midterm 2 - lecture 5 Flashcards
Types of flap positioning
_ returned to its original positions (as in the modified Widman flap)
Replaced flap
Types of flap positioning
_ moved or advanced laterally, coronally, or apically to a new position.
Positioned:
Types of flap positioning
_ positioned flap eliminates the pocket by apically displacing the soft tissue wall of the pocket.
In doing so it preserves and/or increases _
The apically positioned
the width of the attached gingiva
by transforming the previously unattached keratinized pocket wall into attached gingiva tissue.
Types of flap positioning
The _ positionnig flaps may be used to cover areas of gingival recession.
coronally (regenerative too) and laterally positioned
_ describes any strand of material utilized to ligate (tie) blood vessels or approximate (sew) tissues.
suture
The primary objective of _ is to position and secure surgical flaps in order to promote optimal healing.
dental suturing
- Provide adequate tension of wound closure without dead space but loose enough to prevent tissue ischemia and necrosis 2.Maintain hemostasis 3.Permit healing by primary intention4.Reduce postoperative pain5.Prevent bone exposure resulting in delayed healing and bone resorption 6.Permit proper flap position
suture materials
silk
polyester (nylon and ePTFE)
non-resorbable
suture materials
plain gut, chromic gut, coated vicryl
resorbable
natural - plain gut and chromic gut
synthetic - coated vicryl
suture type
Resorbed by proteolytic enzymatic digestive process in 7-10 days
poorest tensile strength
moderate tissue rxn
uses - rapidly healing mucosa
avoid removal
gut type chromic gut
weakest
suture type
resorbed by slow hydrolysis 56-70 days
high tensile strength
minimal tissue rxn
used to resist muscle pull
subepitheliual mucosal surfaces
coated vicryl
Used to resist muscle pull (eg. Horizontal mattress suture)Subepithelial mucosal surfacesResorbable
suture type
Gradual encapsulation by fibrous connective tissue. Usually cannot be found after 2 yrs
moderate tensile strength
moderate tissue rxn
mucosal surfaces
Nonresorbable
surigcal silk
suture material
non-resorbable
high strength
extremely low tissue rxn - inert
all types of soft tissue approximation
Expanded polytetrafluoroethylene(ePTFE), Gore-Tex (monofilament)
_ and _ sutures are used most often
Silk and synthetic
_ sutures are used only when retrieval is difficult.
gut
_ sutures are recommended for bone augmentation procedures to prevent the “wicking” and to reduce inflammatory response and permit longer retention (10-14 days)
Monofilament
gortex eptfe
_ and _ sutures are recommended for guided tissue regeneration procedures.
4.Gore-Tex and coated vicryl
ePTFE or goretex is the best!!!!!
Placement of needle in tissue
1.Force should always be applied in the direct
ion that follows the curvature of the needle2.Suturing should always be done from a _ to _ tissue
3.Grasp the needle in the body _ of the length from the swaged area. 4.Avoid retrieving the needle from the tissue by the tip. This will damage or dull the needle. Grasp the body as far back as possible
5.Sutures should be placed in _tissue whenever possible
6.An adequate tissue bite is required to keep the flap from tearing
from a movable to a non movable tissue
one-quarter to one-half of the length
keratinized tissue whenever possible
Knot tying
- The completed knot must be tight, firm, and tied so that slippage will not occur.
- Knots should not be _
- Knots should be small and the ends cut short (2-3 mm).
- Do not tie suture too tightly as tissue necrosis may occur
- Avoid excessive tension with smaller gauge suture materials as breakage may occur.
placed in incision lines
Knots have three components
:1.The loop created by the knot
2.The knot itself, which is composed of a number of tight “throws” each throw represents a weave of the two strands.
3.The ears, which are the cut ends of the suture.
made by tying two overhand knots, each done in opposite directions. The first loop is made by passing the suture material over the jaws of the needle holder, and the second knot is subsequently made by forming a loop under the jaws of the needle holder. This knot may loosen when a synthetic or monofilament suture material is used.
square knot
alsomade with two overhand knots but both are in the same direction. With a needle holder, one overhand knot is made so that the loop forms over the jaw of the needleholder and is then tightened. A second overhand knot is then made so that the loop goes in the same direction over the needle holder and is tightened.
slip knot
the most commonly used knot in dental surgery. It is a modified square knot. The first overhand knot is doubled: there fore two loops of the suture are formed over the jaws of the needle holder and tightened. The last loop is formed under the jaws of the needle holder in a direction opposite from the first loops.
surgeon’s knot
The _has a basic design composed of three parts
- The eye which is swaged (eyeless) and permits the suture and needle to act as a single unit to decrease trauma.
- The body which is the widest point of the needle and is also referred to as the grasping area. The body comes in a number of shapes ( round, oval, rectangular, etc)
- The point which runs from the tip to the maximum cross-sectional area of the body. The point also comes in a number of different shapes (conventional cutting, reverse cutting, taper cut, etc)
surgical needle
1.The smaller the needle, the smaller the needle holder required.2.Needles should be grasped _the distance from the swaged area to point. 3.The needle should be placed securely in the tips of the jaws and should not rock twist or turn.4.Do not over-close the needle holder to avoid causing damage to the needle
one-quarter to one-half from swag point
_ sutures are most often used for the following 1.Vertical incision2.Tuberosity and retromolar areas3.Bone regeneration procedures4.Widman flap, open flap debridement, replaced flap, apically positioned flap 5.Edentulous spaces6.Partial or split-thickness flaps7.Dental implants
Interrupted
