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FlapsandSuturingforRoutineExodontia

Dr. Karl Koerner

FlapsUsefulforGeneralDentists

Cervical(severgingivalfibersbutnoreflection)Mini(formostsingleextractions)Envelope (formultipleextractions)

TriangularSemilunar

Straightor“surgical”highspeed.

Cervicalreflection.

Flap#1.Cervical.Fiberscutwitha15cblade(or11or12)oreventhetipofaLuxator.NoPEneededunlessyouusea700intothePDL.

Flap#2.MiniflapMadewithaPE,exposingenoughbonetoplaceforcep beaktobone.Suturepapillaewhendone.

Flap#3.Envelope.1)Buccalplateboneremovalnotadvisedasshowninprinthere.2)Cryertoobig.shouldhavebeenthe“miniCryer”.

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Triangularflap,asoftenusedtoremovedeeperimpactedthirdmolars.

Eitherhandpiece canbeusedfororalsurgery-- aslongasthehighspeed isa”surgical”one.

Flap#4.Triangular.Angledrelease- onetoothaway fromtheoneworkedon.

Whathappenswhenyou“slip”withaLuxatororelevator?

Facialartery

SlippedIntoMBF

Preventsslipping.

Triangularflap

Flap#5.Trapezoidal.Atrapezoidalflapwouldinvolvea2nd releaseontheotherside.(Notcommonlydone.Oneexamplecouldbewithsinuslateralwindowflaps.)

SuturingIdeasUsefulinGenenal Practice

RegularInterrupted

“X”Suture(sometimescalledfigure-of-eight)

HorizontalMattress

CrossHorizontalMattress

Continuous-lock

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References.Startingwithalongertailasanoptionthatis

madeshorterbeforetheknotistied.

Dr.Silverstein’sRuleof3s.

• Needlepenetrates3mmfromtheedgeofthewoundoratthebaseofapapilla.• Suturesalonganincisionare3mmfromeachother.• Whentheassistantcutsthethread,itiscut3mmfromtheknot.• Surgeon’sknotis3timesaroundtheneedleholder(firstoneisdouble).Eachtime,thedirectionchanges.

RegularinterruptedSuture(1st type).

Suturingareleasingincision.Needleentersfromthe“loose”side.Ifthefixedsidetears(lesslikelywitha½circleneedleeventhougha3/8circleisgenerallybetterforexodontia)thenyoucanhelpbyliftingupthefixedsideslightly.Knotonthe“fixed”side.

Needlegoesfromflaptofixedside.

Onlyifthefixedsideistearing,dothis. Knotonthefixedside.

ReverseInterruptedSuture(3rd type).Doesn’tsnagthemembranewithagraft.Knotonthetop.

Advantages:Betterforbonegraftswith

membranes.

Lingual

Knotontop.

Buccal

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Somenotes:

• 3/8circleneedleisbetterforexodontia.• Longerstretchtothelingual.

• Reversecuttingislesstraumatictotissuethana“cutting”needle.• Hemostatsshouldneverbeusedtotiesutures,onlyneedleholders(drivers).• Chromicgutiscommonforexodontia.Tensilestrengthfor5daysandresorbable.• Plaingutkeepsstrengthforonly1-2days.• 3.0or4.0arecommonlyused.

“X”Suture.TheXisontopofthesofttissueallowingforbetterhemostasis.

Advantages:Fastandeasy.

Buccal

HorizontalMattress.Easytoplace.

Advantages:Cansometimesactinplaceoftwointerruptedsutures,especiallyforasmallersocket.

Cocero,N,etal.BleedingrateduringoralsurgeryOforalanticoagulanttherapypatientswithassociatedsystemicpathologicentities:Aprospectivestudyofmorethan500extractions.JOralMaxiiolfac Surg.72:858-867,2014.

Examplesofusingahorizontalmattressforexodontia.

CrossHorizontalMattress.CanrestonahemostaticagentORonamembrane.

Advantages:Helpskeepaproductaddedtothesocketinplace.Mayneedinterrupteds onmesialanddistal.

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Manydentalsuturevideos.

The End