Suture closure for surgical flap stabilization in modern periodontal and implant surgery: an update

Nowadays, complication-free wound healing processes are the key to successful treatment outcomes in the context of periodontal and implant surgery, both clinically and scientifically. The main challenge here is to achieve primary wound healing in the majority of cases. Among the scientifically documented factors that influence the healing process, it is primarily the blood supply in the surgical area and the stability of the wound achieved postoperatively that can be directly influenced by the clinician. The surgical wound closure plays a decisive role in this context in order to achieve sufficient stabilization of the wound without negatively affecting the healing process through unnecessary traumatization of the tissue or excessive tensile forces on the wound edges. It is important to bear in mind that wound healing after surgical procedures in the oral cavity does not take place under optimal conditions. A moist, microbiologically contaminated environment is present and complete immobilization of the wound is hardly possible during the early healing phases. The sutures must therefore ensure that the surgical flaps are passively secured in the intraoperatively established position, that the wound edges are in as close contact as possible - especially if grafts that initially rely on nutrition through plasmatic circulation are used - and that the wound is stabilized during the first few postoperative days. The suture material and suturing technique must be selected so that the knots do not loosen and both the suture material and soft tissue can withstand the mechanical stresses during the early wound healing phases. The search for available mechanical anchors should be the focus of interest.