A comparative study of the effect of one-suture and suture-less techniques on post-operative complications following third molar surgery

Abstract

Title: A comparative study of the effect of one-suture and suture-less techniques on post-operative complications following third molar surgery.

Author: Dr Saleh Alkadi BDS(Hons), MFDS RCSI, NBDE

Objective: Lower third molar surgery remains one of the most common surgical procedure in oral and maxillofacial surgery. It has its own risks, and postoperative complications, that influence the recovery period, and affect a patient?s quality of life. It has been suggested that wound closure technique is an operative factor that influences early post-operative complications, after lower third molar surgery. This is a comparative study that investigates two secondary closure techniques; partial closure using one suture and the suture-less technique, after using a modified buccal envelope flap for lower third molar surgery. 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.

Materials and methods: We carried out a prospective, randomised, double-blind, split mouth controlled trial, to investigate the effect of closure technique on post-operative complications and wound healing following lower third molar surgery. Thirty- seven patients, who had bilateral impacted third molars of similar surgical difficulty, were recruited, with thirty-four successfully completed 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 self-assessment scales. All patients attended follow-up appointment at one week, to objectively assess facial swelling and wound healing, and at one month, to assess wound healing.

Results: The results showed a statistically significant difference between the two techniques in a) post-operative pain at day five (p = 0.046), and six (p = 0.034), b) socket healing at one week (p = 0.002), and one month (p = 0.014), and c) soft tissue healing at one week (p = 0.016). The results showed no statistical significant difference between the two techniques in a) post-operative pain during the first four days, b) post-operative swelling, c) post-operative bleeding, d) food impaction within surgical site and e) periodontal health of the buccal side for the adjacent lower second molar at one month (all p >0.05).

Conclusion: The one-suture technique for lower third molar surgery is superior to the suture-less technique in reduction of post-operative pain, and improving wound healing during early post-operative period. There is no difference between the two techniques in reduction of post-operative swelling.