Chapter 2

Surgical Armamentarium, Sutures, Anesthesia, and Postoperative Management

Serge Dibart

ARMAMENTARIUM

This includes the basic surgical kit:

• Mouth mirror
• Periodontal probe (UNC15; Hu-Friedy, Chicago, IL, USA)
• College pliers (DP2; Hu-Friedy)
• Scalpel handle no. 5 (Hu-Friedy) with blade no. 15 or 15C
• Tissue pliers (TPKN; Hu-Friedy)
• Periosteal elevator 24G (Hu-Friedy)
• Prichard periosteal elevator (PR-3; Hu-Friedy)
• Gracey curette 11/12 or Younger-Good universal curette (Hu-Friedy)
• Rhodes back-action periodontal chisel (Hu-Friedy)
• Castroviejo needle holder (Hu-Friedy)
• Goldman-Fox curved scissors (Hu-Friedy)
• A 5–0 silk suture with P-3 needle
• A 5–0 chromic gut suture with C-3 needle
• Periodontal dressing

For basic microsurgical procedures, add the following to the kit:

• Magnifying loupes x4 (or higher) wide field or surgical microscope
• Surgical headlight (optional)
• Miniblade scalpel handle with miniblades (round tip and spoon blade angle of 2.5 mm)
• Micro Castroviejo needle holder
• Castroviejo curved microsurgical scissors
• Microsurgical tissue pliers
• A 6–0 chromic gut suture with C-1 needle
• A 7–0 coated vicryl suture 3/8 with 6.6-mm needle

SUTURES

Use the smallest and least reactive suture material compatible with the surgical problem (Halstead 1913).

Types

Two major categories of suture materials exist—resorbable and nonresorbable. These sutures are best used with tapercut needles, which have a sharp point and pass atraumatically through the mucogingival tissue, making them ideal for periodontal plastic surgery use.

Nonresorbable sutures Silk (braided)

A silk suture is easy to use, and its smooth handling ensures knot security. A disadvantage, however, is that it will absorb plaque and may infect the wound if kept longer than 1 week.

Polyester (nylon monofilament, polytetrafluoroethylene)

The polyester suture can be kept in the mouth longer, for 2–3 weeks, with little risk of infection. A disadvantage is that it is likely to untie if extreme care is not exerted when tying the knot. This is a result of the materials’ characteristics.

Resorbable sutures

Gut

A gut suture has mild tensile strength and is resorbed by the body’s enzymes in approximately 5–7 days. A disadvantage is that its knot-handling properties are inferior to those of silk sutures. Gut sutures may untie, so care must be taken not to cut the ends too short. Gut sutures may also irritate the tissues.

Chromic gut

A chromic gut suture has moderate tensile strength and is resorbed in 7–10 days. This suture is more practical than the gut suture.

Polyglycolic acid (synthetic)

The polyglycolic acid suture has good tensile strength, resorbs slowly (within 3–4 weeks intraorally),/>

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