Suturing

Sutures maintain the position of the flap reattachment during the initial phase of the first-intention healing process. A suture should just compensate for the tension of the flap. It should be atraumatic, non-allergenic, and easy to use.

Armamentarium

• Sutures
• Tissue forceps
• Needle holder
• Scissors
• Instrument case

Types of Healing

The surgical site should be closed only after irrigation to remove all debris, and careful visual and radiographic inspection of the surgical area. A radiograph should be taken with the flap in place to detect any foreign objects in the bone crypt or adhering to the flap, and to confirm the depth and density of the retrofilling cement.

Accurate passive coaptation of edges facilitates hemostasis, reduces the size of the wound to be repaired, prevents bone destruction, and renders a fast healing process with no pain or inflammation. This is primary-intention healing. Secondary-intention healing occurs when active coaptation of edges increases tension that prevents micro-revascularization, so drying out, tissue shrinkage and necrosis occurs. Secondary-intension healing occurs also when edges are not coapted, so inadequate hemostasis is produced with bone exposure and pain. Blood and serum can accumulate under the flap, and a separation of the flap from the underlying bone causes inflammation and/or infection, with a delayed healing process.

Wound healing varies from region to region in the body and depends on several factors, including the type of tissue, the type of wound, and the type of healing. In periradicular surgery, the tissues include free and attached gingiva, the alveolar mucosa, periosteum, bone, periodontal ligament, and cementum. Healing occurs by primary or secondary intention. An incisional blunt dissectional wound can be considered to heal by primary intention, whereas a dissectional wound involving the resected root surface and osseous crypt heals by secondary intention.

All wounds progress through three broad, overlapping phases in the process of healing: inflammatory, proliferative, and maturation phases