Is Horizontal Mattress Suturing More Effective Than Simple Interrupted Suturing on Postoperative Complications and Primary Wound Healing After Impacted Mandibular Third Molar Surgery?

Abstract

The aim of this clinical study was to compare the influence of 2 different suturing techniques on postoperative complications and wound healing after surgical extractions of impacted mandibular third molars. In this randomized split mouth study, 30 patients were examined in whom 60 consecutive surgical extractions of symmetrically positioned impacted mandibular third molars were performed. After the extractions, the surgical flaps were sutured with either the simple interrupted or horizontal mattress suturing technique. Postoperative swelling and trismus were recorded on the 2nd, 7th, and 10th days. Pain was recorded in a 7-day diary and wound dehiscence was recorded on the10th postoperative day. Statistical evaluation of data was made using Mann-Whitney U test and Pearson correlation. There were no statistical differences between the 2 suturing techniques in terms of postoperative pain, trismus, and swelling (P > 0.05). There was significantly less wound dehiscence in the horizontal mattress suturing group than in the simple interrupted suturing group (P: 0017). According to the results of this study, the horizontal mattress suturing technique is more effective than the simple interrupted suturing technique on wound healing after impacted mandibular third molar surgery, although it does not decrease the levels of pain, trismus, and swelling.

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

“…Following impacted mandibular third molar surgery, morbidities such as trismus, swelling, pain, and delayed wound closure are severe health concerns for the patients. 1 In this study, we investigated whether the suturing technique has any effect on reducing postoperative complications. Removal of the impacted third molar is a procedure that demands technical skill, sound judgment, sound knowledge of anatomy and surgical principles, the rationale of antibiotic therapy, good anesthesia, proper medication, nutritional balance, and total patient care.…”

“…However, there is no guideline for how the evaluation of primary wound closure after third molar surgery should be done. 1 There is no evidence on which suture material is superior to another in terms of reducing the postoperative complications of impacted third molar surgery. In our study, 3.0 size silk suture material was used as several studies have demonstrated its use after third molar surgery.…”

“…The simple interrupted suturing technique is most commonly used after any oral surgical procedures, including impacted mandibular third molar surgery. 1 According to Holland and Hindle, primary closure is preferred by Howe, Archer, Kruger, Thoma and Killey key whereas many other authors preferred the wound to heal by secondary intention. 8 In secondary healing, the socket remains in communication with the oral cavity whereas in primary healing the socket is covered and sealed hermetically by a mucosal flap.…”

“…The incidence of the impacted mandibular third molar is 20% to 30% in population and it can be symptomatic and asymptomatic. 1 The surgical objective is to quickly and carefully remove the impacted tooth with reduced complications. 2 In spite of various precautions taken, the postoperative period following surgical removal of the impacted third molar is frequently associated with pain, swelling, and trismus along with decreased masticatory capability.…”

“…Therefore, reducing the post-operative complications of impacted mandibular third molar surgery has always been an issue in oral and maxillofacial surgery. 1 Studies show that the amount of post-operative discomfort is also related to the type of wound closure. One of the factors most closely linked to the intensity of postoperative pain and swelling is a type of healing of the surgical wound.…”