fromthe buccal surface to the lingual surface in onemotion. In contrast, the 1/2 circle needle is traditionallyused in more restricted areas; forinstance, in the buccal of the maxillary molarsand the facial aspect of the maxillary andmandibular incisors. In addition, the 1/2 circleneedle is routinely used for periosteal andmucogingival surgery. 1 - 4Suture needles also are classified as eitherconventional cutting or reverse cutting. 5 I nd e n t i s t r y, the clinician always should usereverse cutting sutures to prevent the suturematerial from tearing through the papillae orsurgical flap edges, which is referred to as “cutout.” Usually, a cut out is caused by a conventionalsuture needle because it has an insideconcave curvature that is sharpened, whereas areverse cutting needle has a smooth inner curvatureand its third cutting edge is located onits convex (outer) edge. 4 Generally in dentistry,the 3/8 reverse cutting needle with a 3-0 or 4-0thread diameter and the 1/2 reverse cuttingneedle with the thinner and more delicate 5-0or 6-0 thread diameter are the most commonlyused needle and thread combinations, accordingto the author’s private communicationswith suture manufacturers.KnotsSurgical knot tying is an important componentto the art of suturing. It is essential for knotsecurity and to obviate untimely knot untyingthat the appropriate surgical knot be used for thespecific suture material being secured. Forinstance, when using silk, e-PTFE, chromic gut,or plain gut suture material, a slip (granny) surgicalknot should be used. However, with the166 Compendium / March 2005 Vol. 26, No. 3