Comparison of primary and secondary closure techniques after removal of impacted mandibular third molars

There is a diversity of opinion among authors of oral surgery textbooks regarding the technique of wound closure after removal of impacted mandibular third molars. A primary closure is preferred by Howe,¹ Archer,² Guralnick,³ Kruger,⁴ Thoma,⁵ and Killey and Kay.⁶ Other authors, however, prefer the wounds to heal by secondary intention. They include Bourgoyne,⁷ Blair and Ivy,⁸ Padgett,⁹ and Mead.¹⁰ The use of a drain is also suggested.^8,9 On the other hand, Clark¹¹ and Winter¹² indicate that the wounds may be treated by either method, and Woodward¹³ advocates the use of a small V-opening posterior to the second molar to facilitate postoperative irrigation of the wound. We were unable to find reports of an objective evaluation of the various closure techniques.The purpose of this study was to compare closure by primary intention and a closure that used a window, with healing by secondary intention. The effectiveness of the techniques was evaluated relative to the degree of patient comfort and the postoperative condition of the surgical site.     

The effect of surgical drain together with a secondary closure technique on postoperative trismus, swelling and pain after mandibular third molar surgery

This investigation compared the results of 2 types of wound closure after mandibular third molar removal. In both the test group and the control group, the molars were removed using a mucoperiosteal flap as described by Szmyd; a wedge of tissue distal to the second molar was removed before closure to secure self-irrigation of the empty socket. The test group received a gauze drain partially submerged into the socket to secure more drainage and to prevent primary wound healing. Examinations were performed 2 days and 7 days after surgery, and pain, swelling, trismus and wound condition were recorded. Analyses of variance indicated that there was no significant difference between the 2 types of wound closure.     

Postoperative swelling and trismus after mandibular third molar removal with the lingual split bone technique.

Several factors have been suggested as possible causes for the development of the swelling and trismus which occur after the surgical removal of impacted third molar teeth. In this investigation, measurements of swelling and trismus were made before and after lower third molar removal by the lingual split technique, in a series of 53 patients. No single cause of these surgical sequelae was identified and the duration and pattern of both swelling and trismus were recorded.     

Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables

PURPOSE: This paper is intended as an investigation of the relationship between preoperative findings and short-term outcome in third molar surgery. MATERIAL AND METHODS: We assessed 153 consecutive surgical extractions of mandibular third molars performed in 140 patients between April 1998 and March 2001. RESULTS: Fifty-four (35%) of the 153 extractions were performed in male subjects and 99 (65%) in female subjects. The median age was 27 years. The amount of facial swelling varied depending on age and sex. Severe pain was associated with depth and preoperative index of difficulty. Average pain was associated with preoperative index of difficulty. CONCLUSION: In conclusion, we consider that the short-term outcomes of third molar operations (swelling and pain) differ depending on patients' characteristics (age and sex) and preoperative index of difficulty. Further mega-trial studies of the association between preoperative findings and short-term outcome will help to elucidate the true nature and magnitude of the association.     

Comparative study of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars

Aim

Aim of the study is to compare the primary and secondary healing after surgical removal of impacted mandibular third molars, in terms of swelling, severity of pain, trismus, and periodontal healing between two types of closure.

Materials and methods

A total of 60 patients, divided into two groups randomly: group A, with 30 patients in which primary closure was done; group B, with 30 patients in which secondary closure was done. A comparison between two groups was done in terms of postoperative pain, swelling, trismus at first, third, and seventh postoperative days, and periodontal healing near adjacent second molar after 6 months.

Results

The swelling and pain in group A were greater than that in group B, with a statistically significant difference (p <?0.05). Mouth opening is greater in group B compared to group A. There is no significant difference in periodontal healing in between two groups after 6 months. Complication like alveolar osteitis was noted in 1 patient (3.3%) in group B.

Conclusion

We conclude that secondary closure was better than primary closure in terms of postoperative pain, swelling, and trismus. Irrespective of any closure technique, there is no difference in terms of periodontal healing.

     

Interrelation of complaints after removal of impacted mandibular third molars

Swelling, pain and trismus were evaluated quantitatively after the removal of impacted mandibular third molars on 30 healthy individuals. Evaluation took place 48 h and 7 days after surgery. The mutual correlation between the complaints was determined as well as the correlation between the length of the operation and the degree of postoperative complaints. It is concluded from the study that the longer the operation takes, the more postoperative pain can be expected. However, neither swelling nor trismus is correlated with the length of time of the operation. The size of the swelling was not related to the degree of trismus or postoperative pain. A strong interrelation between postoperative pain and trismus indicates pain as the main reason for reduced mouth opening after removal of impacted mandibular third molars.     

Alveolitis sicca dolorosa after removal of impacted mandibular third molars

The aim of the investigation was to study the occurrence of alveolitis and other side effects in women taking oral contraceptives after surgical removal of impacted mandibular third molars. Reactions to surgical removal of 156 bilateral third molars were examined in 78 patients. The material was divided into 2 groups. In 1 group, the patients took oral contraceptives of the combined type and in the other group the patients took no contraceptives. Each group was further divided into 2 subgroups: (1) removal of a molar during menstruation; and (2) removal of the contralateral molar in the same patient at the middle of the menstrual cycle. The results showed significantly more alveolitis in the group taking oral contraceptives and in women who were operated on during menstruation. These findings would suggest that oral surgery involving fertile women should be undertaken during periods free from oral contraceptives and menstruation.     

Efficacy of hyaluronic acid spray on swelling,pain, and trismus after surgical extraction of impacted mandibular third molars

The aim of this study was compare the efficacies of two oral sprays in reducing swelling, pain, and trismus after the extraction of impacted mandibular third molars. This prospective double-blind, randomized, crossover clinical trial included 34 patients with bilateral symmetrically impacted mandibular third molars of similar surgical difficulty. Hyaluronic acid or benzydamine hydrochloride spray was applied (two pumps) to the extraction area, three times daily for 7 days. Swelling was evaluated using a tape measure method, pain with a visual analogue scale (VAS), and trismus by measuring the maximum inter-incisal opening. Assessments were made on the day of surgery and on days 2 and 7 after surgery. Statistically significant differences were detected for the swelling and trismus values between the two treatment groups on the second postoperative day (P = 0.002 and P = 0.03, respectively). However, there was no statistically significant difference in VAS scores between the two groups. The administration of hyaluronic acid spray was more effective than benzydamine hydrochloride spray in reducing swelling and trismus. Although no evidence of a reduction in pain levels was detected, hyaluronic acid appears to offer a beneficial effect in the management of swelling and trismus during the immediate postoperative period following impacted third molar surgery.     

The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery

Our aim was to assess the influence of sutureless and multiple-suture closure of wounds on postoperative complications after extraction of bilateral, impacted, mandibular third molars in 30 patients in a split mouth study. After the teeth had been removed, on one side the flap was replaced but with no suture to hold it in place (study side), and on the other side the wound was closed primarily with three sutures (control side). Recorded complications included pain, swelling, bleeding, and formation of periodontal pockets. The results showed that patients had significantly less postoperative pain and swelling when no sutures were used (p=0.005). There were no signs of excessive bleeding or oozing postoperatively on either side. Six months postoperatively there was no significant difference in the depth of the periodontal pocket around the second molar.     

Effect of methylprednisolone on complications after removal of impacted mandibular third molars

Bilateral impacted mandibular third molars were surgically removed in 20 healthy patients. The effects of methylprednisolone on postoperative healing was investigated in a double-blind, cross-over study. Some decrease in postoperative discomfort (swelling and trismus) was noted in the methylprednisolone group. No statistically significant difference was noted, however in comparison with a placebo group.     

Evaluation of intra-alveolar chlorhexidine dressings after removal of impacted mandibular third molars.

Chlorhexidine gluconate (CHX) has been investigated for its possible benefit in the prevention of alveolar osteitis complicating third molar removal. In a double-blind, placebo-controlled clinical study, 70 randomly selected healthy patients were subjected to uncomplicated mandibular third molar removal followed by CHX-gelatin sponge and saline solution-gelatin sponge intra-alveolar dressings. Each patient was followed for 6 days for postoperative discomfort and complications, and scored accordingly. The results demonstrated that patients receiving 0.2% CHX intra-alveolar dressings exhibited a significant reduction in postoperative discomfort and complications when compared with saline solution-treated control sites (p less than 0.005). Further, this phenomenon was not found to be related to patient factors including age, sex, and race, nor did any correlation exist between treated or control sites, and surgical factors including performing surgeon, surgeon's dominant hand, time of surgery, surgical site, and difficulty of the removal. These findings warrant further studies concerning the apparent clinical benefit of postextraction intra-alveolar CHX dressings for the reduction of postoperative alveolar osteitis.     

Reevaluation of the lingual split-bone technique for removal of impacted mandibular third molars

In 1970 the author published an article on the results of use of the split-bone technique for removal of impacted mandibular third molar teeth. By this method, first described by Ward, a thin segment of distolingual bone is removed and the tooth delivered lingually. This clinical update reviews the previous paper, adds additional cases and findings, and gives the author's current views of the value of the technique, indications for its use, and possible complications.     

The effect of methylprednisolone on pain, trismus, and swelling after removal of third molars

Thirty-one healthy patients whose third molars needed to be removed were randomly placed into two groups. Before sedation the control group (n = 16) received normal saline solution and the experimental group (n = 15) received 125 mg of methylprednisolone intravenously. Swelling was measured by photographic and face-bow techniques, trismus was determined by measuring maximal interincisal opening, and pain was evaluated by asking the patients to report the number of pain pills they used and assess th severity of their pain daily. The swelling and pain, but not the trismus, that developed after third molar removal were significantly reduced by a single dose of methylprednisolone.     

Acetylsalicylic acid compared with acetylsalicylic acid plus codeine as postoperative analgesics after removal of impacted mandibular third molars

In a multicenter, double blind clinical trial a combination of acetylsalicylic acid 500 mg + codeine phosphate 30 mg has been compared with acetylsalicylic acid 500 mg as postoperative analgesics in patients with pain after surgical removal of impacted mandibular third molars. Evaluation of the results from 129 patients showed that the combination of acetylsalicylic acid and codeine provided better pain relief and also the number of tablets used was smaller and the time intervals between repeated doses were longer than with acetylsalicylic acid only. Adverse effects were few and similar for both drugs. It may be concluded that the combination of 500 mg acetylsalicylic acid and 30 mg codeine phosphate provides a useful analgesic for more severe pain conditions in oral surgery.