A Review of Dental Suturing for Optimal Soft-Tissue Management
A Review of Dental Suturing for Optimal Soft-Tissue Management A Review of Dental Suturing for Optimal Soft-Tissue Management
CE 1knowledge with regard to the various types ofsuturing armamentarium available to assist inobtaining optimal wound closure. The successof technique-sensitive procedures such as conventionalperiodontal therapy, dental implanttherapy, mucogingival microsurgery, periodontalcosmetic plastic surgery, regeneration ofhard and/or soft tissue, and excisional treatmentof pathologic tissue depends on the clinician’sknowledge and skill of executing propersuturing for optimal wound closure.The recent innovations in suturing materialsnot only eliminate some of the difficultiespreviously encountered during surgicalclosure, but also decrease the potential forpostoperative infections.AcknowledgmentSpecial thanks to David Kurtzman, DDS, acosmetic dentist located in Marietta, Georgia,for his beautiful illustrations.References1. Silverstein LH. Essential principles of dental suturing for theimplant surgeon. Dent Implantol Update. 2005;16(1):1-7.2. Silverstein LH. Suture selection for optimal flap closureand tissue healing. Perio-implant showcase. Pract PerioAesthet Dent. 2005;16:2-3.3. Cohen ES. Sutures and suturing. In: Atlas of CosmeticReconstructive Periodontal Surgery. 2nd ed. Philadelphia:Lea & Febiger; 1994:9-30.4. Silverstein LH. Principles of Dental Suturing: The CompleteGuide to Surgical Closure. Mahwah, NJ: Montage Media;1999.5. Wound Closure Manual, Somerville, NJ: Ethicon Inc;1985:1-101.6. Lilly GE, Salem JE, Armstrong JH, et al. Reaction of oraltissues to suture materials. 3. Oral Surg Oral Med OralPathol. 1969;28:432-438.7. Meyer RB, Antonin CJ. A review of suture materials, partI. Compend Contin Educ Dent. 1989;10:260-264.8. Macht SD, Krizek TJ. Sutures and suturing—current concepts.J Oral Surg. 1978;36:710-712.9. Manor A, Kaffe I. Unusual foreign body reaction to a braidedsilk suture: a case report. J Periodontol. 1 9 8 1 ; 5 3 : 8 6 - 8 8 .10. Mejias JE, Griffin TJ. The absorbable synthetic sutures.Compend Cont Educ Dent. 1983;4:567-572.11. Hutchens LH. Periodontal suturing: a review of needles,materials and techniques. Postgrad Dent. 1995;2(4):1-15.168 Compendium / March 2005 Vol. 26, No. 3
Quiz11. When proper suture techniqueis used with the appropriatethread type and diameter, tensionis placed on the woundmargins so:a. primary intention healingoccurs.b. secondary intention healingoccurs.c. tertiary intention healingoccurs.d. the knot is directly over theincision.2. In those circumstances inwhich the intraoral tissues mostlikely will never regain theirpreoperative strength, the clinicianshould consider using asuture material that retainslong-term strength for up to:a. 7 days.b. 14 days.c. 21 days.d. 28 days.3. If a suture is to be placed in atissue that heals rapidly, theclinician should select aresorbable suture that will loseits tensile strength at:a. 7 days.b. 14 days.c. 21 days.d. about the same rate that thetissue gains strength.4. Sutures of biologic origin are:a. nonantigenic.b. gradually digested by intraoralenzymes.c. made from human protein.d. easy to tie knots in.5. Surgical gut sutures may breaktoo rapidly to maintain flapapposition, particularly if usedin patients with:a. very low intraoral pH.b. very small flaps.c. large tongues.d. Class III malocclusion.6. The minimum coaptation timefor tissue flaps is approximately:a. 1 day.b. 3 days.c. 5 days.d. 7 days.7. Pulling bacteria and fluids intothe wound site is called:a. repopulating.b. bonding.c. wicking.d. delaminating.8. A cut out is caused by a conventionalsuture needle becauseit has:a. a very large radius.b. a very small radius.c. an inside concave curvaturethat is sharpened.d. an outside concave curvaturethat is sharpened.9. The type of knot that is usedfor each material is determinedby the mode in which:a. each type of thread is manufactured.b. the attached gingival will beapproximated.c. the unattached gingival willbe approximated.d. oral fluids degrade it.10. When performing a mattresssuture, the needle penetrationthrough the surgical flap shouldbe how far away from the flapedge?a. 1 mm to 2 mmb. 3 mm to 4 mmc. 5 mm to 6 mmd. 8 mm to 10 mmThis article provides 1 hour of CE credit from Ascend Media’s Dental Learning Systems, in association with the University ofSouthern California School of Dentistry and the University of Pennsylvania School of Dental Medicine, representatives of whichhave reviewed the articles in this issue for acceptance. Record your answers on the enclosed answer sheet or submit them on a separatesheet of paper. You may also phone your answers in to (888) 596-4605 or fax them to (703) 404-1801. Be sure to include yourname, address, telephone number, and social security number.Vol. 26, No. 3 Compendium / March 2005169
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Quiz11. When proper suture techniqueis used with the appropriatethread type and diameter, tensionis placed on the woundmargins so:a. primary intention healingoccurs.b. secondary intention healingoccurs.c. tertiary intention healingoccurs.d. the knot is directly over theincision.2. In those circumstances inwhich the intraoral tissues mostlikely will never regain theirpreoperative strength, the clinicianshould consider using asuture material that retainslong-term strength <strong>for</strong> up to:a. 7 days.b. 14 days.c. 21 days.d. 28 days.3. If a suture is to be placed in atissue that heals rapidly, theclinician should select aresorbable suture that will loseits tensile strength at:a. 7 days.b. 14 days.c. 21 days.d. about the same rate that thetissue gains strength.4. Sutures <strong>of</strong> biologic origin are:a. nonantigenic.b. gradually digested by intraoralenzymes.c. made from human protein.d. easy to tie knots in.5. Surgical gut sutures may breaktoo rapidly to maintain flapapposition, particularly if usedin patients with:a. very low intraoral pH.b. very small flaps.c. large tongues.d. Class III malocclusion.6. The minimum coaptation time<strong>for</strong> tissue flaps is approximately:a. 1 day.b. 3 days.c. 5 days.d. 7 days.7. Pulling bacteria and fluids intothe wound site is called:a. repopulating.b. bonding.c. wicking.d. delaminating.8. A cut out is caused by a conventionalsuture needle becauseit has:a. a very large radius.b. a very small radius.c. an inside concave curvaturethat is sharpened.d. an outside concave curvaturethat is sharpened.9. The type <strong>of</strong> knot that is used<strong>for</strong> each material is determinedby the mode in which:a. each type <strong>of</strong> thread is manufactured.b. the attached gingival will beapproximated.c. the unattached gingival willbe approximated.d. oral fluids degrade it.10. When per<strong>for</strong>ming a mattresssuture, the needle penetrationthrough the surgical flap shouldbe how far away from the flapedge?a. 1 mm to 2 mmb. 3 mm to 4 mmc. 5 mm to 6 mmd. 8 mm to 10 mmThis article provides 1 hour <strong>of</strong> CE credit from Ascend Media’s <strong>Dental</strong> Learning Systems, in association with the University <strong>of</strong>Southern Cali<strong>for</strong>nia School <strong>of</strong> Dentistry and the University <strong>of</strong> Pennsylvania School <strong>of</strong> <strong>Dental</strong> Medicine, representatives <strong>of</strong> whichhave reviewed the articles in this issue <strong>for</strong> acceptance. Record your answers on the enclosed answer sheet or submit them on a separatesheet <strong>of</strong> paper. You may also phone your answers in to (888) 596-4605 or fax them to (703) 404-1801. Be sure to include yourname, address, telephone number, and social security number.Vol. 26, No. 3 Compendium / March 2005169
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