Oral tissues have excellent healing potential owing to the presence of cells with tissue regeneration capability, a dense vasculature, and a high turnover rate of connective tissue and epithelium. So, in contrast to the skin, wound healing in oral gingiva results in little scar formation.
Saliva provides a unique environment for rapid tissue repair: pH, ionic strength, the presence of calcium and magnesium required for healing, lubrication and hydration that prevents tissue dehydration and increases wound cleaning by breakdown and removal of fibrin and tissue debris, and growth factors that are related to proliferation, adhesion and migration of connective and epithelial cells, inflammatory reactions and remodeling of extracellular matrix.
Sutures should be removed after no later than hours, because the peak tissue reaction to sutures occurs between the second and seventh days, and the collagen content in granulation tissues, which determines tensile wound strength, is present after 3 days. When the wound is protected against excessive forces, small amounts of mechanical stress result in increased collagen strength and collagen formation. Larger forces disrupt the neovasculature and collagen fibers, thereby delaying healing.
The thinner the non-absorbable suture, the sooner it must be removed, otherwise it will become buried by the healing tissue and will be difficult to find. Sutures must be taken out using a sterile and aseptic technique, in order to diminish the expected transient bacteremia to a minimum. The steps are the following:
- Clean the suture and surrounding tissues with a chlorhexidine-saturated cotton pellet.
- Grasp the knot section and gently lift the knot from its bed. Cut the suture between the knot and the point the suture enters the tissue - the closer to the tissue the better. Avoid passing through the tissue any sections of suture that have been exposed (and contaminated) in the oral cavity.
- When removing continuous sutures, each section should be cut and pulled out individually.
- Reclean the area with a chlorhexidine-saturated cotton pellet.