Stitches - Placing / Removing / Types sutures.

If a dentist has created a gum tissue flap during their patient's surgical tooth extraction, it will need to be stitched back into place. In regard to this process, this page discusses:

A) Placing stitches.

Here are the steps a dentist will perform when "closing" a gum tissue flap.

1) The dentist will first check to insure that the edges and surface of the bone that will lie underneath the flap are rounded and smooth.

If they need adjusting, the dentist will recontour them using their dental drill or else a hand instrument called a "bone file" (a rasp-type tool). The patient may feel pressure or vibration from these tools but there will be no pain involved.

Placing stitches to stabilize a gum tissue flap.

2) The dentist will then position the tissue flap back into pretty much its original position and begin placing the stitches.

The number of stitches required will vary with each individual case, simply depending how many the dentist feels are necessary to adequately stabilize the flap to its neighboring stable (undisturbed, firm) gum tissue.

3) Placing stitches is similar to sewing with a needle and thread.

a) The dentist will use a prepackaged, pre-assembled needle with attached suture material (silk, nylon, "gut", etc...).

A suture needle with attached suture material.

b) They'll grasp the suture needle with a pair of hemostat-like forceps and guide it through the thickness of the flap. The curved nature of the needle allows it to glide into and then back out of the tissue more easily than if a straight needle were used.

c) The patient will feel the tugging pressure of the suturing process as each individual stitch is threaded through and tied off but there will be no pain.

B) The effects of stitches on wound healing.

Just as a point of interest, here are some of the effects that placing sutures in a wound have.

1) Stitches enhance some aspects of wound healing.

The primary purpose of stitches is the stabilization of the tissue flap that lies over an extraction site. This stabilization enhances the healing process by helping to minimize dead space that might otherwise exist between wound parts. It also helps to minimize the overall size of the wound.

Additionally, stitches help to strengthen the wound during the early stages of healing. And, overall, they help to create a more predictable healing process and subsequent end result.

2) Sutures can help to minimize wound bleeding.

The stitches placed in a wound create soft tissue compression. This pressure can help to minimize the amount of bleeding that takes place.

3) Stitches create an inhibitory effect on wound healing.

There is one aspect of placing sutures that has an inhibitory effect on wound healing. To the tissues in which they are placed, stitches are a foreign object. Their presence will trigger inflammation and "foreign body" reactions, which will delay the healing process to some minor degree.

Stitches are placed in wounds for specific reasons. If these reasons do not exist, you're actually better off without them.

C) Types of stitches.

There are generally two types of suturing material that a dentist can elect to use. The difference between the two is based on whether they are "resorbable" or "nonresorbable."

Stitches that dissolve away on their own.

Resorbable (absorbable) stitches have the advantage that they do not need to be removed. They will simply come out (dissolve, disintegrate) on their own, usually within a week of being placed (depending upon the specific type of material from which they have been made). They are sometimes called "gut" sutures.

Stitches that don't dissolve.

In comparison, nonresorbable (nonabsorbable) sutures are made out of materials (such as silk or nylon) that will not dissolve.

Nonresorbable stitches must be removed. This appointment is usually scheduled somewhere between seven to ten days after they were originally placed.

D) Removing stitches.

Removing stitches is usually easy, quick and pain free.

When should stitches be removed?

In most cases, on the same day that your oral surgery is performed, your dentist will schedule a return appointment for you when your stitches can be removed. The timing of this appointment can vary (and is up to the discretion of the dentist) but usually sutures are removed somewhere between 7 and 10 days after they were originally placed.

How are they taken out?

The process of removing stitches is quite easy. The dentist will use a small pair of scissors to clip the suture thread. They will then grab one of the free ends (the knotted end) with a pair of "cotton pliers" (dental tweezers) and pull the thread out.

There's no need for anesthesia. You might feel a slight tug on a stitch as the dentist positions it so it can be cut. But otherwise you shouldn't feel a thing.

 All FYI's ► 

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