midterm 2 - lecture 5

Question 1

Types of flap positioning

_ returned to its original positions (as in the modified Widman flap)

Answer 1

Replaced flap

Question 2

Types of flap positioning

_ moved or advanced laterally, coronally, or apically to a new position.

Answer 2

Positioned:

Question 3

Types of flap positioning

_ positioned flap eliminates the pocket by apically displacing the soft tissue wall of the pocket.
In doing so it preserves and/or increases _

Answer 3

The apically positioned

the width of the attached gingiva
by transforming the previously unattached keratinized pocket wall into attached gingiva tissue.

Question 4

Types of flap positioning

The _ positionnig flaps may be used to cover areas of gingival recession.

Answer 4

coronally (regenerative too) and laterally positioned

Question 5

_ describes any strand of material utilized to ligate (tie) blood vessels or approximate (sew) tissues.

Answer 5

suture

Question 6

The primary objective of _ is to position and secure surgical flaps in order to promote optimal healing.

Answer 6

dental suturing

1. Provide adequate tension of wound closure without dead space but loose enough to prevent tissue ischemia and necrosis 2.Maintain hemostasis 3.Permit healing by primary intention4.Reduce postoperative pain5.Prevent bone exposure resulting in delayed healing and bone resorption 6.Permit proper flap position

Question 7

suture materials

silk

polyester (nylon and ePTFE)

Answer 7

non-resorbable

Question 8

suture materials

plain gut, chromic gut, coated vicryl

Answer 8

resorbable

natural - plain gut and chromic gut

synthetic - coated vicryl

Question 9

suture type

Resorbed by proteolytic enzymatic digestive process in 7-10 days

poorest tensile strength

moderate tissue rxn

uses - rapidly healing mucosa
avoid removal

Answer 9

gut type chromic gut

weakest

Question 10

suture type

resorbed by slow hydrolysis 56-70 days

high tensile strength

minimal tissue rxn

used to resist muscle pull
subepitheliual mucosal surfaces

Answer 10

coated vicryl

Used to resist muscle pull (eg. Horizontal mattress suture)Subepithelial mucosal surfacesResorbable

Question 11

suture type

Gradual encapsulation by fibrous connective tissue. Usually cannot be found after 2 yrs

moderate tensile strength

moderate tissue rxn

mucosal surfaces
Nonresorbable

Answer 11

surigcal silk

Question 12

suture material

non-resorbable

high strength

extremely low tissue rxn - inert

all types of soft tissue approximation

Answer 12

Expanded polytetrafluoroethylene(ePTFE), Gore-Tex (monofilament)

Question 13

_ and _ sutures are used most often

Answer 13

Silk and synthetic

Question 14

_ sutures are used only when retrieval is difficult.

Answer 14

gut

Question 15

_ sutures are recommended for bone augmentation procedures to prevent the “wicking” and to reduce inflammatory response and permit longer retention (10-14 days)

Answer 15

Monofilament

gortex eptfe

Question 16

_ and _ sutures are recommended for guided tissue regeneration procedures.

Answer 16

4.Gore-Tex and coated vicryl

ePTFE or goretex is the best!!!!!

Question 17

Placement of needle in tissue
1.Force should always be applied in the direct
ion that follows the curvature of the needle2.Suturing should always be done from a _ to _ tissue
3.Grasp the needle in the body _ of the length from the swaged area. 4.Avoid retrieving the needle from the tissue by the tip. This will damage or dull the needle. Grasp the body as far back as possible
5.Sutures should be placed in _tissue whenever possible
6.An adequate tissue bite is required to keep the flap from tearing

Answer 17

from a movable to a non movable tissue

one-quarter to one-half of the length

keratinized tissue whenever possible

Question 18

Knot tying

1. The completed knot must be tight, firm, and tied so that slippage will not occur.
2. Knots should not be _
3. Knots should be small and the ends cut short (2-3 mm).
4. Do not tie suture too tightly as tissue necrosis may occur
5. Avoid excessive tension with smaller gauge suture materials as breakage may occur.

Answer 18

placed in incision lines

Knots have three components
:1.The loop created by the knot
2.The knot itself, which is composed of a number of tight “throws” each throw represents a weave of the two strands.
3.The ears, which are the cut ends of the suture.

Question 19

made by tying two overhand knots, each done in opposite directions. The first loop is made by passing the suture material over the jaws of the needle holder, and the second knot is subsequently made by forming a loop under the jaws of the needle holder. This knot may loosen when a synthetic or monofilament suture material is used.

Answer 19

square knot

Question 20

alsomade with two overhand knots but both are in the same direction. With a needle holder, one overhand knot is made so that the loop forms over the jaw of the needleholder and is then tightened. A second overhand knot is then made so that the loop goes in the same direction over the needle holder and is tightened.

Answer 20

slip knot

Question 21

the most commonly used knot in dental surgery. It is a modified square knot. The first overhand knot is doubled: there fore two loops of the suture are formed over the jaws of the needle holder and tightened. The last loop is formed under the jaws of the needle holder in a direction opposite from the first loops.

Answer 21

surgeon’s knot

Question 22

The _has a basic design composed of three parts

1. The eye which is swaged (eyeless) and permits the suture and needle to act as a single unit to decrease trauma.
2. The body which is the widest point of the needle and is also referred to as the grasping area. The body comes in a number of shapes ( round, oval, rectangular, etc)
3. The point which runs from the tip to the maximum cross-sectional area of the body. The point also comes in a number of different shapes (conventional cutting, reverse cutting, taper cut, etc)

Answer 22

surgical needle

Question 23

1.The smaller the needle, the smaller the needle holder required.2.Needles should be grasped _the distance from the swaged area to point. 3.The needle should be placed securely in the tips of the jaws and should not rock twist or turn.4.Do not over-close the needle holder to avoid causing damage to the needle

Answer 23

one-quarter to one-half from swag point

Question 24

_ sutures are most often used for the following 1.Vertical incision2.Tuberosity and retromolar areas3.Bone regeneration procedures4.Widman flap, open flap debridement, replaced flap, apically positioned flap 5.Edentulous spaces6.Partial or split-thickness flaps7.Dental implants

Answer 24

Interrupted

Question 25

This technique is utilized when facial and lingual flaps have been elevated and is the most commonly used suturing technique in dentistry.1.Pass the needle through the facial flap from the outer (epithelial) surface.2.Pass the needle under the contact point. 3.Pass the needle through the lingual flap from the inner surface4.Pass the needle under the contact point again5.Tie on the facial surface of the tooth so that the knot is not in the line of incision6.Cut suture material 2 to 3 mm from the knot.

Answer 25

Simple loop modification of interrupted suture technique

Question 26

This technique is utilized in restricted areas (e.g. lingual second molar). Although this interposes suture material between the edges of the flaps, usually with a 4-0 size thread material, the surgical flaps are still coapted to allow primary closure of the flap edges.1.Pass the needle through the facial flap from the outer (epithelial) surface.2.Pass the needle under the contact point. 3.Reverse the needle and enter the lingual flap from the epithelial (outer) side.4.Pass the needle back under the contact point5.Tie on the facial surface of the tooth so that the knot is not in the line of incision6.Cut suture material 2 to 3 mm from the knot

Answer 26

Figure 8 modification of interrupted suture technique

Question 27

This technique is indicated when a flap has been elevated on only one side of the arch, or when facial and lingual flaps are to be positioned at different levels. This technique involves only two papillae.1.Pass the needle through the outer surface of the more mesial papilla2.Move the suture around the tooth. 3.Pass the suture needle under the distal contact point of the same tooth. 4.Penetrate the flap with the suture needle from its inner side5.Pass the needle back under the distal contact point, around the tooth,, under the mesial contact point, and tie a knot. 6.Cut the suture material 2 to 3 mm from the knot

Answer 27

Single interrupted sling suture technique

Question 28

This technique is indicated for a flap with three or more papillae on only one surface. 1.Begin on the distal aspect by tying an interrupted suture and cutting the short end only.2.Pass the needle under the contact point to the opposite side. 3.Loop the needle and thread around the tooth.4.Pass the needle through the next interdental area below the contact point without penetrating the tissue.5.Penetrate the flap from the outer surface6.Repeat the procedure until the last interdental area, with the needle ending on the side opposite the flap7.Prior to tying the suture, adjust the suture tension along the length of the flap in order to obtain the desired flap position.8.To tie the suture, leave a loop 15 to 20 mm in length on the flap side of the last tooth during the final pass through.9.Utilizing a needle holder, the slack suture material is handled as if it were a free end suture and tied in the usual manner on the side opposite the elevated mucoperiosteal flap

Answer 28

Continuous independent sling suture technique