exam 2 (L6) - flap positioning, suturing, and healing

Question 1

positioning a flap apically achieves what?

Answer 1

• eliminates pocket
• can increase width of attached gingiva by transforming keratinized gingiva from pocket wall
• can also be used for CCL

Question 2

positioning a flap coronally or laterally achieves what?

Answer 2

covers areas of gingival recession

Question 3

what is a suture?

Answer 3

a material used to ligate blood vessels or approximate tissues

Question 4

what is the primary objective of suturing?

Answer 4

to position and secure surgical flaps to promote optimal healing

Question 5

what are the goals of suturing?

Answer 5

• provide tension to close wound without dead space, but loose enough to prevent ischemia and necrosis
• maintain hemostasis (to stop bleeding)
• healing by primary intention
• reduce post-op pain
• prevent bone exposure (delayed healing, BL)
• permit proper flap position

Question 6

what are the 2 classes of suture materials?

Answer 6

• resorbable (natural = plain gut, chromic gut; synthetic = coated vicryl)
• non-resorbable (silk, polyester = nylon, PTFE)

Question 7

what are the characteristics of chromic gut sutures?

Answer 7

• resorption 7 - 10 days
• lowest tensile strength
• moderate tissue reaction
• used for rapidly healing mucosa

Question 8

what are the characteristics of coated vicryl sutures?

Answer 8

• resorption slow, 56 - 70 days
• very high tensile strength
• minimal tissue reaction
• used to resist muscle pull; sub-epi use
• most used resorbable (and it is synthetic)

Question 9

what are the characteristics of silk sutures?

Answer 9

• non-resorbable (2 years)
• moderate tensile strength
• moderate tissue reaction
• used on mucosal surfaces
• commonly used

Question 10

what are the characteristics of ePTFE (monofilament) sutures?

Answer 10

• non-resorbable
• very high tensile strength
• extremely low tissue reaction
• used for all types of soft tissue approximation

Question 11

what are the qualities of an ideal suture material?

Answer 11

• pliability
• knot security
• sterilizable
• elastic
• non-reactive
• adequate tensile strength

Question 12

which sutures are used most often?

Answer 12

silk (non-resorbable) and synthetic (resorbable)

Question 13

when are gut sutures used?

Answer 13

when retrieval is difficult

Question 14

when are monofilament sutures recommended?

Answer 14

when doing bone augmentation procedures to prevent “wicking” (bacteria imbibed into suture) and reduce inflammatory response, permit longer retention

Question 15

which sutures are recommended for guided tissue regeneration?

Answer 15

• Gore-tex (ePTFE) (non-resorbable)

- coated vicryl (resorbable)

Question 16

what are the 3 parts of the needle, and how is it held?

Answer 16

• swaged (eyeless) end (suture is internally attached)
• body
• point
• grasp 1/4th to 1/2 length on body from swaged area

Question 17

how short should the ends be cut on sutures, and why?

Answer 17

• 2 - 3 mm

- helps avoid pathogenic absorption by sutures

Question 18

T / F:

sutures should be placed in keratinized tissue whenever possible.

Answer 18

T

Question 19

what are the 3 parts of a surgical knot?

Answer 19

• loop
• knot
• ears (cut ends)

Question 20

what are the 3 knot types discussed?

Answer 20

• square knot (first loop over, second loop under needle holder jaws)
• slip knot (first loop over, second loop over)
• surgeon’s knot [square knot variant] ( 2 loops over, 1 loop under)

Question 21

what 5 suture techniques were mentioned?

Answer 21

• interrupted suture (simple loop, figure 8)
• mattress (vertical, horizontal)
• periosteal
• continuous (continuous locking, continuous horizontal mattress)
• sling suture (independent, continuous)

Question 22

when is the simple loop modification of an INTERRUPTED suture used?

Answer 22

• when facial and lingual flaps have been elevated

- it is the most common suture used in dentistry

Question 23

when is the figure-8 modification of an INTERRUPTED suture used?

Answer 23

used in very restricted areas (ex: lingual 2nd molar)

Question 24

when is the single interrupted SLING suture used?

Answer 24

when flap has been elevated on only 1 side of the arch OR when facial and lingual flaps need to be positioned at different levels

Question 25

when is the continuous independent SLING suture used?

Answer 25

when a flap has 3 or more papillae on only 1 surface

Question 26

what is the purpose of periodontal dressings?

Answer 26

• assist healing by protecting tissues during healing stage (maintain flap closure); they have NO curative properties!
• aids patient comfort

Question 27

what is a disadvantage of periodontal dressing?

Answer 27

rinsing with antibacterial agents doesn’t prevent plaque formation under dressing

Question 28

what is a commonly used periodontal dressing?

Answer 28

CoePak; has 2 tubes filled with oxidizers (Zn(OH2)), fungicides, carboxylic acids, and chlorothymol (bacteriostatic)

Question 29

what is the most important variable in determining long-term success of periodontal surgery?

Answer 29

• post-operative care and maintaining wound stability

- done via CHX rinse 2x/day (Peridex, Periogard)

Question 30

what precautions are taken during suture removal?

Answer 30

cut suture as close as possible to tissue to avoid dragging contaminated sutures through wounds; cut each section of continuous sutures individually

Question 31

healing after surgery has what 3 main steps?

Answer 31

• inflammation
• fibroblastic granulation
• matrix formation and remodeling