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The Suture Book Silverstein Pdf
braided non-absorbable suture materials are most commonly used to close the oral soft tissue. they are less expensive than absorbable sutures. they are commonly used in the following situations:
- stitches placed to close the mucogingival junction.
- stitches used in the placement of splints when covering interproximal surfaces of the anterior teeth.
- stitches placed in the suture line of surgical flaps when there is tension against the oral mucosa.
this is a very common suture in the united states. there are about 50 different brands of absorbable, non-absorbable, and partially absorbable sutures available. these sutures are made of polymers such as polyglycolic acid, polydioxanone, polylactic acid, polylactic-co-glycolic acid, polypyrrolidone, polycaprolactone, polyurethane, polyanhydride, polybutylene terephthalate, polyorthoesters, and polyethylene glycol. [7] [1] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31]
the more absorbable the suture is, the faster it resorbs. absorbable sutures should be used in situations where there is minimal tension on the suture. in the oral cavity, this includes situations where there is tension against the periosteum, bone, or the alveolar mucosa. in the anterior alveolar region, it is important to place mattress sutures to keep tension on the muscles of mastication. absorbable sutures are rarely used in the maxillary or mandibular tubercles.
it is important that absorbable suture materials with adequate tensile strength are selected for the closure of the oral cavity. the most commonly used absorbable sutures in the united states are made of polyglycolic acid. polyglycolic acid is the most commonly used absorbable suture for surgical closure in the united states. other absorbable sutures include polydioxanone, polylactic acid, polylactic-co-glycolic acid, polycaprolactone, polyanhydride, polybutylene terephthalate, polyorthoesters, and polyethylene glycol.
reusable needles are an essential part of most suturing techniques. these needles are used primarily in an anterograde fashion, and are inserted into the wound and the suture placed through the wound from the point of insertion. the suture is then pulled through the tissue. the needle is withdrawn and the suture is tied. this process is repeated until the suture is tied properly. [11]
the modified loop technique is an alternative to the buried, buried, or modified buried loop suture techniques when using non-resorbable materials, such as polypropylene. the modified loop technique utilizes a modified loop with the needle within the loop, creating an anastomosis without the need to bury the knots. it is suggested to keep the suture thread tensioned toward the tooth socket, avoiding knot formation. [5] [10] [11] [12]
the interrupted and the interruptedtechnique are the most common methods of closure used in implant-site flaps. the difference between the two techniques is the number of passes required to close the wound. the interrupted technique is commonly utilized with resorbable materials. the interrupted technique uses a continuous suture, tying the knots of the suture thread in an interrupted fashion. it is recommended to avoid the use of a non-resorbable suture thread, as the knot may weaken the suture thread, causing it to break. resorbable suture materials must be used to prevent loosening of the knot, which is an inevitable risk with non-resorbable sutures. [5] [10] [11] [12]
the ultimate goal of wound closure is to optimize the wound healing process, which includes minimizing risk of infection and minimizing pain. traditionally, flaps were closed with suture material and secured with a tie. the tie technique leaves a tension-producing knot at the base of the wound. in addition to the disruption of the wound’s natural tension, the tie technique requires additional time and skills to secure the suture, which may result in significant tension in the suture thread. for these reasons, the modified buried-knot technique was developed to reduce the tension created by tying a knot and to prevent the loosening of the suture material. [10] [5]
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