288 Theories and techniques of oral implantology

The strands are thoroughly dried under tension and then cut to the desired lengths. The strands are separated according to gauge and thickness and carefully polished. They are tested for tensile strength, regauged, sterilized, and finally packaged, usually in a sterile glass tube or in a pack coiled in a fiber reel.

Nonabsorbable ligature materials. Among the ligature materials that are not digested by the body and that must be removed after some healing has taken place are silk, silkworm gut, cotton, nylon, linen, horsehair, and dermal or skin sutures.

Silk sutures are the most widely used. Silk is much stronger than catgut, more workable, and not as readily irritating to the tissues, and it has a greater tensile strength. The raw material is obtained from the silkworm cocoon and is manufactured into braided and twisted ligatures. The braided type is the stronger and more popular material. Silk ligature material is supplied in spools of 25 or 100 yards and in precut lengths in paper envelopes. It comes in sizes 000000 through 5.

All suture materials must meet rigid specifications for sterility and uniform standards. They must be able to withstand sterilization at temperatures beyond the lethal requirements for the most resistant bacteria and their spores. They must also pass Food and Drug Act requirements.

Suture needles. There are two basic types of surgical needles, those with and those without eyes. Eyed needles are those into which the suture material must be threaded. They can be used repeatedly but should be carefully cleaned, resharpened, polished, and sterilized between operations.

Swaged, or eyeless, needles—which are some-times called nontraumatic needles—come already fastened to one or both ends of the suture material. If both ends are attached, the set-up is called a double-armed suture. Swaged needles are used once and then discarded. Therefore they are never dull and save the time involved in needle threading. They are supplied in ready-to-use sterile tubes.

Both types of needles, eyed and eyeless, are manufactured in many sizes, shapes, and thicknesses.

Suturing techniques

Although the Manual of Operative Procedure and Surgical Knots* claims that there are more than 1,400 different kinds of suturing techniques,

*Published by Ethicon, Inc., Sommerville, N. J.

Fig. 7-74. The continuous locked or blanket suture is commonly used for surface-to-surface contact of the wound. (Drawing courtesy Ethicon, Inc.)

Fig. 7-75. Continuous over-and-over closing sutures used for surface-to-surface contact. (Drawing courtesy Ethicon, Inc.)

Fig. 7-76. When the tissues are thin and under tension, interrupted sutures (simple surgical ties) may be used.