Use of Modified Vertical Internal Mattress Suture Versus Simple Loop Interrupted Suture in Modified Widman Flap Surgery- A Randomized Clinical Study.

Periodontitis is inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing.The destruction of tooth supporting tissues is caused by interaction of bacteria present in the dental plaque and the host .The elimination of bacterial plaque, calculus ,toxic material adhering to tooth surface and other plaque retentive factors can be achieved by nonsurgical and surgical periodontal therapies .The primary objective of periodontal therapy is arresting infection, restoring the lost structure and to maintain healthy periodontium .

The requirement of access for scaling and root planning, pocket depth reduction, correction of gross gingival aberrations ,and establishment of morphology of the dento-gingival area conducive to infection control led to the development of the various surgical procedures. The initial surgical procedures used in periodontal therapy involved excision of the diseased gingival tissue . The main disadvantages of these procedures are unwanted root exposure, poor aesthetics, decrease in width of attached gingiva, excision of frenum attachment and creation of shallow vestibular depth.

Proper management of supracrestal soft tissue flap during suturing appears to be of critical importance in ultimate outcome of surgical periodontal pocket management .A number of studies advocate the proper management of supra-alveolar component of flap in management of infrabony defects employing regenerative techniques with grafts / barrier membrane to minimize postoperative exposure, contamination and/or exfoliation of the grafted material and / or barrier membrane. However review of the available literature does not reveal studies conducted to evaluate the effectiveness of close approximation of flaps by different suturing techniques. Sites with suprabony periodontal pocket depth of 4mm have approximately 6 mm height of unsupported supracrestal soft tissue flap which increases with further increase in pocket depth. Moreover, with advancing probing depth, base of the unsupported soft tissue wall of periodontal pocket comes closer to the musculature in the vestibule, thereby eliciting requirement of a more efficient suturing technique to resist muscle pull for prevention of any disturbance to healing granulation tissue.

The interrupted suturing encompasses two suturing technique; the simple loop and figure of eight. Modified vertical internal mattress suture is a variation of the vertical mattress suture which is especially useful in maximizing wound eversion, reducing dead space, and minimizing tension across the wound. Wound eversion maximize flap approximation. The recommended time for removal of this suture is 5-7 days to reduce the risk of scarring (cross hatching).

Thus the most suitable suturing technique to achieve healing by primary intention and connective tissue reattachment/ periodontal regeneration need to be explored. The present study is intended to determine the influence of the simple interrupted and modified vertical internal mattress suturing technique on the outcome of modified Widman flap surgery .