Effect of the suture technique on postoperative pain, swelling and trismus after removal of lower third molars: A randomized clinical trial

Abstract

BackgroundTo evaluate the intensity of pain, swelling and trismus after the removal of impacted lower third molars comparing two different suture techniques of the triangular flap: the complete suture of the distal incision and relieving incision and the partial suture with only one suture knot for closure of the corner of the flap and the closure of the distal incision, without suturing the relieving incision.Material and MethodsA prospective, randomized, crossover clinical trial was conducted in 40 patients aged from 18 to 45 years who underwent surgical extraction of impacted lower third molars at the Department of Oral Surgery in the Odontological Hospital of the University of Barcelona during the year 2011. Patients were randomly divided in 2 groups. Two different techniques (hermetical closure and partial closure of the wound) were performed separated by a one month washout period in each patient. Postoperative pain, swelling and trismus were evaluated prior to the surgical procedure and also at 2 and 7 days post operatively.ResultsNo statistically significant differences were observed for pain (p<0.06), trismus (p<0.71) and swelling (p<0.05) between the test and the control group. However, the values of the three parameters related to the test group were lower than those for the control group.ConclusionsPartial closure of the flap without suturing the relieving incision after surgical extraction of lower third molars reduces operating time and it does not produce any postoperative complications compared with complete closure of the wound. Key words: Third molar, surgical flaps, suture techniques, postoperative pain, swelling, trismus.

A Comparative Study of the Effect of Primary and Secondary Closure Technique Following Removal of Impacted Mandibular Third Molars

“…Escoda et al study shows that there are no statistically significant differences in trismus between the complete and partial closure. 5 In this study, a significant difference was observed in the amount of trismus on 2 nd postoperative day between primary and secondary closure.…”

“…4 Primary and secondary closure is used for wound management after extraction of impacted lower third molars. 5 In primary healing, the socket is covered and sealed hermetically by a mucosal flap, whereas, in secondary healing, the socket remains in communication with the oral cavity. 4 Conflicting opinions have been expressed in the literature concerning these two types of healing.…”

A Review of Wound Closure Technique-Patient Morbidity Relationship After Wisdom Tooth Surgery

“…Researchers (12, 13, and 14) founded a significant difference in term of pain, swelling and trismus between the two techniques favoring the single suture techniques. In another study, researchers revealed no statistical significant difference between the two techniques (15) . Anighoro et al (16) showed a significant reduction in postoperative pain and trismus in single suture technique, however, no difference in the values of facial swelling when compared with multiple suturing technique.…”

A Comparative Study of the Effect of Sutureless Versus Multiple Sutures Technique on Complications following Third Molar Surgery in Nepalese Subpopulation

“…e magnitude of these sequelae depends on the extent of inflammatory response resulting from the extent of tissue damage produced [7], which in turn depends on certain demographics including age, gender, oral health status, and anatomic and operative factors such as increased surgical difficulty, magnitude of ostectomy, and duration of surgery [7]. Different closure techniques with or without incorporation of drains [8]; use of drugs such as analgesics [9], corticosteroids [10], and antibiotics [11]; and physical therapeutic methods such as cryotherapy [12], soft laser application [13], and sutureless techniques [14][15][16][17][18] are among the number of modalities reported in the literature to minimize postoperative pain, swelling, and trismus. Damage to the capillary vessels and the release of inflammatory cytokines as a result of trauma lead to increased permeability of vessels and accumulation of serosanguineous fluid and exudate [16].…”

“…Sutureless closure with minimal manipulation of soft tissues and healing by secondary intention, decreasing time of surgery, leaving a self-drainage pathway for inflammatory exudate, and thereby reducing postoperative inflammation with impact on improving the oral health related quality of life index. Abundant data exists regarding the advantages of sutureless technique after third molar surgery like less pain, swelling, and trismus with comparatively few undesirable effects [5,7,[15][16][17][18] related to healing by secondary intention. In addition, there may be high potential for the formation of a periodontal pocket in relation to the adjacent second molar, but however, the literature is equivocal.…”