Background: Lower third molar surgery remains one of the most common surgical procedure in oral and maxillofacial surgery. It has its own risks, and post-operative complications, that influence the recovery period, and affect a patient’s quality of life. This study aims to determine which of the two secondary closure techniques assessed is superior in improving wound healing, and reducing post-operative complications, following lower third molar surgery.

Material & Methods: We carried out a prospective, randomised, double-blind, split-mouth controlled trial on 37 patients, who had bilateral impacted third molars of similar surgical difficulty, were recruited, with 34 successfully completing the study. We compared partial closure using one suture to the suture-less technique. Surgical sites were divided into two groups, Group A: one suture, and Group B: suture-less. Each patient received both treatments at the same time. During the first post-operative week, all patients were asked to daily assess pain, facial swelling, and bleeding, using subjective self-assessment scales.

Results: The results showed a statistically significant difference between the two techniques in the following outcomes: a) less post-operative pain in one suture technique at day five (p = 0.046), and six (p = 0.034), b) better socket healing at one week (p = 0.002), and one month (p = 0.014) in one suture technique, and c) better soft tissue healing at one week (p = 0.016) in one suture technique.

Conclusion: The one-suture technique for lower third molar surgery is superior to the suture-less technique in reduction of post-operative pain at day five and day six, and improving wound healing at one week and at one month post-operatively. There is no difference between the two techniques in reduction of post-operative swelling.

Keywords: Suture, Suture less, Impacted third molar, Pain, swelling, wound healing.

1. BOULOUX, G. F., STEED, M. B. & PERCIACCANTE, V. J. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am,2007; 19:117-28, vii.
2. ODUSANYA, S. A. & ABAYOMI, I. O. Third molar eruption among rural Nigerians. Oral Surg Oral Med Oral Pathol,1991; 71:151-4.
3. PAHKALA, R., PAHKALA, A. & LAINE, T. Eruption pattern of permanent teeth in a rural community in northeastern Finland. Acta Odontol Scand,1991; 49:341-9.
4. ELSEY, M. J. & ROCK, W. P. Influence of orthodontic treatment on development of third molars. Br J Oral Maxillofac Surg,2000; 38: 350-3.
5. GROVER, P. S. & LORTON, L. The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol,1985; 59: 420-5.
6. LYTLE, J. J. Etiology and indications for the management of impacted teeth. Northwest Dent,1995; 74: 23-32.
7. ALLEN, R. T., WITHEROW, H., COLLYER, J., ROPER-HALL, R., NAZIR, M. A. & MATHEW, G. The mesioangular third molar--to extract or not to extract? Analysis of 776 consecutive third molars. Br Dent J,2009; 206: E23; discussion 586-7.
8. YAMALIK, K. & BOZKAYA, S. The predictivity of mandibular third molar position as a risk indicator for pericoronitis. Clin Oral Investig,2008; 12: 9-14.
9. OFFENBACHER, S., BECK, J. D., MOSS, K. L., BARROS, S., MENDOZA, L. & WHITE, R. P., JR. What are the local and systemic implications of third molar retention? J Oral Maxillofac Surg,2012; 70: S58-65.
10. GHAEMINIA, H., PERRY, J., NIENHUIJS, M. E., TOEDTLING, V., TUMMERS, M., HOPPENREIJS, T. J., VAN DER SANDEN, W. J. & METTES, T. G. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev, 2016;
11. LIEBLICH, S., KLEIMAN, M. & ZAK, M. Parameters of care: clinical practice. Guidelines for oral and maxillofacial surgery.(AAOMS parcare 2012). Journal of Oral and Maxillofacial Surgery,2012;
12. 2000. National Institute for Clinical Excellence. Guidance on the extraction of wisdom teeth [Online]. National Institute for Clinical Excellence. London: NICE. Available: https://www.nice.org.uk/guidance/ta1 2000].
13. COLORADO-BONNIN, M., VALMASEDA-CASTELLÓN, E., BERINI-AYTÉS, L. & GAY-ESCODA, C. Quality of life following lower third molar removal. International journal of oral and maxillofacial surgery, 2006;35: 343-347.
14. JAKSE, N., BANKAOGLU, V., WIMMER, G., ESKICI, A. & PERTL, C. Primary wound healing after lower third molar surgery: Evaluation of 2 different flap designs. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2002; 93: 7-12.
15. JENSEN, M. P., KAROLY, P., O'RIORDAN, E. F., BLAND, F., JR. & BURNS, R. S. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain,1989; 5: 153-9.
16. WILLIAMSON, A. & HOGGART, B. Pain: a review of three commonly used pain rating scales. J Clin Nurs,2005; 14: 798-804.
17. SEYMOUR, R. A., MEECHAN, J. G. & BLAIR, G. S. An investigation into post-operative pain after third molar surgery under local analgesia. Br J Oral Maxillofac Surg, 1985;23: 410-8.
18. DE BRABANDER, E. C. & CATTANEO, G. The effect of surgical drain together with a secondary closure technique on postoperative trismus, swelling and pain after mandibular third molar surgery. Int J Oral Maxillofac Surg,1988; 17: 119-21.
19. KAZEMIAN, M., ESHGHPOUR, M., ILKHANI, S. & GHADIRIMOGH-ADDAM, N. The Effect of Sutureless Surgery on Postoperative Pain and Swelling Following Mandibular Third Molar Surgery. Journal of Dental Materials and Techniques,2016; 5: 63-67.
20. QUADRI , A., QUADRI , S. & KHAN , T. Comparative Study of Post-operative Complications in Third Molar Surgery with and without Sutures: A Prospective Study. Int J Sci Stud,2016; 4: 168-171.
21. OSUNDE, O. D., SAHEEB, B. D. & ADEBOLA, R. A. Comparative study of effect of single and multiple suture techniques on inflammatory complications after third molar surgery. J Oral Maxillofac Surg,2011; 69: 971-6.
22. KHANDE, K., SALUJA, H. & MAHINDRA, U. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars. J Maxillofac Oral Surg, 2011;10: 112-7.
23. RAKPRASITKUL, S. & PAIRUCHVEJ, V. Mandibular third molar surgery with primary closure and tube drain. Int J Oral Maxillofac Surg,1997; 26: 187-90.

Dr Vidhi Verma

Final year P.G. Resident, Department of Oral & Maxillofacial Surgery, MGDCH, Jaipur