Because sutures are a foreign material in the body and impede the healing process, the minimum number of stitches and the thinnest suture that provides adequate flap reattachment should be used. Sutures should be removed at the earliest biologically acceptable time (minimum 48 h, maximum 96 h).
The 5-0, 6-0 and 7-0 monofilament suture has replaced the 4-0 silk suture as the standard choice. Generally, 5-0 is used for suturing flaps with sulcular incisions and free gingiva, and 6-0 and 7-0 for suturing flaps with paramarginal incisions on attached gingiva.
Microsurgery tends to increase the number of stitches while reducing the size of the suture. Furthermore, the small size of the suture prevents the surgeon from exerting an over-tension on flap tissue.
- Multifilament sutures have easy handling and knot security, but also suffer hydration and contamination.
- Monofilament sutures have worse handling and worse knotting, but suffer less contamination.
- Absorbable sutures produce inflammation while being absorbed.
- Non-absorbable sutures are more biologically inert. Surgical wounds gain strength rapidly in the first few days owing to non-collagenous proteins, so non-absorbable sutures are the best choice for endodontic microsurgery. However, a 5-0 absorbable suture can be used in the particular areas of vertical releasing incisions.