Suturing

Question 1

Instruments:
• 4.0 silk non-resorbable suture
• Parts of suture: tail, body, tip
o Never grab the ____ of the suture with the needle holder = it will damage it
o Instead hold the suture at the ____ - helps to twist the needle while suturing o The needle is our friend - “follow the curvature of the needle”
• After completing the suturing procedure: all sharps must go in the ____ box (NOT the trash)

Answer 1

tip
tail end
red biohazard

Question 2

• S - simple interrupted
o Enter suture ____ mm below the free gingival margin
▪ Penetrate tissue from ____ and make way to the
lingual
▪ Pull suture through; make ____ forward loops and ____
backward loop around the needle holder and grab short
end of the thread = this will create a knot
▪ Leave about ____ mm of suture after the knot - cut the rest
off

Answer 2

2-3
buccal
two
one
3

Question 3

• E - external vertical mattress
o Very common in periodontics
o Suture overlying/on top of the gingival papilla between two
teeth = pushes everything in the ____ position
o Used for: ____ elimination, osseous surgeries (apical flap
and crown ____)

o Identify the mucogingival junction and enter the needle a little ____ to it on the buccal
▪ The needle will exit ____ at the coronal portion of
the gingiva
▪ The ____ is used as the anchorage
o Now, bring the suture/needle over to the lingual side and repeat - enter at the apex portion of ____ and exit coronally
o Then, bring the needle back to the buccal (pull the suture through the interproximal as if you were flossing) - and then ____ loops forward, ____ loop backward ⇒ knot (leave ____ mm of suture after cutting)
▪ Remember, when you pull the suture, pull the ____ portion of the suture for the knot (prevents wasting the suture)

Answer 3

apical
pocket
lengthening

apex
buccally
periosteum
lingual flap
two
one
3
longer

Question 4

• H - horizontal internal mattress

o Mostly used for high ____ wounds: ____ ridge after
guided bone regeneration (GBR) procedure
o They don’t create ____ closure as simple interrupted, but it
helps when tension is high (as in after a bone grafting procedure)
▪ But, a benefit of this suture = lingual and buccal tissue contact each other and ____ up the healing process
▪ The coronal portion of the flap is open, so surgeons will use ____ on the coronal portion of the flap to seal the flaps
o Enter needle on ____ surface and travel through gingiva until exiting on the lingual
▪ Then, reverse the order: enter ____ and exit through the buccal ▪ In the end it will look like a ____
• Used to secure the membrane beneath the flap
o Same process for tying the knot as previous methods above^

Answer 4

tension
denture
precise
speed
simple interrupted
buccal
lingual
rectangle/square

Question 5

• C - crisscross (aka figure-8)

o Done after ____ of a tooth and cleaning of the extraction socket
o Used mainly to secure ____ material (ie. collagen,
bone graft)
o Penetrate the ____ flap (not too deep because we
don’t want to pull the grafting material out)
▪ Exit diagonally through the ____ and then go back to the buccal and enter again
▪ Then, pull through and exit through the
adjacent diagonal lingual side
▪ This will create an “____” over the graft material
o Come back to the starting point and tie the knot as in the previous methods

Answer 5

extraction
grafting
buccal
lingual
X