Chapter 3. Materials for surgical dentistry

Surgical suture is a thread used to close the wound edges together during surgery.

Requirements for suture materials.

1. Atraumatic: absence of a traumatic effect when the thread passes through tissue.
2. Strength: the property of a material to resist destruction, it is evaluated by three criteria: tear strength, tensile strength and the strength of the thread in the node.
3. Good handling properties: soft, elastic, flexible, low coefficient of friction, and absence of ‘thread memory’.
4. Compatibility (inertness): no toxic, allergic, carcinogenic effects on body tissues.
5. Absence of capillary action and wicking, that is, the ability to absorb the discharge from the punctured canal and pass it between the fibers.
6. Biodegradability (preferable): the process of destruction of material in the biological environment of the body. Simply put, the thread should dissolve after wound healing.
7. Universality: the possibility of application in different types of surgical procedures.
8. The package should have a convenient labeling and be easy to open.

Suture materials are classified by the following characteristics:

• by origin;
• by biodegradability (absorption);
• by thread structure;
• by diameter (thickness) of the thread.

1. By origin, there are natural organic, natural inorganic and synthetic materials. Natural organic products include catgut, silk, flax, horsehair, and cellulose derivatives (occelon, kacelon, rimin). Natural inorganic materials include metal wire (steel, nichrome, platinum, titanium). Synthetic ones include artificial polymer derivatives of polyglycolic acid, lactic acids, polydioxanone, polyethers, and fluoropolymers.

2. By biodegradability (absorption), suture materials are classified as:

• absorbable:
  • based on biomaterials (catgut, collagen);
  • cellulose-based materials (occelon, kacelon, rimin);
  • polyglycolide-based materials (Polysorb, Biosin, Vicryl, Dexon, Maxon, etc.);
  • polydioxanone-based materials (polydioxanone);
  • polyurethane-based materials;
• conventionally absorbable (polyamides and polyurethanes): capron, maxilene, sutron, ethylone, nurolon, etc., as well as a material of natural origin, such as silk;
• non-absorbable:
  • polyethers (dacron, mersilene, ethibond, etc.);
  • polypropylene (pelene, premylene, etc.);
  • polyolefins (prolene, surgipro, surgilen, etc.);
  • fluoropolymers (Corolene, Gore-Tex, Vitafon, etc.);
  • metal wire (steel, nichrome, platinum).

3. By the structure of threads, the following types of suture materials are distinguished:

• Monofilament fiber is a single, whole thread with a smooth, even surface (Vicryl, Polysorb, Monofast, Monocryl, etc.) (Fig. 3.1).
• Polyfilament sutures s in cross-section are composed of multiple fibers:
  • a twisted thread produced by twisting several threads along the axis (flax, twisted silk, capron, etc.) (Fig. 3.2);
  • braided, made by braiding several strands like a rope (dacron, ethibond, mersilene, mersilk, etc.) (Fig. 3.3);

4. Complex thread or coated thread are threads impregnated or coated with a polymer material (Terylene, Cardioerg, Vicryl, Polysorb) (Fig. 3.4). Due to this coating, the thread will pass through tissue with minimal trauma.

The European Association of the Surgical Suture Industry uses the following symbols to mark the threads (Fig. 3.5–3.16).

5. Classification of suture materials by thread size (thickness).

The most commonly used standard for suture size is the USP (United States Pharmacopeia), indicating dimensions on a numerical scale. Thus, for example, a suture size less than 0 is indicated in descending order: 1/0 > 2/0 > 3/0. However, if the size is greater than 0, the thread size increases in ascending order: 1 < 2 < 3, etc. (Table 3.1).

Surgical needles are used for piercing and passing threads through tissues.