Global Journal of Otolaryngology ISSN 2474-7556 Review Article Glob J Otolaryngol Volume 12 Issue 2 - December 2017 Copyright © All rights are reserved by Hassan H Koshak DOI: 10.19080/GJO.2017.12.555833 Dental Suturing Materials and Techniques Hassan H Koshak* Head of the Dental Department, Ministry of Interior Security Forces Medical Services, Saudi Arabia Submission: November 27, 2017; Published: December 12, 2017 *Corresponding author: Hassan H Koshak, Head of the Dental Department, Ministry of Interior Security Forces Medical Services, Jeddah 21352, Saudi Arabia, Tel: ; Email: Introduction On the basis of work by Koch and Pasteur, Lister concluded that Successful dental suturing ororal surgery is dependent on wound suppuration could be prevented by disinfecting sutures, dressings, and instruments with carbolic acid. Initially Lister used have been used (sutures, stents, paste dressings, tissue tacks and accurate coaptation of the flaps. Various methods and materials silk as a suture material, on the assumption that it was absorbable and therefore could also be used for ligatures. Later he searched most popular method. The term “suture” describes any strand of adhesives) for precise flap placement. Suturing has remained the for a more rapidly absorbable material and consequently began to material utilized to ligate blood vessels or approximate tissues. use catgut. Catgut is produced from animal connective tissue, in The primary objective of dental suturing is to position and secure particular bovine sub serosa. Over the years it gradually emerged that animals born and bred in South America were most suitable intention) provides support for tissue margin until they heal, surgical flaps in order to promote optimal healing (first / primary because they had the lowest fat content thanks to their natural without dead space and reduce postoperative pain. Inadequate husbandry conditions. The use of catgut was never called into question until the appearance of BSE at the beginning of the 21st and delayed wound healing. suturing may result in flap skipping, exposed bone / necrosis, pain century. Alternative products had already been developed by this History of the Suture Materials and Classical Literature time. These are the synthetically manufactured absorbable suture Review materials, which have largely superseded catgut in Europe. However, The technique of closing wounds by means of needle and thread catgut continues to play a major role in wound care worldwide. A is several thousand years old. The history of surgical sutures can wide variety of sterilization methods have been tested at various be traced back to ancient Egypt, and the literature of the classical times. Nowadays sutures are mostly sterilized by ethylene oxide period contains a number of descriptions of surgical techniques or gamma irradiation. In response to the requirements of modern involving sutures. Before catgut became the standard surgical surgery and thanks to the efforts of users and manufacturers over suture material towards the end of the 19th century, many different the last few decades, a wide variety of sutures have now been developed [7,8]. ligatures. Materials that had been tried included gold, silver and Definitions paths had been followed to find a suitable material for sutures and bow- strings, and gut strings from sheep and goats. At the beginning steel wire, silk, linen, hemp, flax, tree bark, animal and human hair, of the 19th century metal threads were tested as suture material. At a. Suture material is an artificial fibre used to keep wound that time inertness of a material with respect to body tissues was together until they hold sufficiently well by themselves by stronger scar. considered an advantage. Nevertheless, metal threads had major natural fibre (collagen), which is synthesized and woven into a b. Suture is a stitch/series of Stiches made to secure and could easily result in knot breakage; in addition, suppuration of apposition of the edges of a surgical/traumatic wound (Wilkins). disadvantages: their stiffness rendered knot- tying more difficult the wound edges occurred frequently [1-6]. c. Any strand of material utilized to ligate blood vessels or These negative experiences with metal contributed to the approximate tissues (Silverstein L.H 1999). establishment of silk as the number one suture material. Wounds Goals sewn with silk cicatrized within a few days, and the small knot caused no problems. For these reasons most surgeons at that time a. Provide an adequate tension of wound closure without chose silk for sutures and vessel ligatures. A fundamental change dead space but loose enough to obviate tissue ischemia and in the assessment of suture materials followed the publication in necrosis. 1867 of Lister’s research on the prevention of wound suppuration. Glob J Otolaryngol 12(2): GJO.MS.ID.555833 (2017) 0027 Global Journal of Otolaryngology b. Maintain hemostasis. The Ideal Suture c. Permit primary intention healing. a. It can be utilized in any operation. d. Provide support for tissue margins until they have healed b. It can be handled easily and comfortably. and the support is no longer needed. c. Minimal tissue reaction. e. Reduce postoperative pain. d. High breaking strength. f. Prevent bone exposure resulting in delayed healing and e. High knot security. unnecessary resorption. f. It does not cut, tear or shrink the tissue. Requisites for suture materials g. It is non-allergenic, non-carcinogenic sizes. h. It is absorbed predictably with no tissue reaction. a. High uniform tensile strength, permitting use of finer b. High tensile strength retention in vivo, holding the wound i. It is reasonably priced. securely throughout the critical healing period, followed by Suture’s Physical Characteristics rapid absorption. The Physical Configuration c. Sterile. d. Pliable for ease of handling and knot security. a.b. MonofilamentousTwisted or braided. or multifilamentous. e. Freedom from irritating substances or impurities for optimum tissue acceptance. The Tensile Strength a. The weight required to break a suture, divided by its cross f. Predictable performance. sectional area. g. Prevent or limit bacterial adhesion and proliferation. h. Uniform diameter. b.The KnotIdentified Strength by a different number of zeros. i. No carcinogenic. a. The amount of force needed to cause a knot to slip. j. Biologically inactive. material. b. It is proportional to the coefficient of friction of the available today meet these criteria. With the possible exception of coated Vicryl, none of the sutures The Elasticity: The ability of a suture to regain its original form Principles of Suture Selection and length after being stretched. The selection of a suture material by a surgeon must be based on The Plasticity: The ability of a suture to expand when stretched, a sound knowledge of the: but not to return to its initial length. a. Healing characteristics of the tissues, which are to be The Memory: The ability of a suture to return to its former approximated. b. The physical and biological properties of the suture Classificationshape after being manipulated.of Suture MaterialsIt’s a reflection of its stiffness. materials. a. According to fate: Absorbable or Non-absorbable (Figure c. The condition of the wound to be closed. 1). d. Probable post-operative course of the patient [9,10]. b. According to source: Natural or Synthetic. When a wound has reached maximal strength, sutures are contaminated wounds as bacteria can linger within them and c.d. According toto structure: coating: MonofilamentCoated or Uncoated, or Multifilament. Dyed or no longer needed. Multifilament sutures should be avoided in may convert it into an infected one. Where cosmetic results Undyed. are important, close and prolonged apposition of wounds and e. According to tissue reaction: Reactive or Not reactive. avoidance of irritants will produce the best results. The smallest should be used. inert monofilament suture materials such as polyamide or prolene f. According to handling: Easy or Difficult to handle. 0028 How to cite this article: Hassan H K. Dental Suturing Materials and Techniques. Glob J Oto 2017; 12(2): 555833. DOI: 10.19080/GJO.2017.12.555833. Global Journal of Otolaryngology Figure 1: Classification of suture materials. a. Enzymatic degradation for animal protein. Absorbable Sutures b. Hydrolysis. Popular in periodontal and implant surgeries, less postoperative c. The speed of absorption is roughly proportional to the vascularity of surrounding tissue. forms natural or synthetic. inflammation, more patient’s comfort and it is availablein two Non-absorbable Sutures Natural Absorbable Sutures: Materials suitably resistant to the action of living mammalian Monofilaments of highly purified collagen, mild to moderate tensile strength, mild inflammatory strand permitting infection). Patient’s discomfort and it is available tissue. Treated for capillarity (the passage of tissue fluid along the reaction, and difficult to handle. Should not be used in high acidic in two forms natural and synthetic. radiation therapy). Available in two types: environment (reflux bulimia, esophagitis, Sjogern’ssyndrom, Natural Non-absorbable Sutures a. Plain Gut resorption rate from 3 to 5 days. a. Silk: Braided siliconized proteinogenous suture derived b. Chromic Gut: Dyed with chromium salt solution and from silk worms, superior handling quality, high elasticity, good prolonged resorption rate from 7 to 10 days. collection (Wick effect), high potential for infection, and severe Synthetic