Introduction
Oral surgeons and dentists employ various suture needles and techniques to ensure that post-operative dental wounds heal effectively and promptly. These methods are crucial for minimizing complications and promoting rapid recovery. Proper suturing can greatly influence the outcome of dental procedures, affecting both healing times and patient comfort. Read the article to learn about dentistry's commonly used suturing techniques and their impact on the healing process.
What Types of Suture Needles Are Used in Dental Surgeries?
Suturing dental or oral surgical wounds presents a challenge for maxillofacial surgeons and dentists to effectively allow dentoalveolar, surgical, or implant wounds to heal postoperatively. This article explores the suturing needles and techniques used in dentistry and oral surgery. A myriad of surgical suture needles are available in the commercial dental market for purchase by maxillofacial surgeons and dentists. The common types of needles that are preferred are as follows:
Reverse-Cutting Suture Needles: These are the primary choices for dentists and oral surgeons. The reverse-cutting needle is triangular in cross-section, with the base of the triangle facing the inner part of the circle created by the needle. This shape ensures that the oral mucosa does not tear easily during suturing, as tension is applied when making the knot.
3/8-Circle Needle: This needle is the second most commonly used in dentoalveolar surgeries.
1/2-Circle Needle: This needle is less preferred by dentists due to the restricted working space, such as in the regions of posterior molars or maxillary posterior areas.
What Are the Materials and Knots Commonly Used in Dental Surgery?
Just like the needle shape, another important factor is the suturing material chosen for placing the appropriate knot and technique. These materials can be natural resorbable sutures, synthetic resorbable sutures, or non-resorbable sutures, depending on the surgeon's method of choice. The most common knots utilized in dentoalveolar surgeries are the slip knot and the surgeon’s knot.
The surgical slip knot is preferred by many oral surgeons for tightening the suture against the oral tissue, which further aids in the approximation of flap edges. This knot is commonly used with natural gut or chromic gut suture materials. However, it is not recommended when using resorbable or non-resorbable synthetic materials for suturing.
What Are the Different Suturing Techniques in Dental Surgery?
Let us now look at the different types of suturing techniques used in dentistry and maxillofacial surgery. Suturing techniques consist of various methods that will be discussed in detail below.
Simple interrupted and crisscross suturing techniques are commonly used and widely utilized in dental settings. Both the simple interrupted technique and the crisscross technique provide the surgeon with the ability to approximate tension-free wounds and flaps together.
The Simple Interrupted Technique: This technique involves the surgeon penetrating the buccal gingiva mucosal tissue, crossing the wound, and exiting through the lingual tissue. The needle is oriented medially throughout these movements while suturing. Once a loop is created, the suture thread is tied off at the point of entrance where the material was first used at the wound. This technique is considered most effective for closing very small or small oral wounds or after small oral lesion resections. Multiple sutures can be placed using this technique to close larger wounds easily.
The Crisscross Technique: This technique is ideal for maxillofacial surgeons operating on dental extraction sites. The dentist must maintain both the blood clot and materials packed into the socket to achieve effective hemostasis (stopping blood flow) or for bone augmentation (increasing bone volume) procedures, such as gel foam, collagen plugs, or graft material. The crisscross technique can be performed in two different ways:
The first method involves inserting the needle through the mesial or buccal gingiva and exiting through the distal or buccal gingiva, crossing over the alveolar ridge or extraction site. The needle then enters the mesial/lingual gingiva and exits the distal or lingual tissue margins. The suture is tied off at the entry point, which is the extraction site.
The second method involves inserting the suture needle into the mesial or buccal gingiva, crossing the extraction site, and exiting from the mesial or lingual tissues. The suture is then brought across the extraction site, entering the distal or buccal gingiva and exiting the distal or lingual gingiva. The suture thread is tied off at the entry point at the extraction site.
Horizontal Mattress Technique: This technique is another commonly used interrupted method recommended for suturing flaps under tension. The suture needle first enters the mesial or buccal gingiva and exits the mesial or lingual gingiva. The thread then enters the distal or lingual tissue, crosses over the wound, penetrates the distal or lingual tissue, and is tied off at the entry point. Surgeons often use a longer-lasting material such as a resorbable suture with this technique.
The Continuous Suture: This method is used for longer or more extensive oral wounds, such as full-mouth extractions. The continuous suture can be either locking or non-locking. The benefits of using the continuous suture technique include a more even distribution of pressure across the oral wound, which helps in maintaining consistent tension and improving wound closure. Additionally, this technique can reduce the risk of wound dehiscence (surgical wound reopening after closure) and promote more efficient healing by minimizing the need for frequent knot-tying. The continuous suture is particularly advantageous in areas where stability and uniformity are crucial for optimal recovery
Successful patient outcomes post-operatively are determined by these common suturing techniques and the armamentarium that dentists or oral surgeons routinely use. These choices vary based on procedures such as dental implantation, soft tissue grafting, bone harvesting, or even simple wound closure after a tooth extraction.
Conclusion
The suturing technique adapted by your dentist plays a major role in wound healing. For smaller, uncomplicated wounds, simple interrupted sutures or the crisscross technique can be quite effective. To conclude, while the crisscross and interrupted techniques are generally not recommended by dentists or surgeons for flaps or wounds that cannot be approximated under tension, the horizontal mattress sutures and continuous sutures can be used for extensive oral wounds, suturing flaps under tension, and distributing even pressure across the wounds.
