exam 2 (L6) - flap positioning, suturing, and healing Flashcards
positioning a flap apically achieves what?
- eliminates pocket
- can increase width of attached gingiva by transforming keratinized gingiva from pocket wall
- can also be used for CCL
positioning a flap coronally or laterally achieves what?
covers areas of gingival recession
what is a suture?
a material used to ligate blood vessels or approximate tissues
what is the primary objective of suturing?
to position and secure surgical flaps to promote optimal healing
what are the goals of suturing?
- 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
what are the 2 classes of suture materials?
- resorbable (natural = plain gut, chromic gut; synthetic = coated vicryl)
- non-resorbable (silk, polyester = nylon, PTFE)
what are the characteristics of chromic gut sutures?
- resorption 7 - 10 days
- lowest tensile strength
- moderate tissue reaction
- used for rapidly healing mucosa
what are the characteristics of coated vicryl sutures?
- 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)
what are the characteristics of silk sutures?
- non-resorbable (2 years)
- moderate tensile strength
- moderate tissue reaction
- used on mucosal surfaces
- commonly used
what are the characteristics of ePTFE (monofilament) sutures?
- non-resorbable
- very high tensile strength
- extremely low tissue reaction
- used for all types of soft tissue approximation
what are the qualities of an ideal suture material?
- pliability
- knot security
- sterilizable
- elastic
- non-reactive
- adequate tensile strength
which sutures are used most often?
silk (non-resorbable) and synthetic (resorbable)
when are gut sutures used?
when retrieval is difficult
when are monofilament sutures recommended?
when doing bone augmentation procedures to prevent “wicking” (bacteria imbibed into suture) and reduce inflammatory response, permit longer retention
which sutures are recommended for guided tissue regeneration?
- Gore-tex (ePTFE) (non-resorbable)
- coated vicryl (resorbable)
what are the 3 parts of the needle, and how is it held?
- swaged (eyeless) end (suture is internally attached)
- body
- point
- grasp 1/4th to 1/2 length on body from swaged area
how short should the ends be cut on sutures, and why?
- 2 - 3 mm
- helps avoid pathogenic absorption by sutures
T / F:
sutures should be placed in keratinized tissue whenever possible.
T
what are the 3 parts of a surgical knot?
- loop
- knot
- ears (cut ends)
what are the 3 knot types discussed?
- 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)
what 5 suture techniques were mentioned?
- interrupted suture (simple loop, figure 8)
- mattress (vertical, horizontal)
- periosteal
- continuous (continuous locking, continuous horizontal mattress)
- sling suture (independent, continuous)
when is the simple loop modification of an INTERRUPTED suture used?
- when facial and lingual flaps have been elevated
- it is the most common suture used in dentistry
when is the figure-8 modification of an INTERRUPTED suture used?
used in very restricted areas (ex: lingual 2nd molar)
when is the single interrupted SLING suture used?
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
when is the continuous independent SLING suture used?
when a flap has 3 or more papillae on only 1 surface
what is the purpose of periodontal dressings?
- assist healing by protecting tissues during healing stage (maintain flap closure); they have NO curative properties!
- aids patient comfort
what is a disadvantage of periodontal dressing?
rinsing with antibacterial agents doesn’t prevent plaque formation under dressing
what is a commonly used periodontal dressing?
CoePak; has 2 tubes filled with oxidizers (Zn(OH2)), fungicides, carboxylic acids, and chlorothymol (bacteriostatic)
what is the most important variable in determining long-term success of periodontal surgery?
- post-operative care and maintaining wound stability
- done via CHX rinse 2x/day (Peridex, Periogard)
what precautions are taken during suture removal?
cut suture as close as possible to tissue to avoid dragging contaminated sutures through wounds; cut each section of continuous sutures individually
healing after surgery has what 3 main steps?
- inflammation
- fibroblastic granulation
- matrix formation and remodeling
