How to close intraoral wounds and incisions

How to close intraoral wounds and incisions

Best practices for choosing dental sutures, needles and suturing methods
May 01, 2011

You're staring at a 5-mm hole left after extracting a dog's lower second premolar. Which suture, needle and knot do you choose? A similar packet to what you used on that ovariohysterectomy you performed earlier in the day? Actually, that would be a poor choice.

The objective of dental suturing is to close surgical defects and promote first intention healing without traction of the soft tissue. You'll want suture material that has little tissue reaction and is easy to handle, strong enough to hold the tissues together and attached to a strong needle that stays sharp and stable in the needle holder. When used properly, surgical sutures should hold the gingiva or flap edges in apposition until the wound has healed enough to withstand normal functional stresses, thus improving patient comfort.

Suture materials

Suture material is classified as natural or synthetic; absorbable or nonabsorbable; monofilament or multifilament. A suture should:
  • Have tensile strength appropriate for its respective use
  • Have tissue biocompatibility
  • Be easy to handle
  • Allow minimal knot slippage
  • Absorb with minimal reaction after the tissue has healed

It's important to select the specific suture thread and diameter based on the thickness and general health of the tissues to be sutured.

For intraoral surgery, absorbable suture that will lose its tensile strength at about the same rate the tissue gains strength is generally chosen. Normally, wound healing takes place in 14 to 21 days, with variation based on blood supply, patient age, nutritional status, presence of infection or systemic disease and corticosteroid use. Suture options include:

Photo 1: 5-0 surgical plain gut suture on a ½ circle reverse cutting needle.
Plain catgut suture, which absorbs by the action of intraoral enzymes (Photo 1). Catgut loses most of its tensile strength in 24 to 48 hours and is resorbed in the oral cavity within one week. Because of this rapid loss of tensile strength, especially in infected areas, surgical gut should be avoided for intraoral surgery. Chromic-coated catgut increases absorption up to 10 days and tensile strength up to five days.

Synthetic, absorbable suture materials, which deliver minimal tissue reaction, loss of tensile strength and increased absorption times that provide adequate time for oral incisions to heal. They're hydrophobic—primarily broken down through the process of hydrolysis with only a mild tissue reaction. Exposure to oral infections and digestive enzymes doesn't markedly affect the absorption rate.

Photo 2: 4-0 PGA suture on a ⅜-in. reverse cutting needle.
Polyglycolic acid (PGA—Dexon), an absorbable, synthetic, multifilament suture material that retains strength intraorally for 21 to 28 days and remains in the mouth for months (Photo 2). But I think that's too long. PGA possesses 1.4 times the wet knot strength of chromic gut and two times the strength of plain gut.