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Clinical technology/Intra oral suture

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Suture in mucosa or gingival flap surgery after reduction, in order to mucosa, gingival flap fixed position. There are many methods including suture, suture, suture suspension, mattress suture, suture anchor, wherein the suspension suture and suture suture between teeth is the most commonly used method in flap surgery.

First, A suture instrument

Small needle thread should be selected in the opening of the mouth.

1.Needle    Gingival mucosa suture commonly used circular needle, triangular needle

2.Needle-holde    Select the different length, size of the beak and handle of the needle holder

3.Shear line    For oral periodontal surgery can choose smaller blunt scissors. Ophthalmology commonly used shear

4.Suture    Periodontal surgical sutures are often used black thread, easy to identify in the oral narrow field of vision, no stimulation to the oral mucosa, and a certain degree of tension and strength, not easy to break, easy to operate. The suture length should be appropriate, usually about half the length of the needle is appropriate.

Second, basic operation

1.Tie    The suture of the periodontal surgical instruments is more than the application of the surgical knot, and it is not easy to loosen or slip.

2.Take out the stitches    Usually in 5 ~ 7 days after suture stitches. Also according to the postoperative wound healing speed, range, depth, wound tension, beauty factors specific circumstances to decide, once demolished, also continuously removed.

Third, the suture

There are many types of suture in the mouth, which should be based on the requirements of tissue healing and close to the root of the teeth and alveolar bone surface, select the appropriate suture method.

Fourth, mouth suture knot matters needing attention

1.Knot tighten, the two points of force and ligation point three points should be in a straight line; if the three lines into a certain angle, in the tightened, easy to make the ligation avulsion or thread off. In the tightening line, hands force should be uniform, if a hand is easy to slide into a loose knot, and slippage.

2.No matter what method of knot, two adjacent single intersection must be in the opposite direction, that is, hands should be crossed, or easily labeled as a slip knot and loose.

3.When knot tying, must follow the direction of the line through the forced tension, or very easy to break the ligation line.

4.Deep knotting, due to the small space and make the hands to close to the ligation, this time can be tied to one end of a pull wire, the other end of the first available hand in the past by the knot at the reverse time, evenly tighten the knot. In case of large tissue tension ligation, often on the second node when the first knot has loosened, the tightening of the first knot after at this time, a toothless forceps clip buckle with assistant, to tighten the knot to remove second tweezers.

5.The location should not be knotted in the wound. To lay the first knot, the two ends should be to one side, then play the second knots, so as not to loose.

Here are a few common suture methods

1.Interrupted suture between teeth

The interdental suture in the tooth gap, the buccal, lingual papilla flap sutured directly applicable to the sides of the tongue lips, gingival flap tension is highly consistent. The direct ring interrupted suture, also can use figure 8 suture suture. Can also be used for the longitudinal suture gingival flap incision.

Direct circular suture:

Its operation method is adjacent to both sides of the edge of the wound with stitches to close, from the free end to enter through the gums, the other end is fixed, the alignment ends of gingival flap position after knot fixation, the wound should be in good contact, keep spreading. The needle into the gingival flap tissue, from the wound to both sides of the distance should be equal draw. The action should be gentle, otherwise easily gingival tissue tear.

8 shaped interrupted suture:

It is suitable for the buccal lingual gingival tissue, tension is large, highly inconsistent, the needle can not simultaneously through both sides of gingival flap case. Its operation method is the needle in the buccal, lingual two times from the surface to the inside of the needle gingival tissue, the formation of cross in the adjacent surface, the in situ formation of 8 suture knot. Figure around the interproximal teeth within the organization, so that both sides of buccal lingual gingival flap to root surface close to the fixation.

(1) (2) direct circular suture;

(3) (4) 8 shaped interrupted suture

2.Suspension suture

Is the use of suspension suture operation area teeth gingival flap suspension fixation, instead of buccal and lingual gingival flap simple suture, especially suitable for buccal, lingual sides gingival flap of different heights, so that each side of the red reset gingival flap were closely fitted to the teeth and bone surface, is not easy to happen loose or excessive tension.

Double nipple suspension suture of single tooth:

To fix the mesial and distal gingival papilla by surgery in two teeth, can be used for unilateral or bilateral flap flap. The operation method is the first needle from near the outer surface of the nipple flap, suture around the teeth, to reach the ipsilateral distal gingival flap, from the outer surface of distal gingival papilla the needle in the back near the papilla, knotted, suspended double nipple unilateral flap in the tooth.

Continuous suspension suture:

It is divided into unilateral and bilateral continuous suspension suture. When the operation involves a number of teeth, and the buccal and lingual gingival flap reset highly inconsistent, available unilateral continuous sling suture; buccal lingual gingival flap is highly consistent, available bilateral continuous suspension suture, this time should be taken should be around at the ends of the the adjacent tooth ring, to strengthen the fixed buccal lingual gingival flap function.

Unilateral flap when the double nipple suspension suture

Unilateral continuous suspension suture

Bilateral continuous suspension suture

3.horizontal mattress suture

Mattress suture is applicable to a large gap between two teeth or papilla is wide, the gingival flap can better fit the bone surface, can do a horizontal mattress suture in the nipple. This method can be combined with continuous suspension suture.

Continuous suspension plus horizontal mattress suture

4.Anchor suture

Anchored suture is the last molars in gingival flap or edentulous space at the gingival flap with anchor like fixed to the adjacent tooth. Suture applied to the last molar wedge flap. Note the needle should be as close as possible to the teeth, gingival flap close to the tooth surface, avoid healing after the formation of V notch in the teeth adjacent to the gums.

Anchor suture

Check: after suture suture, should carefully check whether the gingival flap close the bone surface, gingival margin without curl, bone surface are covered, tension is moderate. If the pale gums said the tension is too large. In the gingival flap after a gentle pressure check the wound without bleeding.

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