Dentistry/repeated suture failure
QUESTION: I had a bone graft for 2 upcoming implants. the sutures have failed twice already within a week and have been replaced using different knots and a horizontal stich. I may have to have new ones replaced again because part of the membrane is still exposed. The incision keeps splitting even though I am eating only soft foods. My dentist is hesitant to use silk because of the bacterial wick effect. He made an incision on the buckle side to loosen the tissue to pull over for a good primary closure. But the sutures fail within 2 days. He now wants to make another loosening insicion on the lingual side to help pull the gum tissue together. The resorbable mebrane and the grafts are still in place, but the mebrane is partially exposed still. Any suggestons?
ANSWER: Robert - Of course, without examining you it is a little difficult to sure, but usually failure of sutures occurs when the doctor fails to properly develop the flaps that cover the area. I may be wrong, but it sounds like the dentist doing the treatment is not a oral and maxillofacial surgeon. A partial exposure of the membrane should not really be a problem if the graft was done properly. A knowledgeable doctor knows that a partial exposure will still allow the underlying graft particles to fuse to form bone. That is, as long as the tissue flaps have no excess pressure on them.
You don't say what postoperative instructions the doctor gave you. During healing it is important to keep the area clean. A gentle warm salt water rinse does more than cleaning. It increases the blood flow and can promote healing.
I wish I could be more helping, but I would need a little more information. If the area continues to break down, a second opinion locally by a surgeon might be appropriate.
If you have additional questions, feel free to contact me again.
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QUESTION: Thaank you for your attentiom. My dentist has done a couple dozen of these with a good success rate but he is not an oral surgeon. He is going to try again tomorrow with silk stiches even though they wick bacteria because I am very concious of keeping the area clean. He has me using an antibacterial rinse twice a day and amoxycillin to prevent infection. As of yesterday the membrane was still in place and the graft material was hardening up nicely, butitfeels as if the mebrane is falling apart in little pieces. Initially I thought it was the sutures disintegrating. He doesn't want the mebrane exposed at all because he feels it will dissolve too quickly due to saliva enzymes. Thanks a million for your quick and thourough reponse.
ANSWER: Robert - Your dentist needs to be very carefull or he can lose more than the just the graft. He could cause degeneration of the area. So it is important that no aggressive resuturing or incisions be done or blood flow to the region will be further reduced.
I wish you well and hope you heal quickly.
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QUESTION: Hello again doctor. I am having another go round this morning, with more suturing, but it feels as if the graft material in one area has disappeared. Can he repack it and resuture? Should the area be left alone to heal, with another try in a few months by a surgeon? I am having anxiety over the fact that repeated resuturing could cause degeneration.
Robert - Of course, without examining the area I cannot be completely sure, but too much activity in an area will decrease healing and, in fact, create future problems. For now leaving the area alone to heal is recommended. Once that area heals, if additional graft is necessary, then it can be done. So leaving the area alone for at least 4 months would be beneficial for the health of the area.
So repeated suturing at this time is detrimental. It is obvious that if this dentist wants to resuture, he knows very little about healing and proper surgical technique. So wait and let the area heal, for now, and in the future additional treatment, if necessary, can be done.