Primary Closure: Best Techniques?
Dr. M. asks:
This question maybe simple, yet it is undefinitive. I would like to get some advice on the best techniques for obtaining primary closure over implant and bone graft sites. Is there a general or standard protocol for making incisions into the periodontal tissue? Is it better to do full thickness or partial thickness flaps? Is the horizontal mattress suture the best technique for suturing flaps to achieve stable primary closure? How much tension should the sutures have? Is it better to use resorbable or non-resorbable suture material? I understand each case is decided on an individual basis. But what I am looking for is techniques that provide the most chance of success. Thanks.
3 Comments on Primary Closure: Best Techniques?
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sb oms
1/24/2011
Take some CE please -there are so many good classes out there.
this is too broad a topic for one post
Steven
1/25/2011
I agree with the first posting. A few generalities:
1. Flap should be released, ie with partial thickness dissection into the vestibule so that tension-less closure can be accomplished. I emphasize that there should be NO tension on the flaps with closure.
2. Horizontal mattress sutures are often used initially to secure initial closure of the flaps, followed by interrupted sutures as needed.
3. Non-resorbable sutures allow for a greater time period for flap immobilization.
Rob Dunn
2/1/2011
Once the tension has been released by vestibular incision of the periosteum, I prefer to use non-resorbable sutures such as 4.0 prolene which allow more accurate placement of the flaps, and as above give better long term flap stabilisation
