Guide to Suturing Materials for Surgical Success

by | Jan 15, 2021 | Dental Materials, Dental Treatments | 0 comments

Surgical Suturing


DMD cEnter has provided on its previous post certain guide of suturing techniques for success in your surgical treatments. Click this link: READ

And, a post you can share to your patients, Click this Link: READ

Now, we will discuss with you the guide for the materials you will use on suturing for even a successful treatment.

A suture is an artificial fibre used to keep wound together until they hold sufficiently well by themselves by natural fibre (collagen) which is synthesized and woven into a stronger scar. The main purpose of a suture is to hold severed tissues in close approximation until the healing process provides the wound with sufficient strength to withstand stress without the need for mechanical support. Since wounds do not gain strength until 4-6 days after injury, the tissues are approximated till then by sutures.

Regardless of suture composition, most of the time the body reacts as if it is a foreign body. Thus, the body responds by producing a reaction of varying degrees.

➢Easy to handle
➢Causes only minimal tissue injury or tissue reaction ( nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic)
➢Holds securely when knotted (no fraying ‬or cutting)
➢High tensile strength
➢Favorable absorption profile
➢Resistant to infection
➢Can be used in any tissue
➢Can create good knot security
➢Minimal tissue reaction


Classification Of Suture Materials

Absorbable vs Non-Absorbable

I. Absorbable Sutures

- In general, as dentist we will place a gauze on the area where the extraction is done for you to bite after the treatment. We instruct our patient to let it stay for a few hours to allow the clot to form, so, we advice them that it is good to replace this as often as necessary.

Absorbable sutures are broken down by the body via enzymatic reactions or hydrolysis. The time in which this absorption takes place varies between material, location of suture, and patient factors.

Absorbable sutures are commonly used for deep tissues and tissues that heal rapidly; as a result, they may be used in small tissue anastomosis, suturing in the soft tissue on surgical flaps.

For the more commonly used absorbable sutures, complete absorption times will vary:

➢Vicryl rapide = 42 days
➢Vicryl = 60 days
➢Monocryl = ~100 days
➢PDS = ~200 days

II. Non-Absorbable Sutures

– Non-absorbable sutures are used if the surgical site requires long-term tissue support, remaining walled-off by the body’s inflammatory processes (until removed manually if required).

Uses include tissues that heal slowly, such as fascia or tendons, closure of extra oral flap, or vascular anastomoses.

Suture materials can be further categorised by their raw origin:

Synthetic vs Natural

I. Natural

– These are sutures made of natural materials (e.g. silk or catgut). They are less frequently used, as they tend to provoke a greater tissue reaction and suture antigenicity can lead to inflammatory reactions.

Should not be used in high acidic environment (reflux bulimia, esophagitis, Sjogern’s syndrome, radiation therapy).

II. Synthetic

– Comprised of man-made materials (e.g. PDS or nylon). They tend to be more predictable than the natural sutures, particularly in their loss of tensile strength and absorption.

Suture materials can also be sub-classified by their structure:

Monofilament vs Multifilament

I. Monofilament Suture

– A single stranded filament suture (e.g nylon, PDS*, or prolene). This structure is relatively more resistant in harboring microorganisms, meaning lower risk for infection but also have a poor knot security and ease of handling. These sutures also exhibit less resistance to passage through tissue than multifilament suture.

II. Multifilament Suture

– These sutures are made of several filaments that are twisted together (e.g braided silk or vicryl). Generally this type of suture has greater tensile strength, better pliability and flexibility than monofilament suture. They handle easier and hold their shape for good knot security. Because multifilament materials have increased capillarity, they tend to ‘‘wick’’ oral fluids along the suture to the underlying tissues. This wicking action can carry bacteria along with saliva thus it may act as a tract for the introduction of pathogens increasing risk of infection


The diameter of the suture will affect its handling properties and tensile strength. Diameter of surface material it is measured in sizes from 1-0 to 10-0.10-0 is the smallest diameter and least amount of tensile strength. Tensile strength of the suture should never exceed the tensile strength of the tissue. In oral surgery the size 3-0 has the appropriate amount of strength; the polyfilament (braided) nature of the silk makes it easy to tie and is well tolerated by the patient’s tongue in that the cut ends of the suture tend to lie flat and are not pointed. The color makes the suture easy to see when the patient returns for suture removal. Sutures that are holding mucosa together are usually left in place no longer than 5 to 7 days, so the wicking action is of little clinical importance. Many surgeons prefer 3-0 chromic sutures to avoid the need to later remove them.

In other procedures 4-0 is most commonly used in periodontal flap surgeries and 5-0 is mostly used for delicate tissues and for soft tissue graft surgery


Parts of the Suturing Needle

The surgical needle allows the placement of the suture within the tissue, carrying the material through with minimal residual trauma.

The ideal surgical needle should be rigid enough to resist distortion, yet flexible enough to bend before breaking, be as slim as possible to minimise trauma, sharp enough to penetrate tissue with minimal resistance, and be stable within a needle holder to permit accurate placement.

Surgical Needles

Needle Sizes

Needles can be Classified as:
a. Straight (limited use in oral surgery) or curved Needle Body.
b. Swaged or eyed. Made up of either SS or carbon

Needle bodies can be round: cutting, or reverse cutting:

I. Round Bodied Needles

Commonly used in friable tissue such as liver and kidney.

II. Cutting Needles

Cutting needles are triangular in shape, and have 3 cutting edges to penetrate tough tissue such as the skin and sternum, and have a cutting surface on the concave edge.

III. Reverse Cutting Needles

Reverse cutting needles have a cutting surface on the convex edge, and are ideal for tough tissue such as tendon or subcuticular sutures, and have reduced risk of cutting through tissue.

The needle point acts to pierce the tissue, beginning at the maximal point of the body and running to the end of the needle, and can be either sharp or blunt:

Blunt needles are used for abdominal wall closure, and in friable tissue, and can potentially reduce the risk of blood borne virus infection from needlestick injuries.

Sharp needles pierce and spread tissues with minimal cutting, and are used in areas where leakage must be prevented.

Needle Point Geometry

The needle shape vary in their curvature and are described as the proportion of a circle completed – the ¼, ⅜, ½, and ⅝ are the most common curvatures used. Different curvatures are required depending on the access to the area to suture.

Needle Shapes


Knowing the types of materials to use in any given situation, improves the competency and success of the procedure. It should be kept in mind that the materials reacts on tissue differently, thus being informed prevents complication and improves quality of care to our patient.


Dr. Bryan Anduiza - Writer
Dr. Mary Jean Villanueva – Editor | Writer


Latest Posts

DMD cEnter Logo

DMD cEnter is Your One Stop
That's ALL Dental.

Other Related Articles:
Post CoVid Care: Things to Know After Recovering From COVID-19

Post CoVid Care: Things to Know After Recovering From COVID-19

If one had suffer from CoVid-19 especially the Delta variant, one is just grateful to fully recover from it. However,...
Read More
Debunking the Myths & the Facts About CoVid

Debunking the Myths & the Facts About CoVid

Fear arises generally when we don’t know the facts about what we are facing. DMD cEnter and Usapang Dentista tries...
Read More
Vitamins ABC In Dentistry

Vitamins ABC In Dentistry

In the current pandemic situation, many are trying to increase their immunity system through vitamins intake. Let's get to know...
Read More
Choices of Pediatric Obturating Materials

Choices of Pediatric Obturating Materials

Not every dentists can successfully handle pediatric patients, then, more so if the case is Endodontics. Thus, our choices of...
Read More
Bevels In Dentistry For Durable Restoration

Bevels In Dentistry For Durable Restoration

Bevels in Dentistry for durable restoration are important to review and refresh as dental professionals especially nowadays that patients cannot...
Read More
Advancing Aesthetic Dentistry To The Next Level

Advancing Aesthetic Dentistry To The Next Level

Are you willing to advance your knowledge & dental treatment to the world of facial aesthetics? Or, do you feel...
Read More
Assessing Pulp Vitality

Assessing Pulp Vitality

We all know that majority of us don’t like much doing RCT, however, it is very much a necessary evil...
Read More
How To Address Dental Phobia

How To Address Dental Phobia

Do you know how to handle dental phobia of your patients whether subjective or objective? Can you fully understand your...
Read More
Addressing GERD

Addressing GERD

GERD or Gastroesophageal Reflux is a common condition and as dentist we need to know how to recognize and address...
Read More
5 Probable Causes of Post-Operative Tooth Sensitivity

5 Probable Causes of Post-Operative Tooth Sensitivity

Are you one of those dentists that scoff off post-operative tooth sensitivity complain of your patients as a natural occurrence...
Read More
DMD cEnter Logo

A One Stop Place That's Everything About Dental. We Make Dental Practice Better with 4Cs:
Create · Connect · Communicate · Collaborate

+63 27 624 5309

6th Floor · B&P Building · Arnaiz Ave · Legazpi Village · Makati City · 1229 · Philippines

The Digital Place To Be For The Dental Community

As Dentists, do you want to enhance even better your dental skills & techniques? Do you want to have opportunity to earn and learn?
As Patients, do you want to find the right dentist for you?
As Entrepreneurs, do you want more exposure in your market and business solutions?
If the Answer if YES