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The hidden X suture: a technical note on a novel suture technique for alveolar ridge preservation

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¹ÚÁ¤Ã¶ ( Park Jung-Chul ) - Dankook University College of Dentistry Department of Periodontology
±¸±âÅ ( Koo Ki-Tae ) - Seoul National University College of Medicine Department of Periodontology
ÀÓÇöâ ( Lim Hyun-Chang ) - Kyung Hee University School of Dentistry Department of Periodontology

Abstract


Purpose: The present study investigated the impact of 2 different suture techniques, the conventional crossed mattress suture (X suture) and the novel hidden X suture, for alveolar ridge preservation (ARP) with an open healing approach.

Methods: This study was a prospective randomized controlled clinical trial. Fourteen patients requiring extraction of the maxillary or mandibular posterior teeth were enrolled and allocated into 2 groups. After extraction, demineralized bovine bone matrix mixed with 10% collagen (DBBM-C) was grafted and the socket was covered by porcine collagen membrane in a double-layer fashion. No attempt to obtain primary closure was made. The hidden X suture and conventional X suture techniques were performed in the test and control groups, respectively. Cone-beam computed tomographic (CBCT) images were taken immediately after the graft procedure and before implant surgery 4 months later. Additionally, the change in the mucogingival junction (MGJ) position was measured and was compared after extraction, after suturing, and 4 months after the operation.

Results: All sites healed without any complications. Clinical evaluations showed that the MGJ line shifted to the lingual side immediately after the application of the X suture by 1.56¡¾0.90 mm in the control group, while the application of the hidden X suture rather pushed the MGJ line slightly to the buccal side by 0.25¡¾0.66 mm. It was demonstrated that the amount of keratinized tissue (KT) preserved on the buccal side was significantly greater in the hidden X suture group 4 months after the procedure (P<0.05). Radiographic analysis showed that the hidden X suture had a significant effect in preserving horizontal width and minimizing vertical reduction in comparison to X suture (P<0.05).

Conclusions: Our study provided clinical and radiographic verification of the efficacy of the hidden X suture in preserving the width of KT and the dimensions of the alveolar ridge after ARP.

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Alveolar process; Bone regeneration; Bone resorption; Suture techniques; Tooth extraction

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