Suturing for Tension-Free Primary Wound Closure

Primary wound coverage, and tension-free wound closure are considered important principles for successful GBR procedures (1). Essentially, we want to make sure the graft material and the membrane are not exposed to the oral cavity. Proper suturing techniques, including avoiding excessive tension on sutures, are essential to achieving, and maintaining, primary closure (2).

This video reviews two cases to provide some tips on how best to suture sites for larger grafting cases with significant defects that might prove challenging for primary closure. Sutures employed in the cases are Chromic Gut or Vicryl (PGA). One quick tip from the second case is that it is important to make sure you enter the buccal flap below the mucogingival junction so you can take advantage of the elasticity.

REFERENCES

I. PASS: Principles for Predictable Bone Regeneration, Hom-Lay Wang, DDS, MSD, and Lakshmi Boyapati, BDS, IMPLANT DENTISTRY / VOLUME 15, NUMBER 1 2006.

This articles reviews the 4 main principles for GBR: primary wound closure, angiogenesis, space creation/maintenance, and stability of both the initial blood clot and implant fixture.

II.  Basic Suture Techniques for Oral Mucosa  Terrence J. Griffin, Yong Hur, and Jing Bu, Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011

This articles reviews the main principles of suturing: Avoid Excessive Tension on Sutures, Suture Whenever Possible From Movable to Immovable Tissue, Always Try to Keep Knots Away From Wound Edges, Use as Few Knots as Possible, Use the Smallest Suture Possible to Close the Wound, Use the Least Amount of Sutures That Will Secure the Wound