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MicroteachingSutures and Suturing (2)

The document outlines various suturing techniques used in oral and maxillofacial surgery, including interrupted and continuous sutures, along with their specific types and applications. It emphasizes the importance of technique choice based on the operator's skill, surgical requirements, and the need for dexterity in periosteal suturing. Detailed descriptions of each suturing method, including indications and procedural steps, are provided to guide practitioners in effective flap management.

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barun kumar
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9 views28 pages

MicroteachingSutures and Suturing (2)

The document outlines various suturing techniques used in oral and maxillofacial surgery, including interrupted and continuous sutures, along with their specific types and applications. It emphasizes the importance of technique choice based on the operator's skill, surgical requirements, and the need for dexterity in periosteal suturing. Detailed descriptions of each suturing method, including indications and procedural steps, are provided to guide practitioners in effective flap management.

Uploaded by

barun kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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MICROTEACHING

Suturing technique

Dr. Barun Kumar


MDS (OMFS)
ASSOCIATE PROFESSOR
Suturing Techniques
1- Interrupted
a- Figure eight
b- Circumferential director loop
c- Mattress-vertical or horizontal
d- Intrapapillary
Suturing Techniques
2- Continuos
a- Papillary sling
b- Vertical mattress
c- Locking
Suturing Techniques

• The Choice of technique is generally


made on the basis of a combination of the
individual operator’s preference,
educational background, and skill level,
as well as surgical requirement
Periosteal Suturing
• Generally requires a high degree of
dexterity in both flap management and
suture placement. Small needles (P-3),
fine sutures (4-0 to 6-0) and proper
needle holder are a basic requirement
Interrupted Sutures
• Indications
1- Vertical incision
2- Tuberosity and retromolar areas
3- Bone regeneration procedures with/without GTR
4- Widman flaps, open flap curettage, repositioned
flaps, or apically positioned flaps where maximum
interproximal coverage is required
5- Edentulous areas
6- Partial or spilt-thickness flap
7- Osseointegrated implants
Interrupted Sutures
• Types
1- Circumferential, direct, or loop
2- Figure eight
3- Vertical or horizontal mattress
4- Interstitial papillary placement
Interrupted Sutures
• Figure eight and Circumferential:
- Suturing is begun on the buccal surface 3-4 mm from the
tip of the papilla so as to prevent tearing of the thinned
papilla
- The needle is first inserted into the outer surface of the
buccal flap and then either through the outer
epithelialized surface (figure eight) or through the CT
under the surface (circumferential)
- The needle is then returned through the embrasure and
tied buccally
Interrupted Sutures
• Mattress sutures:
- Are used for greater flap security and control
- They permit more precise flap placement
especially when combined with periosteal
stabilization
- They also allows for good papillary
stabilization and placement
Interrupted Sutures
• Vertical mattress technique
– Needle is inserted 7-10 mm apical to the tip of
the papilla.
– Passed through the periosteum, emerging again
from the epithelialized surface of the flap 2-3
mm from the tip of the papilla
– The needle is brought through the embrasure,
where the technique is again repeated lingually
or palatally
– The suture is then tied buccally
Interrupted Sutures
• Horizontal mattress technique
– Needle is inserted 7-8 mm apical and to one side of
the midline of the papilla.
– Emerging again 4-5 mm through the epithelialized
surface on the opposing side of the midline
– The suture may or may not be brought through the
periosteum
– The needle is then passed through the embrasure,
and the suture after being repeated lingually or
palatally is tied buccally
Interrupted Sutures
• Intrapapillary technique
– Recommended for use only with modified
widman flaps and regeneration procedures
– the needle is inserted buccally 4-5 mm from
the tip of the papilla, passed through the
tissue emerging from the tip of the papilla
– This is repeated lingually and tied buccally
Interrupted Sutures
• Sling technique
– It is primarily used for a flap that has been
raised on only one side of a tooth involving one
or two adjacent papillae
– Most often used in coronally and laterally
positioned flaps
– The technique involves use of one of the
interrupted sutures, which either anchored
about the adjacent tooth or slung around the
tooth to hold both papilla
Continuous Sutures
• Advantages
1- Can include as many teeth as required
2- Minimize the need for multiple knots
3- Simplicity
4- Permit precise flap placement
5- The teeth are used to anchor the flap
6- Avoid the need for periosteal sutures
Continuous Sutures

• Disadvantages
– The main disadvantage of continuous suture
is that if the suture breaks, the flap may
become loose or the suture may come untied
from multiple teeth
Continuous Sutures
• Types
1- Independent sling sutures
2- Mattress sutures
a- Vertical
b- Horizontal
3- Continuous locking
Continuous Sutures

• Independent sling suture


– When flap position is not critical
– When buccal periosteal sutures are used for
buccal flap position and stabilization
– When maximum closure is desired
Continuous Sutures
• Technique
– After the initial buccal and lingual tie, the
suture is passed about the neck of the tooth
interdentally and through the lingual flap
– Then again brought interdentally through the
buccal papilla and back interdentally about the
lingual surface of the tooth to the buccal papilla
– Then it is brought about the lingual papilla and
then about the buccal surface of the tooth
– This alternating buccal-lingual suturing is
continued until the suture is tied off with a
terminal end loop
Continuous Sutures
• Vertical and horizontal mattress suture
– The technique is similar to that previously described for the
interrupted suture .

• Locking suture
– It is indicated primarily for long edentulous areas, tuberosities, or
retromolar areas.
– It has the advantage of avoiding the multiple knots of interrupted
sutures
– If the suture broken, it may completely untie
Continuous Sutures
• Technique
– A single interrupted suture is used to make the
initial tie
– The needle is next inserted through the
underlying surface of the buccal flap and the
underlying surface of the lingual flap
– The needle is then passed through the remaining
loop of the suture, and the suture is pulled
tightly, thus locking it
– This procedure is continued until the final
suture is tied off at the terminal end

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