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

Abstract

PurposeThe 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.MethodsThis 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.ResultsAll 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±0.90 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±0.66 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).ConclusionsOur 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.

Prognostic performance of combined use of high-sensitivity troponin T and creatine kinase MB isoenzyme in high cardiovascular risk patients with end-stage renal disease

“…BMI results were significantly decreased in hemodialysis patients compared to healthy controls, suggesting that patients with low BMI are at high risk of morbidity. These findings are in line with previous studies, which demonstrated that increased BMI is associated with better survival, whereas low BMI and weight loss are associated with increased mortality (the so-called obesity paradox) [ 14 , 15 ]. Both cardiovascular biomarkers (hs-TnT and CK-MB) were significantly higher in hemodialysis patients than in healthy controls.…”

Alveolar ridge preservation with an open-healing approach using single-layer or double-layer coverage with collagen membranes

“…Some of the subjects had X sutures, while others received hidden X sutures. In the previous study by the current authors, Hidden X sutures have been proven to be advantageous for counteracting alveolar ridge resorption and preserving more width of the keratinized tissue [ 16 ].…”

“…The ‘up’ sides of all the membranes were laid facing the occlusal plane. The membrane was held in place by suture thread (Ethilon 4-0, Ethicon, Cincinnati, OH, USA), using hidden X sutures [ 16 ] or X sutures, and secondary healing was obtained. No efforts were made to obtain primary closure.…”

“…However, collagen membranes undergo degradation when exposed to the oral cavity, and due to their tendency for fast resorption, it has been suspected that collagen membranes may not be able to provide suitable stabilization for bone grafts during the healing period, especially with single coverage. The authors of the present study have previously analyzed the effects of open-healing ARP in clinical, histological, and radiographic aspects in 2 previous studies [ 16 17 ]. In those studies, double-layer coverage with resorbable collagen membranes was used to protect the operated sites.…”

A comparison of different compressive forces on graft materials during alveolar ridge preservation

“…The reasons for tooth extraction were periodontal lesions, dental caries, or fracture. Each residual extraction socket involved bone loss of less than 50% in all dimensions [ 21 ]. The exclusion criteria were pregnancy or lactation, a history of radiotherapy or chemotherapy for a malignancy in the past 5 years, autoimmune diseases, allergy to collagen, a history of systemic diseases that would contraindicate surgical treatment, long-term nonsteroidal anti-inflammatory drug therapy, requiring antibiotic prophylaxis, heavy smoking (>10 cigarettes per day), uncontrolled or untreated periodontal disease, and inability to provide consent for participation in the study or to accept the proposed treatment plan.…”