A lecture for 4th stage dentistry college (oral and maxillofacial surgery department )

1. principles of suture and flap
design
Dr.Mohammed rhael
Tikrit dentistry college

2. Tips for Surgical skill
 Knowledge of the basic principles of surgery
 Knowledge of anatomy
 training

3. Incision vs flap

4. Basic principles of incision in oral
surgery
 Use new sterilized blade ( number 15 )
 Scalpel grasped in a pen grasp for maximum
control and tectile sensetivity
 The incision should be made at right angle to the
undelying bone
 The scalpel should moved in single constant firm
movement

8. Basic principle of flap design
Avoid anatomical structures
The base wider than the apex
Adequate width for maximum
visualization
The flap should be wider than
anticipitaed bony defect
Delicate handling of flap without
tension
Vertical releasing incision should
start at buccal vestibule and end
at the interdental papilla not at
the buccal or labial surface .

9. Sites where vertical releasing incision
contraindicated
Transveres incision in palate
Lingual incision of the mandible
Canine eminence
Between lower premolars

17. Three sided flap (trapezoidal flap)

20. Semilunar flap

22. Flap for palatal tori removal

23. Flap for oro-antral fistula closure

25. suturing

26. • Monofilament , multifilament
• Absorbable , non absorbale
• Natural ,synthetic

28. Absorbable sutures
• Plain cutgut
• Chromic cutgut
• Polyglactin (vicryl)
• Polydioxanone (PDS)

29. Non –absorbable sutures
• Silk
• Nylone
• Polypylene (prolene )

30. Needles
• Needle of 18 -26 mm in length are the suitable
for oral surgery
• According to suture side of the needle
• Eyed , eyeless
• According to the tip of the needle
¼ circle , ½ circle , 3/8 circle , 5/8 circle

37. • According to the cross section of needles
• Needle with round or oval cross section
• Needles with triangular cross section 9
cutting or reverse cutting )

38. Needle holder , tissue forcepse

39. Needle holder vs mosqueto

40. Basic principles of suturing
• Non touch technique
• Fewer number of suture as possible
• From mobile to fixed tissue
• 3-5 mm from margin and needle should enter at right
angle to the mucosa
• Avoid over tightening , overlapping of the wound
• Undermine the incision to facilitate insertion of the
needle and decrease tension
• Suture removed after 5-7 days

43. Suture techniques
• Simple interrupted suture
• Continous suture ( locking or non locking)
• Mattress suture
• Figure of eight suturing

50. Video

51. Thank you for listening