APICAL MATTRESS SUTURE

 

RAISING A FLAP

(4'28'')

It makes it mobile and also interrupts blood supply.

Blood supply only recovers after periosteum gets reattached.

Periosteum re-attachment is 70%, after at least 4 weeks. Only after at least 6 weeks will we have significant periosteum-bone contact.

 

PULL THE LIPS TO EVALUATE FLAP TENSION

 

 

PREVENTING FLAP  MOBILITY & TENSION ARE KEY FACTORS TO AVOID BONE LOSS

To do it is mandatory to do adequate flap release as well as buccal flap fixation

 

FLAP RELEASE 

(6'44'')

Periosteal incision or

Soft Brushing 

 

HORIZONTAL APICAL MATTRESS

(7'06'')

The needle enters the buccal flap apically, 1 to 1.5mm away from the flap margin, beyond the muco-gingival junction, into alveolar mucosa. It goes to the palate, in & out twice (first inner surface to outer surface & then outer to inner surface of the palatal flap). It comes back to the buccal flap, entering at the inner surface of this flap, exiting at the same level of the first entry. By tightening the knot a gum bead is created.

 

 

SUTURE REMOVAL

(10')

To meet at least 70% of periosteal re-attachment sutures must stay at least 4 weeks.

To stay that long a monofilament must be used.

 

monofilament non resorbable

(nylon, ptfe)

after 4 weeks embedded into the flaps, difficult to remove

 

 

SUTURE KNOTS

flat knot: cross your hands

role forward when short end is in front

role backward when short end is in the back