This document discusses various suturing techniques used in periodontal flap surgery. It begins with an introduction on the purpose of suturing flaps, which is to maintain the flap in position until desired healing. Resorbable sutures are preferred for patient comfort and elimination of removal appointments. The document then describes different suturing techniques like horizontal mattress suture, continuous independent sling suture, anchor suture, closed anchor suture, and periosteal suture. It provides details on their specific uses and how to perform each technique. A variety of suture materials, both resorbable and non-resorbable, are also listed.

1. SUTURING TECHNIQUES
IN PERIODONTAL FLAPS
BY : ANEETINDER KAUR
BDS FINAL YEAR
GOVERNMENT DENTAL
COLLEGE , PATIALA

2. OUTLINE
Introduction
Technique
Ligation and types
Suturing techniques
Horizontal mattress
Continuous independent sling suture
Anchor suture
Closed anchor suture
Periosteal suture

3. INTRODUCTION
PURPOSE : To maintain the
flap in position until desired
healing has taken place ( to
the point where sutures are
no longer needed )
PREFERED TYPE :resorbable
sutures because of the
patient comfort and
elimination of suture removal
appointments
Monofilament sutures show
wicking effect while braided
aid bateria to penetrate
deeper areas of wound
Nonabsorbable
•Silk (braided)
•Polyester (braided)
Absorbable
•Surgical gut
•Plain gut monofilament (30 d)
•Chromic gut monofilament (45-65 d)
•Polyglycolic braided (20d)
•Vicryl
•Dexon
•Monocryl
•Polyglyconate monofilament

4. TECHNIQUE
1. Needle in the needle holder ,
inserted into the tissue at 90
degrees 2 to 3 mm away from the
incision
2. Needle is carried through the
tissue following the needles
curvature
3. Knot should not be placed over
the incision
4. Periodontal flaps are closed with
independent or continuous
sutures , independent sling
sutures
5. The sutures should pass below an
imaginary line forming the based
of the triangle of base of
interdental papilla

5. LIGATION (process of ligature
application )

6. TYPES OF LIGATION
INTERDENTAL LIGATION :
Two types can be used :direct loop suture and figure of eight .
In figure of eight thread is placed between the two flaps and used
when flaps are not in close apposition ( apical flap position or
nonscalloped incisions )
Direct suture aloows better closure of interdental papilla , used in
bone grafts or close apposition is needed
SLING LIGATION
Used for flap on one surface and involving two interdental spaces

8. TYPES OF SUTURES

9. HORIZONTAL MATTRESS SUTURE
USED FOR :interproximal areas of
diastemas or wide interdental spaces
to adapt idp to bone
Two sutures are needed
Can be incorporated with continuous
or independent sling suture
Penetration to bring mesial and distal
edges od papilla against bone
Needle enters the outersurface
crossing the undersurface horizontally
Not be close together at the midpoint
of the base
Needle comes to the outer surface and
continues with the sling suture

10. CONTINUOUS INDEPENDENT SLING
SUTURE
USED WHEN : both facial and
lingual flap is used and involves
many teeth
Initiated on facial aspect closest
to midline
Continuous sling suture for each
interdental papilla
Anchored on the last tooth and
final knot tied
DOESN’T pull on lingual flap and
both flaps are independent of
each other
PREFERED for maxilla

11. ANCHOR SUTURE
BEST FOR : closing of a flap
mesial or distal to a tooth (
mesial or distal wedge procedure
)
Closes facial and lingual flaps
and adapts them tightly
Needle placed at the lineangle
area of facial or lingual flap
adjacent to the tooth , anchored
around the tooth passed bneath
the opposite flap and tied.

12. CLOSED ANCHOR SUTURE
USED FOR : closing a flap that is
located in an edentulous area
mesial and distal to a tooth
CONSISTS of tying direct suture
closing the proximal flap
carrying one of the threads
around the tooth to anchor the
tissue against the tooth

13. PERIOSTEAL SUTURE
USED TO : hold apically displaced
partial thickness flaps on
periosteum
TYPES:
Holding suture :horizontal
mattress at the base of displaced
flap to secure it into place
Closing suture: used to secure
the flap edges to the periosteum
.

14. This Photo by Unknown Author is licensed under CC BY-NC-ND