Many types of suture materials are available. The materials are classified by size, resorbability, and whether or not they are monofilament or polyfilament.
The size of suture is designated by a series of zeros. The size most commonly used in ‘the suturing of oral mucosa is 3-0 (000). A larger size suture would be 2-0, or O. Smaller sizes would be 4-0, 5-0, and 6-0 sutures. Sutures of very fine size such as 6-0, are usually used in cohspicuous places on the- skin, such as the face because smaller
A, Comparison of needles used in oral surgery. Top is P-
3 needle, which is usually 4-0 size suture. Middle is FS-2 needle, and
bottom is X-l. All are cutting needles. B, Tip of needle used to suture
mucoperiosteum is triangular in cross section to make it a cutting
needle. C, Suture may be threaded through needle eye or can be
purchased already swaged onto needle.
Needle holder grasps curved needle two thirds of the
distance from tip of needle.
sutures usually cause less scarring Sutures of size 3-0 are large enough to prevent tearing through mucosa, are strong enough to withstand the tension placed on them intraorally, and are strong enough for easy knot tying with a needle holder.
Sutures may be resorbable or nonresorbable. Nonresorbable suture materials include such types as silk, nylon, and stainless steel. The most commonly used nonresorbable suture in the oral cavity is silk. Nylon and stainless steel are rarely used in the mouth. Resorbable sutures are primarily made of gut. Although the term catgut is often used to designate this type of suture, gut actually is derived from the serosal surface of sheep intestines. Plain catgut resorbs relatively quickly in the oral cavity, rarely lasting longer’ than 5 days. Gut that has been treated by tanning solutions (chromic acid) and is therefore called chromic gilt lasts longer-up to 10 to 12 days. Several synthetic resorbable sutures are also available.These are materials that are long chains of polymers braided into suture material. Examples are polyglycolic acid and polylactic acid .’ These materials are slowly resorbed, taking up to 4 weeks before they are resorbed. Such long lasting resorbable sutures are rarely Indicated in the oral cavity.
Finally, sutures are classified based on whether or not they are monofilament or polyfilament. Monofilament sutures arc sutures such as both plain and chromic gut nylon, and stainless steel. Polyfilament sutures are silk,polyglycolic acid, and polylactic acid. Sutures .that are made of braided material are easy to handle and tie and rarely. come untied. The cut ends are usually soft and
nonirritating to the tongue and surrounding soft tissues.However because of the multiple filaments, they tend to “wick” oral fluids along the suture to the underlying tissues,this working action may carry bacteria along with the saliva Monofilament sutures do not Cause this wicking action but may be more difficult to tie tend to come untied and are stiffer and therefore more irritating to the tongue and soft tissues.
Suture scissors have long handles and short blades: Blades may he angled slightly in either
of two directions.
Suture scissors should be held in same fashion as needle holder.
The most commonly used suture for the oral cavity is 3-o black silk. The size 3-0 has the appropriate amount of strength; the polyfilament nature of the silk makes it easy to tie and easily tolerated by the patient’s soft tissues. The black-color makes the suture easy to see when the patient returns for suture’ removal. Sutures that are holding mucosa together usually stay no longer than 5 to 7 days, so the wicklng action is of little clinical importance. (fcchntques for suturing and knot tying are presented in-Chapter 8.)