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Surgical sites that are 2-5 teeth and require onlay bone grafting and/or membrane fixation can utilize a subperiosteal suturing variation called the “W Periosteal.” Invented by Wade Pilling DMD, DABOI, the “WP” suture technique allows the surgeon to pre-throw the buccal throws of a subperiosteal membrane fixation technique. Once the buccal bites are pre-thrown the membrane and any bone grafting is placed at the surgical site and the lingual bites are thrown. The final suture allows the membrane to be completely secured by one tension relieving suture.

The first throw is at one of the proximal ends of the surgical site and engages deep buccal periosteum similar to the subperiosteal mattress. A second throw also engages the buccal periosteum at the other end of the surgical site. A loop is left with some slack between the two buccal subperiosteal bites. The membrane and any graft is placed along the buccal. The third bite is directly across the incision and passes through the lingual tissue opposite the second periosteal bite. The suture is immediately passed back through the lingual tissue. The needle is then carefully passed through the loop left between the two buccal periosteal bites. The last bites are once again out and back through the lingual tissue, this time opposite the first periosteal bite. The suture is then tied to the tail left at the first periosteal bite. This knot will be secured and buried under the flap, and the suture has three distinct straps across the surgical site in the rough shape of a “W”. This suture allows even and distributed pressure and stability along the length of the membrane.

The suture is then followed by horizontal mattress and wound closure sutures (continuous or interrupted) for watertight and tension free wound closure.