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| Year : 2014 | Volume
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| Issue : 4 | Page : 541-543 |
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| A simplified suturing model for preclinical training |
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Ramesh Kumaresan1, Sivakumar Pendayala1, Balamanikanda Srinivasan1, Kameswari Kondreddy2
1 Academic Unit of Dentofacial Clinical Care, Faculty of Dentistry, AIMST University, Kedah, Malaysia
2 Department of Periodontology, Faculty of Dentistry, AIMST University, Kedah, Malaysia
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| Date of Submission | 21-May-2013 |
| Date of Decision | 31-Mar-2014 |
| Date of Acceptance | 27-Jun-2014 |
| Date of Web Publication | 10-Oct-2014 |
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 Abstract | | |
Objectives: The purpose of this paper is to develop a simple and cost-effective suturing training model.
Materials and Methods: A simplified suturing model is developed for preclinical training purpose. The training model requires only three easily available materials, which include synthetic foam sponge, elastomeric impression material and putty impression material. Construction of this model requires only 15 min.
Results: The training model thus developed resembles a realistic human tissue with a skin analog, deeper connective tissues and a bony base. This enables the students to practice various suturing technique at different tissue planes. Such practice helps the students to perform a live procedure in a more skilled and less traumatic way.
Conclusion: The easy availability and cost-effective nature of the materials, in concert with fast construction time, makes this suturing model appropriate when an affordable alternative is desired. Keywords: Affordability, low-cost, suturing model, suturing skills
How to cite this article:
Kumaresan R, Pendayala S, Srinivasan B, Kondreddy K. A simplified suturing model for preclinical training. Indian J Dent Res 2014;25:541-3 |
How to cite this URL:
Kumaresan R, Pendayala S, Srinivasan B, Kondreddy K. A simplified suturing model for preclinical training. Indian J Dent Res [serial online] 2014 [cited 2021 Jan 17];25:541-3. Available from: https://www.ijdr.in/text.asp?2014/25/4/541/142577 |
Oral surgery training has been recognized as one of the areas in which undergraduate dental students and resident trainees feel stressed and technically unconfident. [1] In addition to the theoretical knowledge, expertise in oral surgery requires high degree of psychomotor skills, which can be achieved only through proficiency based training with deliberate practice. [2],[3] One such competence in oral surgery training is suturing. Textbooks that elucidate the suturing techniques and videos that demonstrate them are available. [4] However, the translation of this theoretical knowledge to practical performance directly on the live human patients is not always the ideal means of training as the social and psychological factors may leave the inexperienced dental student insecure. In addition, the time factor and manpower needed for practical training on patients may not always be possible. [5] Furthermore, the use of live patients as test subjects is not acceptable with today's ethical standards. The probable solution for these problems is the use of preclinical training models that impersonate real-life conditions and through which manual dexterity can be achieved. Such training models also minimize the incidence of needle-stick injuries.
Various means of preclinical suture training are followed in oral and maxillofacial surgery units worldwide. These include suturing on foam, animal skin, waste meat, self-made suturing models, and commercially available suturing models. [4],[6] Foam though easily available, has a finite life, which ultimately needs replacement. An additional factor is its consistency that does not replicate the texture of skin or mucosa and hence not an ideal means of training. Animal skin and waste meat as an option can be obtained from butchers, but their acquisition and storage in the tropical climate may be difficult. Furthermore, microbial contamination and health risk in using animal skin has to be evaluated. Commercially available suturing models to train on are available but not cost-effective in all nations. Hence, this paper describes the construction of a simple and cost-effective suturing model for preclinical training.
| Technique | |  |
Synthetic foam sponge of 4-5 mm thickness was cut to adapt the required size (preferably the size of a glass mixing slab). A thin layer of putty vinyl polysiloxane impression material is applied on the foam sponge, which forms the base for the suturing model [Figure 1]. A 2-3 mm thin layer of light or medium elastomeric impression material is smeared on a glass slab and the precut foam sponge along with the putty base is intently positioned over the impression material [Figure 2]. The impression material sets within 5 min following which it can be easily peeled off the glass slab. This model can be incised similar to tissue and sutured [Figure 3]. | Figure 1: A precut sponge foam with a thin layer of putty vinyl polysiloxane impression material base
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 | Figure 2: The elastomeric impression material is smeared over a glass slab and foam sponge with the base is carefully placed over it
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 | Figure 3: Fully constructed suturing model delineating the various layers skin, connective tissues and the base
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| Discussion | | |
The training model requires only three easily available materials which include synthetic foam sponge, elastomeric impression material and putty impression material, which are readily available in any dental institution. The use of light or medium elastomeric impression materials is recommended because their rubbery nature and good tear strength simulate the elasticity and keratinized texture of skin. [4] It offers acceptable resistance to the passage of a suture needle, and an adequate suture bite prevents suture material from cutting through the incision margins when placing the knot. In addition, the low viscosity of the impression material abets the material to flow into the foam sponge, creating a reliable mechanical bone between them.
The foam sponge resembles the deeper connective tissue, and the elastomeric impression material replicates the skin analogue. The interface between them is practical to master subcuticular sutures. The putty impression material further provides a firm, flexible base to the suturing model. If the suture model is fixed over a curved surface it makes the incised wound to gape [Figure 4], which reflects a realistic situation aiding in understanding the wound tension and the need for adequate bites of tissue to avoid a hematoma. [4] | Figure 4: The gaping of the incised wound emphasizes the need for adequate tissue bites to avoid dead space
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Models prepared in this manner can be stored for several months, but to preclude changes in the material, early use is recommended. Although training suturing technique with commercially available models provides excellent tactile sensation, our tissue simulator is easier and faster to make as it requires only few materials and 15 min time for fabrication. Despite dental specialty, this suturing model can also be implemented in other medical specialties as well where competency in suturing is a requisite. Furthermore, it requires only one tenth of the cost of commercially available suturing models. The easy availability and cost-effective nature of the materials, together with fast preparation time, makes this suturing simulator suitable when an affordable alternative is desired.
| References | | |
| 1. | Macluskey M, Hanson C, Kershaw A, Wight AJ, Ogden GR. Development of a structured clinical operative test (SCOT) in the assessment of practical ability in the oral surgery undergraduate curriculum. Br Dent J 2004;196:225-8. 
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| 2. | De Win G, Van Bruwaene S, De Ridder D, Miserez M. The optimal frequency of endoscopic skill labs for training and skill retention on suturing: A randomized controlled trial. J Surg Educ 2013;70:384-93.
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| 3. | Dantas AK, Shinagawa A, Deboni MC. Assessment of preclinical learning on oral surgery using three instructional strategies. J Dent Educ 2010;74:1230-6.
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| 4. | Uppal N, Saldanha S. Low-cost suturing training model for use in developing nations. Br J Oral Maxillofac Surg 2012;50:e13-4.
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| 5. | Stelzle F, Farhoumand D, Neukam FW, Nkenke E. Implementation and validation of an extraction course using mannequin models for undergraduate dental students. Acta Odontol Scand 2011;69:80-7.
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| 6. | Whitehead FI, Newman A. Models for teaching minor oral surgery. J Dent 1973;2:59-62.
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Correspondence Address:
Ramesh Kumaresan
Academic Unit of Dentofacial Clinical Care, Faculty of Dentistry, AIMST University, Kedah
Malaysia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.142577
[Figure 1], [Figure 2], [Figure 3], [Figure 4] |
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