Needle Holders and Suturing

Needle holders come in various sizes, shapes, materials, and with different beak types. The most common shape in needle holders has finger ring handles, and these are the most dated. The more modern and easier to use needle holders are the Mathieu style spring handle type, which are held in the hand around the body of the instrument and squeezing the handle to release or lock. Castroviejo style spring mechanisms are used in circumstances that require smaller needle and suture sizes. The position of the hand when using spring handles makes it easier to rotate during suturing.

Common beak material used for all needle holder styles are:

·      Stainless steel (least desirable, serrations in the beak loose their edge the quickest)

·      Diamond coated (expensive and wears out, as glued on diamonds fall out over time)

·      Tungsten Carbide (TC) most desirable, longest lasting, no needle slippage, hardest material (serrations in the beak last the longest)

Conventionally, gold color on both handles on needle holders indicates that the beaks have tungsten carbide insert plates (TC).  Only one gold handle on a needle holder indicates that the needle holder is being marketed with variations of other metals/materials that are not necessarily desirable, i.e. tungsten. The advantage of TC needle holders is there is no needle slippage during suturing. Less expensive conventional or standard needle holders are made of stainless steel, which is a softer metal and do not last as long.  TC needle holders will last 2-4 times longer than stainless steel ones. Additionally, with stainless steel needle holders you will need to hold needles in the middle of the beak. TC needle holders can hold needles at the tip of the beak, an advantage for tight areas.

Beak sizes depend on needle sizes/suture sizes.

Typical standard needle holder size with finger ring handles:

·      Mayo-Hegar for suture sizes 3/0, 4/0

·      Crile-Wood for suture sizes 4/0, 5/0

·      Micro Ryder for suture sizes 5/0, 6/0

Spring handle needle holders:

·      TC Castroviejo small beak for suture sizes 6/0 to 10/0

·      TC Mathieu for suture sizes 3/0 to 5/0

Quality made needle holder cost:

·      Higher quality stainless steel finger ring handles varieties = $120+

·      TC in finger ring handles varieties = $180 to $200+

Quality needle holders with spring handles cost:

·      Mathieu TC = $230 to $270+

·      Castroviejo TC = $350 to $700

Typically, needle Holders costing less than $100 are made of a lesser quality stainless steel that use softer metal combinations that lose their serration more easily.

 Note: Castroviejo needle holders should never be acquired with stainless steel beaks, they will not last long. It is suggested to only acquire them with gold handles (TC beaks).

 Suture Needles

The more common suture needles used in dentistry are 3/8 Circle and 1/2 Circle with cutting edge needles that are triangular shaped. Triangular shaped needles should only be used for thick or fibrous tissue, like the palate. These triangular needles are not recommended for use on thin tissue, i.e. interproximal suturing, because of likely tissue tear.

Dentists often resort to using triangular shaped needles because there is less slippage when using stainless steel needle holders.

Most of the tissues that dentists will suture are softer and thinner, which negates using triangular shaped needles. When suturing softer or thinner tissues, taper-point, round-bodied needles are preferred. They are less likely to tear the tissue during penetration, and leave a smooth round hole. TC needle holders should be used for these needles, so there is no needle slippage. If stainless steel needle holders are used for taper-point round-bodied needles, there will likely be needle slippage, as the instrument gets older.

 Needle Holder Maintenance Suggestions

Needle holders will last longer when stored in the unlocked position.  When stored this way, the tension on the handles is released.  Over time, this allows the beak to hold the needle better because the optimally set tension needed for gripping is maintained.

If blood should enter the hinge during use, rinse the hinge with hydrogen peroxide ASAP before the blood dries and before autoclaving to keep the blood from hardening, which can tighten the hinge. Rinsing with water often sets up blood and thickens it. Subsequent autoclaving bakes the blood, which will look like rust. This will negatively affect the hinge. Once blood is baked into the hinge, only friction will unseat it. The heat built up with friction will break up the baked blood. Once the hardened blood is broken up, spray the needle holder hinge with WD40 then rinse with hydrogen peroxide before washing. If the hinge is still stiff, repeat the process.

(If you found this artcle helpful, let us know below. About every month we will submit a new instrument artcle that can advance your instrument useage. If you have a suggestion about a type of dental instrument you would like to know more about in detail, let us know below and we might be able to give you more depth.)