A major and important part of any surgical procedure is to re-position the raised flap (in surgery) or the injured tissue in case of injury to a position where it helps in healing. The healing which is initiated by proper suturing is called as healing by Primary intention.
Definition of Suture material:
Any strand of material utilized to ligate blood vessels or approximate tissues (Silverstein L.H 1999)
Suture material is an artificial fibre used to keep wound together until they hold sufficiently well by themselves by natural fibre (collagen), which is synthesized and woven into a stronger scar.
Suture is a stitch/series of Stiches made to secure apposition of the edges of a surgical/traumatic wound (Wilkins).
There are two main intentions of Suturing:
- To acheive functional and esthetic results
- To decrease post operative infection (caused due to open wounds)
Apart from these two major intentions, a proper suture helps in preventing Hemorrhage or blood loss, prevents Tissue necrosis and also helps to bring back the normal contour and shape of tissues.
Instruments or Armamentarium required for Suturing:
- Suture Needle– different sizes of needles are used depending on the location and tissue to be sutured
- Suture Material
- Needle Holder– to hold the needle while suturing
- Suture Scissors– to cut the excess suture material after suturing
- Adson Forceps or tissue holding forceps– to hold the tissue in place
Types of Suture Materials – Classification based on Resorbability:
Suture materials are chosen if they can qualify with the following properties of suture materials – Tensile Strength, Biocompatibility, Easy of tying, Least tissue irritation and reaction, Diameter and size, Coefficient or friction.
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Resorbable Sutures: These materias resorb on their own after a certain period of time in the oral cavity due to Antigenic Reaction and the Acidic Environment in the Oral cavity. There is no need to remove these sutures after surgery and can be left in the surgical field. These are used in closed type of cases where it is not advised to open the surgical site in future.
1. Natural Resorbable Suture:
- Plain Gut
- Chromic Gut
2. Synthetic Resorbable Suture:
- Poyglycolic acid (PGA)
- Poligecaprone 25
Non Resorbable Sutures: These are Suture materials which do not resorb and are required to be removed after healing of the surgical site. These are mainly used in open or accessible regions.
- Silk sutures – These are cheap and easy to handle and use and are the most used suture materials in dentistry. Some problems with Silk suture is that it is multifilamented which means there will be food impaction and must be cleaned properly to avoid infections.
- Polyster – Monofilament type or Nylon and Polytetrafluoroethylen (PTFE)
What are the Types of Needles Used in Suturing in Dentistry:
A Surgical Needle is the carrier of the Suture material through the tissues to be approximated. The size and shape of the Suture needle differs based on the location, tissue and type of surgery performed.
A Surgical Needle is divided into three parts – Needle point, needle body and swagged or press-fit end. The most commonly used needle sizes in dentistry are 3/8 and 1/2 circle needles.
- Round Needles: These are most commonly used and are less traumatic to the tissue but requires more force while piercing tissue.
- Reverse Cutting: The sharp tip is placed downwards and is used mostly while suturing delicate tissues
- Conventional Cutting: The sharp tip is placed upward and care should be taken as the tip can easily tear the tissue, it is used in thick tissue regions.
There is another type of Classification of Suture Needles:
Eyed Needles: The Eye of the Needle is larger than the diameter of the Suture needle, the suture material is tied in the eye of the needle. Eyed Needles can be Reused, but it causes tissue damage. Split-eyed needle is used for easy threading and release of suture. This type of needle can lead to tissue damage.
Eyeless or Swagged Needles: The suture material is inserted into the eye of needle during manufacturing and the metal of the eye is closed or sealed, this makes the needles unusable for a second time, making them more expensive. It leads to minimal damage to the tissue making it ideal for surgery. It is available in different shapes and sizes to be used in various types of Surgeries.
What are the type of Knots used in Suturing in Dentistry:
A knot is the last step of making sure that a suture is perfectly done, if a knot is not properly placed, the suture material will not be able to hold the tissues in place and the whole purpose of suturing will be lost. There are two types of knots commonly used in Dentistry:
- Slip Knot: It is mostly used with silk, plain gut or chromic suture materials.
- Surgeons knot: USed with synthetic resorbable and Polyster synthetic materials to prevent the knot from becoming loose before healing.
What are the Various Suturing techniques used in Dentistry:
To explain each suturing technique in details we have published a seperate post to make sure that this post is not made long and boring. Please refer to the Link given here – Various Types of Suturing Techniques in Dentistry
- Interrupted simple suture
- Simple Continuous/running suture
- Continuous locking/blanket suture
- Vertical Mattress suture
- Horizontal Mattress suture
- Sling suture for single tooth
- Cross (Crisscross) suture
- Periosteal Suturing technique
Dentistry is a complex profession and a major part of it is Surgical procedures which require knowledge of Suturing techniques and as well as Suturing materials and the armamentarium used for Suturing. Proper Suturing plays a major role in the healing of any major or minor surgery as it helps in healing by primary intention and prevents and secondary infections to the surgical site.
Staples:
This is the latest in closing open wounds which is very effective, but very less used in Oral and Maxillofacial surgeries. The staples are made up of stainless steel making them the suture material with the highest tensile strength with minimal tissue reaction and low incidences of leading to infections. Due to the high tensile strength wounds which are under high tension, Staples are preferred in such cases. With Staples there is minimal scarring as there is no strangulation of sutures leading to minimal cross arch scarring. In Bicoronal flap Staples are the preferred wound closure technique.
Wound Closure Tapes:
The latest in wound closure are Cutaneous tapes which are used in certain cases of wound closure. With these tapes, iatrogenic trauma is avoided as the skin is not pierced with needles or staples. This type of suture closure helps maintain the integrity of epidermis making them more resistant to infections. The limitations of wound closure tapes is they cannot maintain deep tissue approximation or skin edge eversion.
References:
- “Suturing for Optimal Soft-tissue management” – Journal of Oral Implantology 35.2 (2009): 82-90
- International Journal of Periodontics Restorative Dentistry 1998 Oct: 18(5): 474-87. Oral Tissue reactions to suture materials.
- Wound Closure biomaterials and devices, Chu, Chih-Chang, J. Anthony Von Frauhhofer and Howard P. Greisler
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