Box 601

Sutures lor Periodontal flaps

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Silk: braided

Nylon: monofilament (Ethilon) EPTfe: monofilament (Gore-tex) Polyester: braided (Ethibond)

Absorbable Surgical: gut

Plain gut; monofilament (30 days) Chromic gut; monofilament (45-60 days)

Synthetic

Polyglycolic: braided (16-20 days) (Vicryl; Ethicon) (Dexon; Davis & Ceck) Polyglecaprone: monofilament (90 120 days)

(Monocryl; Ethicon) Polyglyconate: monofilament (Maxon)

Technique

I he needle is held with the needle holder and should enter the tissues at right angles and no less than 2 to * mm from the incision. The needle is then carried through the tissue, following the needle's curvature. Ihe knot should not be placed over the incision.

Ihe periodontal llap is closed either with independent sutures or with continuous, independent sling sutures. The latter method eliminates the pulling of the buccal and lingual or palatal flaps together and instead, uses the teeth as an anchor for the Haps. There is less tendency for the flaps to buckle, and the forces on the Maps are better distributed.

Sutures of any kind placed in the interdental papillae should enter and exit Ihe tissue «it a point located below

Interdental Suture

f hj 60 1 i Placement ol suture in the interdental space below the base of an imaginary triangle in the papilla.

Periodontal Sutures Needle

Tig. 60 1 1 Placement of sutures for closing a palatal flap. For slightly or moderately elevated llaps, the sutures are placed in shaded areas; for more substantial elevation of the llap, they are placed in the central (unshaded) area of their palate.

Simple Suture

Fi<j i0 I S A simple loop suture is used to approximate the buccal and lingual flaps A. The needle penetrates the outer surface of the lirsl flap. B, The undersurface of the opposite flap is engaged, and the suture is brought back to the initial side (C), where the knot is tied (D)

the imaginary line that forms the base ol the triangle of the interdental papilla (Fig. 60-1.4). I he location of sutures for closure of a palatal llap depend on the extent of flap elevation that has been performed. The llap is divided in four quadrants as depicted in Fig. 60-14. If the elevation of the llap is slight or moderate, the sutures can be placed in the quadrant closest to the teeth. II the llap elevation is substantial, the sutures should be placed in the central quadrants of the palate.

One may or may not use periodontal dressings. When the llaps are not apically displaced, it is not necessary to use dressings other than tor patient comfort.

Ligation

Interdental I igation. Fwo types ol interdental ligation can be used: the director loop suture d ig. 60-15) anil the figure-eight suture dig. 60-16). In the figure-eight suture, there is thread between the two llaps. Ibis suture is therefore used when the llaps are not in close apposition because of apical llap position or cionscalloped incisions. II is simpler to perform than the direct ligation. I lie direct suture permits a better closure of the interdental papilla and should be performed when bone grafts are used or when close apposition of the scalloped incision is required.

Sling Ligation. The sling ligation can be used for a flap on one surface of a tooth that involves two interdental spaces (I'ig. (>0-17).

f hj 60 1 i Placement ol suture in the interdental space below the base of an imaginary triangle in the papilla.

Tig. 60 1 1 Placement of sutures for closing a palatal flap. For slightly or moderately elevated llaps, the sutures are placed in shaded areas; for more substantial elevation of the llap, they are placed in the central (unshaded) area of their palate.

Fi<j i0 I S A simple loop suture is used to approximate the buccal and lingual flaps A. The needle penetrates the outer surface of the lirsl flap. B, The undersurface of the opposite flap is engaged, and the suture is brought back to the initial side (C), where the knot is tied (D)

Types of Sutures

Horizontal Mattress Suture. I his suture is often used for the interproximal areas of diastcmata or for wide interdental spaces to properly adapt the interproxi mal papilla against the hone. I wo sutures are often nec essary. The horizontal mattress suture can he incorporated with continuous, independent sling sutures, as shown in Fig. 60-1N.

Sling SutureFigure Eight Suturing
Fig. 60 l(> An interrupted figure-eight suture is used to approximate the buccal and lingual flaps. Tin4 needle penetrates the outer surface ol the first flap (A) and the outer surface of I he opposite Map (B). The suture is brought back to the lirst flap (C), and the knot is tied (D)

Fiy 60-17 A single, interrupted sling suture is used to adapt the flap around the tooth A, The needle engages the outer surface of the flap and encircles the tooth (B) C, The outer surface of the same flap of the adjacent interdental area is engaged D, the suture is returned to the initial site and the knot tied.

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Continuous Sling SutureSling Ligation Technique

Fit; <>u 18 A, Continuous, independent sling suture using <i horizontal mattress suture around diastemata or wide interdental areas (B and C) This mattress suture is utilized on both the buccal (D) and the lingual (E and F) surfaces. Continuation of suture on lingual surfaces (C to I) and completed suture (J)

I he penetration ol the needle is performed in such a way that the mesial and distal edges of the papilla lie snugly against Ihe bone. I lie needle enters the outer sur-lace ol Ihe gingiva and crosses Ihe undersurface of the gingiva horizontally. I lie mattress sutures should not be close together at tile midpoint ol the base of Ihe papilla. The needle reappears on the outer surface at the other base ol the papilla and continues around the tooth with the sling sutures.

( ontinuous Independent Sling Suture. Ibis is used when there is both a facial and a lingual flap involving many teelh. I he suture is initiated on the tacial papilla c losest to the midline, because this is the easiest place to position the final knot (Fig. 60-19). \ continuous sling suture is laced lor each papilla on the facial surface. When the last tooth is reached, the suture is anchored around it to prevent any pulling ol the facial sutures when the lingual flap is sutured around the teeth

Periodontal Flap SurgeryContinuous Sling SutureSling Suture Technique
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