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ePaper created 2016-01-07, 12:59:38 | version 1.38.0
accordingtotheirorigininnaturalorsynthetic,orbased on their stay in the tissues in absorbable or non-ab- sorbableandyetaccordingtotheirstructureinmonofil- amentormultifilament.Syntheticsutureshaveconsid- erableadvantageswithrespecttonaturalsuturessuch as silk. Synthetic sutures output lower tissue reaction and greater tensile strength that allows hence the use ofthinnerthreads(Figs.8–10). The absorbable sutures allow a temporary sealing oftheflapsbecausetheyarebrokendownbythebody through a hydrolytic process. This process could be morerapidwherethereisnohomeostasisofthesub- ject, as in the presence of fever, infections or protein deficiencies, and this could lead to an acceleration in the process of absorption of the suture with an inad- equatesealofthesutureinthewoundforthetimere- quired (and of course, this aspect must be carefully considered by the surgeon during the surgery and when choosing the type of suture). Absorbable threads are often preferred for suturing the deeper layers of the wounds, where blood clot stability is ab- solutely necessary (Fig.11). Non-absorbable sutures thatshouldberemovedbythesurgeonareusedinthe superficiallayersofthewoundsorinthecaseofovert infectionsandimmunodepressedpatients.Multifila- ment sutures are composed of several filaments which ensure greater tensile strength and flexibility. Monofilament sutures on the other hand, are more inert, but less easy to manage at the time of their use due to their fragility and the difficulty upon knotting because of their extreme smoothness (Fig.12). There are also suture threads, recently introduced on the market, coated with bacteriostatic agents that can play an active role in the prevention and protection against the risk of bacterial post-surgery superinfec- tion. It is obvious, however, that the choice of the su- ture is a key factor in predicting the outcome of our surgeryand,therefore,itisthemostimportantphase oftheintervention.12,13 Weshould,therefore,paydue attention to this moment, at least equal to that paid when we choose the implant or the biomaterial.In- stead, I often see that this step is regarded as an un- necessary loss of time, therefore a step treated with superficiality and negligence. To face later problems likeadehiscenceoftheflapforwhichwehavenorea- sonable explanation and, even worst, no adequate solution. _Conclusion Dentistryisamongtheothermedicaldisciplines,the one that evolved the most significantly over the past fewyears,fromthepracticeofbarbersurgeonstoareal and veritable medical work, worthy of all the conse- quent attention and due respect. The dental surgery, likewise, has experienced a major acceleration in these years, making interventions that 50 years ago were al- most unthinkable routine and predictable procedures. Butperhaps,surgicalculturehasnotkeptpacewiththis evolution,asifdentalsurgerywereaminorsurgeryand therefore not deserving an adequate and serious ap- proach. Too many times I had to assist to improperly managedinterventions,althoughimportant,withlittle ornoattentiontoroomsterility,thepreparationofthe auxiliary staff, the setup of the surgical table. And choosingforthesuturethefirst(oronly!)suturefound in the drawer. Actually, a failure or a preventable infec- tion as a result of dental surgery, and such may still be responsibleforasignificantmorbidityandacertainrisk ofmortality.Ithereforehopethatsurgeonswillactwith an ever-increasing "surgical" approach, not only with regard to surgery itself but also in the preparation and managementoftheintervention,applyingthemedical procedures and preventive measures that will not only provide for a better understanding of the biological processes that promote healing but also prevent dan- gerous and avoidable post-surgery infection which shouldnotburdenoursurgery._ I research Fig. 10_Post-extraction site after suture removal with no inflammatory reaction. Fig. 11_Suturing deep-layer stitches using the horizontal mattress technique with an absorbable suture. Fig. 12_A continuous suture with an absorbable monofilament. 12 I implants4_2015 Fig. 10 Fig. 12Fig. 11 contact Prof.Mauro Labanca Corso Magenta 32 20123 Milan Italy Tel.:+39 02 804246 mauro@maurolabanca.com Tel.:+3902804246