PRACTICAL APPLICATIONS
Basic Suture Techniques for Oral Mucosa
Terrence J. Griffin,* Yong Hur,* and Jing Bu
Focused Clinical Question: What is the pre-
ferred suture method for maintaining wound closure?
Summary: Optimal wound healing after surgical
procedures requires good soft-tissue management.
The final key step for a refined surgical technique is ade-
quate closure by suturing. This article reviews the most
common suturing methods used in dentistry, and their
applications in various periodontal surgeries are dis-
cussed. The nine most common periodontal suture tech-
niques and six different periodontal surgical categories
were selected by the periodontal faculty at Tufts Univer-
sity School of Dental Medicine. A survey was distributed
to periodontists in the United States, each of whom se-
lected their choice of suture technique for each of the
periodontal surgical procedures. The results of this sur-
vey show that simple interrupted sutures were used in
the majority for each surgical procedure.
Conclusion: Although suture selection and applica-
tion is complex because of multiple variables, an effort was
made to establish a general consensus and current trends
regarding suturing techniques. Clin Adv Periodontics
2011;1:221-232.
Key Words: Hemostasis, surgical; humans; surgical
flaps; sutures; suture techniques.
Soft-tissue healing in dental surgery depends on good
surgical technique and soft-tissue management.1,2 Gentle
flap manipulation, ideal incision placement, and appropri-
ate suture techniques are required for optimal healing.3-7
Proper technique and material for suturing will promote
wound healing through close approximation of the flap
edges, minimized dead space, reduced postoperative bleed-
ing, resistance to tension on the flap margins, and the
prevention of infection.8-14
There are various suturing techniques used in dental ap-
plications.15,16 Each technique has advantages and disad-
vantages. The choice of suture technique comes with the
understanding of the wound anatomy and the surgeons
preference.17,18 With the proper technique, the dentist will
be able to overcome challenges, such as variations of the
anatomy of the wound, tension of the flaps, thickness of
the gingiva, and esthetic needs of the patient.
* Department of Periodontology, Tufts University School of Dental
Medicine, Boston, MA.
Berkshire Medical Center, Pittsfield, MA.
Submitted May 10, 2011; accepted for publication July 19, 2011
doi: 10.1902/cap.2011.110053
The purpose of this article is to review the basic suturing
techniques, their advantages and disadvantages, as well as
their applications in various periodontal surgeries. The
nine most common suturing techniques and six different
periodontal surgical categories were selected by 25 peri-
odontal faculty members at Tufts University School of
Dental Medicine. An informal survey was sent out to peri-
odontists in the United States to gauge the usage of each
suture technique with various periodontal surgical proce-
dures. Frequently, more than one suture technique is used
in a surgery. These survey results were tabulated, and the
general consensus for the applications of each suture tech-
nique will be discussed.
Principles of Suturing
Avoid Excessive Tension on Sutures
Excessive tension on wounds will result in the blanching of
the flaps and wound edges. This may result in necrosis at
the wound edge as a result of interference of the blood sup-
ply (Fig. 1). Another complication is tearing of the flap by
the suture, resulting in tracks, which are small cuts left by
the suture as it dissects through the tissue. These tracks of-
ten contribute to flap retraction, graft exposure, and post-
operative pain.
Suture Whenever Possible From Movable to
Immovable Tissue
This allows for more precise positioning of tissue edges and
better wound closure. It is easier to control the suture nee-
dle and manage the flap if the moveable tissue (i.e., the flap)
is approximated to a steady base.
Always Try to Keep Knots Away From
Wound Edges
Knots are both the most irritating and weakest part of any
suture technique. For this reason, place the knots so that
they are away from the wound edges whenever possible.
Use as Few Knots as Possible
This is a corollary to the previous principle for much the
same reasons. Avoid knots whenever possible because they
represent the weakest part of any wound closure and at the
same time can be the greatest irritant.
Use the Smallest Suture Possible to
Close the Wound
It is generally better to use several small sutures rather than
a lesser number of large-gauge ones. A number of smaller
sutures are less irritating to the tissues than a larger one,
Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011 221
P R A C T I C A L A P P L I C A T I O N S
FIGURE 1 Flap necrosis attributable to excessive swelling and tension for
the wound edges.
especially if it is a multifilament material. In addition,
smaller sutures result in smaller perforations than larger
sutures and heal much more quickly. Several smaller su-
tures are better able to secure the wound and less likely
to result in tissue tears because they do not weaken the in-
tegrity of the tissue as much.
Use the Least Amount of Sutures That Will
Secure the Wound
Do not over-suture. Excess suturing causes needless perfo-
ration of the tissues bordering the wound and interferes
with the blood supply. This will, in turn, affect the integrity
of the wound and its healing.
Advantages and Disadvantages
of Continuous Sutures
Many surgeons prefer continuous suture techniques over
interrupted sutures. Both techniques have advantages and
disadvantages.19
Continuous Sutures: Advantages
The advantages of continuous sutures include: 1) involving
as many teeth as required; 2) minimizing the use of knots;
3) using teeth to anchor the flap; 4) eliminating the need
for periosteal sutures; 5) enabling independent placement
of buccal, lingual, or palatal flaps; and 6) requiring less time
for both placement and removal.
FIGURE 2a Horizontal-mattress sutures placed as a secondary suture line to approximate the wound
edge. 2b Simple-loop interrupted sutures used to close the wound as a primary suture line.
222 Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011
Continuous Sutures: Disadvantages
If breakage or resorption occurs anywhere along its length,
a portion of or the entire flap may loosen, exposing bone,
implants, grafts, etc. The entire suture is only as secure as its
weakest knot.
Primary and Secondary Suture Line
Secondary Suture Line
The secondary suture line (Fig. 2a) is used to give strength to
wound closure and compensate for muscle and soft-tissue
pull. The suture line is usually away from the wound edges.
It is used as an adjunct to the primary suture line by taking
stress away from the edges of the wound. After using a sec-
ondary suture line, a primary suture line is usually used to
close the edges of the wound and complete closure.
Primary Suture Line
The primary suture line (Fig. 2b) is the most common type of
suture line used in surgery. This suture line is used to close
the incision. It is usually the only type of suture used except
in large wounds in which resistance to muscle and soft-tissue
pull and wound security are of paramount importance.
Handling the Needle
The needle consists of the needle point, the body, and the
swaged end (Fig. 3). The needle point is sharp and is de-
signed to pierce through tissues. Designs of the body include
reverse cutting edge, tapered point, tapered cut, or conven-
tional cutting edge. For the most part, the reverse cutting
edge is used because it prevents the needle from tearing
through the tissue as the needle cuts through the tissue.
The swaged end is pressed fitted around the suture line to
provide smooth passage of the needle through the tissue.
The needle holders have a cross-hatching pattern of teeth
for its beak. This prevents the needle from being damaged as
well as gripping the needle adequately. Maximal control of
the needle is achieved when the needle is held approximately
two thirds the length of the needle from the needle point
and z3 mm from the tip of the beak of the needle holder
(Fig. 4). Gripping the needle point or swaged end should be
avoided to prevent damage to the cutting edge or damage to
the swaged end. When suturing, the needle tip should pierce
perpendicular to the soft tissue. Small circular twists of the fore-
arm should be used to pass the needle through the soft tissue.
Periodontal Suture
Techniques
Interrupted Suture Techniques
Simple-Loop (Interrupted) Suture
Technique
This is the most commonly used suture
technique in dentistry. It can be applied
in most periodontal procedures to close
elevated flaps and vertical and horizon-
tal incisions and to stabilize soft tissues.
Dental Suture Techniques

FIGURE 3 Anatomy of a needle.
The technique is as follows (Fig. 5) (Video 1):
n Pierce the outer surface of the buccal flap with the suture
needle.
n Thread the needle under the interproximal contact and
pierce the inner aspect of the lingual flap with the suture
needle.
n Pass the suture needle under the interproximal contact
toward the buccal aspect.
n Tie off the free ends of the suture. Cut off the suture, leav-
ing 2 to 3 mm of suture material.
Figure-Eight (Interrupted) Suture Technique
This is another very commonly used suture technique in
dental surgery and is frequently confused with the simple
loop. The indications for its use are similar to simple-loop
interrupted sutures. The main advantage is easier access
FIGURE 4 Handling the needle holder. 4a Note that the index finger position allows for precise control of
needle holder. 4b Use of thumb and ring finger permits the index finger to control the delicate movements.
4c Castroviejo with pen grip. 4d Needle was grasped at two thirds of the diameter of the needle.
Griffin, Hur, Bu
P R A C T I C A L A P P L I C A T I O N S
between the teeth. A disadvantage is that there will be in-
terposed suture material between the flaps that may pre-
vent ideal approximation of the flap edges compared to
the simple-loop interrupted suture technique.
The technique is as follows (Fig. 6) (Video 2):
n Pierce the outer surface of the buccal flap with the suture
needle.
n Thread the needle under the interproximal contact and
pierce the outer aspect of the lingual flap with the suture
needle.
n Pass the suture needle through the interproximal contact
and tie and cut off the remaining suture, leaving 2 to 3 mm.
Vertical-Mattress (Interrupted) Suture Technique
The vertical-mattress suture technique allows for precise flap
and papilla placement. It is often used in conjunction with peri-
osteal sutures. It is frequently used in periodontal resective ther-
apy and guided tissue regeneration (GTR) procedures.
The technique is as follows (Fig. 7) (Video 3):
n Pierce the buccal flap just above the mucogingival junc-
tion, anchoring the flap to the underlying periosteum.
n Note that the underlying periosteum has not been re-
flected to engage.
n The needle should emerge from the center of the papilla
2 to 3 mm from the flap edge.
n Pass the needle through the contact area and anchor the
lingual flap the same way, starting from the center of the
lingual papilla 2 to 3 mm from the flap edges.
n Thread the needle through the interproximal contact and
tie and cut the suture on the buccal side, leaving 2 to 3
mm of suture material.
Horizontal-Mattress (Interrupted)
Suture Technique (Including ``X``
Modification)
The design of the horizontal-mattress
suture technique resists flap tension
caused by muscle pull and soft-tissue con-
traction. However, additional sutures
are necessary to approximate the wound
edges. The reason for this is that the
horizontal-mattress suture is a secondary
suture line. The placement of the suture is
away from the wound edges and does
not provide complete closure of the
wound edges. Primary suture lines
are then placed to hold the wound
edges together so that healing can
occur by primary intention. This su-
ture can be left for an extended time
such as in augmentation procedures.
The technique is as follows (Fig. 8)
(Video 4):
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P R A C T I C A L A P P L I C A T I O N S

anchorage the teeth. The ability to vary

the tension and vertical position of the
flap to a tooth or implant allows the sur-
geon good control of the extra forces of
the flap.
The technique is as follows (Fig. 9)
(Video 5):
n Pierce the outer aspect of the flap at
its distal end and pass the needle un-
der the interproximal contact.
n Wrap the suture mesially around the
tooth and pass the needle through
the interproximal contact and pierce
the inner aspect of the flap.
n Thread the suture needle through the
mesial interproximal contact and wrap
the suture around the tooth, going
distally.
n Pass the suture needle through the dis-

FIGURE 5 Simple-loop interrupted suture technique. 5a Initial suture placement. 5b Lingual flap tal interproximal contact and tie and
piercing. 5c Tying of the knot. 5d Clinical application. cut the suture, leaving 2 to 3 mm of
suture material.

Continuous Suture Techniques

FIGURE 6 Figure-eight interrupted suture technique. 6a Initial suture placement. 6b Lingual flap
piercing. 6c Tying of the knot. 6d Clinical application.
n Pierce the external side of the buccal flap 3 to 4 mm from
the flap margin.
n Pierce the internal side of the lingual flap 3 to 4 mm from
the lingual flap margin.
n Penetrate the external side of the lingual flap 5 mm lat-
erally from the second piercing.
n Pass the needle through the internal side of the buccal flap
and tie the free ends.
Sling (Interrupted) Suture Technique
The indication for the sling suture is the need for re-
positioning flaps in a coronal direction with additional
Continuous Interlocking Suture
Technique
This is used for long edentulous spans,
such as implant placements, ridge aug-
mentations, or reductions. It is a quick
and efficient way of closing long horizon-
tal or vertical incisions.
The technique is as follows (Fig. 10)
(Video 6):
nFrom the distal end, tie a simple loop
and cut off only the free end.
n Pierce both flap margins 5 mm laterally
from the simple loop.
n Thread the needle under the last hor-
izontal span.
n In increments of 5 mm from the last
locking segment, pierce both flap mar-
gins until the entire span is closed.
n Leave a small loop of suture on the final segment after
piercing both flap margins.
n Use the loop of suture to tie off the suture. Cut off all ex-
cess ends, leaving 2 to 3 mm of material.
Continuous Horizontal-Mattress Suture
Technique
The continuous horizontal-mattress suture technique includes:
n Initial suture placement of simple-loop interrupted
n Horizontal extension of the suture

224 Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011 Dental Suture Techniques
 P R A C T I C A L A P P L I C A T I O N S

Continuous Vertical-Mattress
Sling-Suture Technique
Continuous vertical-mattress sutures
can be used for resective procedures to
position the flap apically and to prevent
the recurrence of periodontal pockets. It
is frequently used for flaps in osseous
and crown-lengthening procedures.
The technique is as follows (Fig. 12)
(Video 8):
n Starting from the mesial aspect, tie an
interrupted vertical-mattress suture
and cut off the free end.
n Wrap the suture distally around the
tooth on the buccal aspect and perform
a vertical mattress on the lingual aspect.
n Pass the needle through the contact
area and perform a vertical mattress
on the buccal aspect.
n Alternate the side of the placement of
the vertical mattress and the sling
through the entire span.
n Leave a small loop of suture on the
final segment.
n Use the loop of suture to tie off the
suture.

FIGURE 7 Vertical-mattress interrupted suture technique. 7a Initial suture placement. 7b Note the
engagement of the periosteum. 7c Buccal view with the second piercing. 7d Lingual flap piercing. 7e
Tying of the knot. 7f Clinical application.
n Locking of the suture
n Final loop
n Tying the suture
n Clinical application
The continuous horizontal-mattress suture is an efficient
way of obtaining secure adaptation of opposing flaps in
edentulous areas. It will resist tension on the flaps from
muscle pull and will evert the flap edges and cause dehis-
cence. Applications for the continuous horizontal-mat-
tress technique are implants and regenerative procedures.
Like with the simple interrupted horizontal-mattress tech-
nique, it is used as a secondary suture line and will require
another suture to maintain the approximation of the flap
edges.
The technique is as follows (Fig. 11) (Video 7):
n Tie a simple loop on the distal aspect and cut the free end.
n Pierce both flaps 5 mm from the initial simple loop.
n Continue the piercings in increments of 5 mm, alternating
between buccal and lingual flaps.
n On the final segment, leave a small loop of suture material
after piercing both flaps.
n Use the loop of suture to tie the suture. Cut off all excess
ends, leaving 2 to 3 mm of excess.
Continuous Independent Sling-
Suture Technique/Continuous
Dependent Sling-Suture
Technique
Continuous independent sling sutures are indicated when
a flap with multiple papillae are elevated on a single side.
This is an extension of the sling-suture technique.
The technique can be applied for the other side if both sides
are elevated. The continuous dependent sling-suture tech-
nique can be used as well if the surgery involves a periodontal
flap for both sides. Surgeries that may require a muco-peri-
osteal flap for both sides include osseous surgeries, crown-
lengthening procedures, and open-flap debridement. The
continuous dependent sling-suture technique has a better
ability to vary flap tension than the continuous independent
sling-suture technique.
For continuous independent sling sutures, the technique is
as follows (Fig. 13) (Video 9):
n Tie a simple loop and cut off the free end.
n Sling around the tooth on the lingual side.
n Pass the needle through the contact area and anchor the
buccal flap by piercing the center of the papilla z2 to 3
mm from the flap margins.
n Continue the sling on the lingual side until the span is
closed.
n On the final segment, leave a loop of suture. Tie off the
free ends of the suture using the loop of suture.

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P R A C T I C A L A P P L I C A T I O N S

For continuous dependent sling

sutures, the technique is as follows
(Fig. 14):
n Enter the outer aspect of the buc-
cal flap from the mesial aspect and
leave a free end.
n Pass the needle through the contact
area, first pierce the opposite side
flap from the inner aspect, and then
return the needle to the buccal as-
pect where you tie off to the remain-
ing free end. The papillae should be
anchored by piercing 2 to 3 mm from
the flap margins.
n Continue the sling around the lin-
gual aspect and pierce the buccal
flap from the outer aspect.
n Pass the needle under the contact
area and pierce the lingual flap from
its inner aspect.
n Return the needle to the buccal aspect
and then wrap around the tooth to
enter the contact area of the next dis-
tal tooth.
n Pierce the underside of the lingual
flap and return to the buccal aspect
where the inner side of the buccal
flap is pierced.
n Now, return through the contact
FIGURE 8 Horizontal-mattress interrupted suture technique. 8a Initial suture placement. 8b Lingual flap area where a sling is formed distally
piercing. 8c Second piercing on the lingual side. 8d Second piercing on the buccal side. 8e Tying of the and then the inner aspect of the buc-
knot. 8f Clinical application.
cal flap is engaged.
n Continue distally by anchoring the
flaps by alternating between the
buccal and lingual sides until the en-
tire span is secured.
n On the final segment, leave a large
loop to tie off the free ends of the
suture.

National Survey of Current

Periodontal Suture
Techniques
The nine most common suturing tech-
niques and six different periodontal
surgical categories were selected by
25 periodontal faculty members at
Tufts University School of Dental
Medicine. The protocol was approved
by the Tufts Medical Center Institu-
tional Review Board. A survey was
sent out to periodontists in the United
States to gauge the usage of each suture
FIGURE 9 Sling-suture technique. 9a Initial suture placement. 9b Piercing after sling around the tooth. 9c technique with various periodontal sur-
Tying the suture after the second sling. 9d Clinical application.
gical procedures. These survey results
reflect the general consensus for the
applications of each suture technique.

226 Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011 Dental Suture Techniques
 P R A C T I C A L A P P L I C A T I O N S

The nine suturing techniques in-

cluded: 1) simple-loop (interrupted);
2) figure-eight (interrupted); 3)
vertical-mattress (interrupted); 4)
horizontal-mattress (interrupted);
5) sling (interrupted); 6) continuous
interlocking; 7) continuous horizontal-
mattress; 8) continuous vertical-sling;
and 9) continuous independent sling/
continuous dependent sling.
The six categories of periodontal
surgeries were: 1) crown lengthening
or periodontal resective procedure
without pocketing; 2) flap surgery
with osseous recontouring or other
resective procedures; 3) GTR; 4)
soft-tissue grafting, such as free gingi-
val graft or subepithelial connective tis-
sue graft; 5) implant therapy without
guided bone regeneration (GBR) proce-
dures; and 6) GBR procedures or max-
illary sinus augmentation.

Results
For crown lengthening and peri-
odontal resective procedures without
periodontal pockets, the interrupted
simple-loop suture was used by 41.5%
of the periodontists surveyed. The in-
FIGURE 10 Continuous interlocking suture technique. 10a Initial suture placement of simple-loop terrupted vertical-mattress suture was
interrupted. 10b Horizontal extension of the suture. 10c Locking of the suture. 10d Final loop. 10e Tying
the suture. 10f Clinical application. used by 21%, whereas the continuous
sling was used by 17% of the polled
periodontists. The continuous vertical
mattress sling was used by 9.2% of the
respondents. The other techniques each
attained a usage of <6% (Fig. 15).
Flap surgery with osseous recon-
touring and other resective periodon-
tal procedures again had interrupted
simple-loop sutures as the majority,
coming in at 36.3% usage. Continuous
sling sutures came in at a close second
at 26.2% use, whereas both continuous
and interrupted vertical-mattress sling
sutures gained the vote of 13.6% from
the respondents. Other techniques each
were used <7% of the time (Fig. 16).
With GTR, interrupted simple-loop
sutures were used by 35.4% of the
dentists. Interrupted vertical-mattress
sutures were used for GTR by 28.7%.
Interrupted horizontal-mattress su-
tures were used by 10.9% and inter-
FIGURE 11 Continuous horizontal-mattress suture technique. 11a Initial suture placement of simple- rupted sling sutures were used by
loop interrupted. 11b Horizontal extension of the suture. 11c Tying the suture. 11d Clinical application. 8.4%. The other techniques were each
used <5% by the polled periodontists
(Fig. 17).

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P R A C T I C A L A P P L I C A T I O N S

FIGURE 12 Continuous vertical-mattress sling-suture technique. 12a through 12c Vertical-mattress interrupted suture. 12d through 12f The second vertical
mattress after buccal sling. 12g Continuation of the vertical mattresses after lingual sling. 12h Tying the suture. 12i Clinical application.

FIGURE 13 Continuous independent sling-suture technique. 13a and 13b Initial sling suture without tying. 13c Sling sutures on the same side on the buccal
aspect. 13d and 13e Continuation on the lingual sling sutures. 13f Tying the suture.

The interrupted simple-loop suture once again was used
most frequently (46.1%) with soft tissue grafts such as the
free-gingival, or subepithelial connective tissue grafts. In-
terrupted sling sutures were used 23.9% and continuous
sling sutures was used 13.2% of the time. The other tech-
niques were each used 5% of the time (Fig. 18).
Implant therapy without GBR was predominantly done
with interrupted simple-loop sutures. Interrupted simple-loop
sutures were overwhelmingly used in 74.2% of the cases.
Other techniques each were used <8% of the time (Fig. 19).
GBR was generally sutured using simple interrupted sutures
at 42.9% from the responding periodontists. Continuous

228 Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011 Dental Suture Techniques

FIGURE 14 Continuous dependent sling-suture technique. 14a Initial sling suture. 14b and 14c Alternate
the placements of sling sutures. 14d Loop positions.
FIGURE 15 The usage of various suture techniques for crown lengthening
or periodontal resective procedure without pocketing. n 523.
FIGURE 16 The usage of various suture techniques for flap surgery with
osseous recontouring or other resective procedures. n 523.
Griffin, Hur, Bu
P R A C T I C A L A P P L I C A T I O N S
sutures were frequently used at 18.6%,
interrupted horizontal-mattress sutures
at 15.8%, interrupted vertical-mattress
sutures at 9.5%, and all other tech-
niques each came in at <5% (Fig. 20).
Discussion
The goal of this survey was to deter-
mine the indications of each suturing
technique for various periodontal sur-
gical procedures for ideal conditions.
The methodology is simpledpoll prac-
ticing periodontists in what suturing
technique they preferred to use for
each surgery type and then tabulate
the results. The suturing technique
with the most number of votes clearly
supports that technique while tech-
niques with the least number of votes
would mean that the technique is not
widely used.
The survey results show that for
each of the various periodontal pro-
cedures the interrupted simple-loop suture was the most
prevalent technique. However there were other techniques
were used significantly as well. In crown lengthening, inter-
rupted vertical-mattress and continuous sling sutures were
used frequently. With flap osseous surgery, continuous
sling and interrupted vertical-mattress sutures were used
frequently. Implants without GBR were sutured primarily
with only simple interrupted sutures.
In GTR, interrupted vertical-mattress, interrupted hori-
zontal-mattress, and interrupted sling sutures were used
with the majority of periodontists. Comments left by the sur-
veyed periodontists about this procedure stated that they
used multiple suture techniques for this type of surgery. In-
terrupted sling sutures were frequently used to stabilize the
membranes, whereas vertical- or horizontal-mattress su-
tures were used to secure the flaps.
Soft-tissue grafts predominantly were sutured using either
continuous or interrupted sling sutures. The choice of
whether to use a continuous or interrupted sling is dependent
on the size of the site. A combination of sutures can be used
for soft-tissue grafts, such as sling sutures on the recipient site
and horizontal-mattress sutures on the donor site. Another
combination is with simple-loop interrupted sutures on the
recipient site and sling sutures on the donor site. The choice
in the various combinations is left up to operator preference.
The results revealed that the continuous interlocking suture
was frequently used for GBR. However, the combination of
horizontal-mattress and simple-loop interrupted sutures was
the most commonly used technique for this procedure.
The survey was simplified by allowing only a single choice
per surgical procedure. However, multiple suture techniques
are often required because of the complexity of the periodon-
tal surgery, adjacent anatomy, and the operators preference.
This survey did not have the depth to address this concern.
We tried to overcome this shortcoming by addressing the
Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011 229
P R A C T I C A L A P P L I C A T I O N S
FIGURE 17 The usage of various suture techniques for GTR. n 523.
FIGURE 18 The usage of various suture techniques for soft-tissue
grafting, such as free gingival grafts or subepithelial connective tissue
grafts. n 523.
FIGURE 19 The usage of various suture techniques for implant therapy
without GBR procedures. n 500.
comments from the periodontists surveyed and integrating
them into a streamlined decision tree.
Suturing is empirical, so there is limited evidence to choose
superior techniques. We propose a decision tree to aid the
dentist in selecting the optimal suture technique based
on surgical goals and their experience (Fig. 21). In general,
230 Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011
FIGURE 20 The usage of various suture techniques for GBR procedures or
maxillary sinus augmentation. n 506.
interrupted sutures enable precise flap placement and better
control compared to continuous sutures. In comparison,
continuous sutures involve more efficient flap management
for wide areas with less knotting.
n The simple-loop technique is easy to place and can be
used in diverse applications.
n The figure-eight technique can be applied in interproximal
papillae with limited access to approach under the flap.
n The horizontal-mattress technique is indicated when
muscle pull will place tension on the flap.
n The vertical-mattress technique can be combined with
periosteal suture for apically positioned flap when the
periosteum is not reflected from the bone.
n Sling sutures can be used when additional coronal an-
chorage is needed.
n Continuous interlocking sutures can be used to close
a long-spanning edentulous ridge.
n The continuous horizontal-mattress technique has the
same indications as the interrupted horizontal-mattress
technique for wide soft- and hard-tissue augmentation
as a secondary suture line.
n The continuous vertical-mattress technique is indicated
for resective surgeries for multiple teeth requiring api-
cally positioned flap.
n The continuous sling-suture technique can be used for
wide periodontal procedures with need of additional
anchorage.
Conclusions
Knowledge of the various suture techniques is required for
the optimal surgical wound healing in dentistry. There is no
single technique that is the best choice because of the sophis-
ticated characteristics of periodontal procedures. In this ar-
ticle, the most common suture techniques in periodontal
procedures are reviewed. The survey tried to show the cur-
rent trend of the selection of suturing techniques based on
the type of surgery. It is very important for the dentist to
know the current techniques and their clinical applica-
tions to promote optimal healing of surgical wounds. n
Dental Suture Techniques
 P R A C T I C A L A P P L I C A T I O N S

FIGURE 21 Selection of proper periodontal suture technique.

Acknowledgment CORRESPONDENCE:
Dr. Terrence J. Griffin, Department of Periodontology, Tufts University
The authors report no conflicts of interest related to this School of Dental Medicine, 1 Kneeland St., Boston, MA 02111. E-mail:
Terrence.Griffin@tufts.edu.
study.

Griffin, Hur, Bu Clinical Advances in Periodontics, Vol. 1, No. 3, November 2011 231
P R A C T I C A L A P P L I C A T I O N S
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