Comparative evaluation of the sutureless and multiple suture technique in third molar impaction: a clinical TRIAL

One of the most frequent procedures in oral and maxillofacial surgery is the surgical extraction of mandibular third molars. The average incidence of third molar impaction is 24.40% approximately with significant regional variations¹. Although environmental characteristics are more likely to be the cause of these differences, genetic factors may play a role. Primary closure of the operating site is usually advocated but is not always essential as advocated by the French Health Authority (HAS)². There is still debate regarding the optimal surgical methods, particularly with regards to the mucosal closure after surgical removal of impacted mandibular third molar. The two approaches used are to allow for healing by either primary or secondary intention. Suturing of sockets after extraction is recommended by some groups on the grounds that wound approximation help in bleeding control and decreases the contamination of operative site and therefore, enhance the rate and quality of healing. Others, however, favor healing by secondary intention because it allows the surgical site to naturally drain, lowering the risk of inflammatory response. Dubois et al. compared hermetic closure to sites where the mesial portion of the wound was allowed to heal through secondary intention.³

On the fifth day, wound dehiscence was noted in fifty percent of the hermetically sutured patients, though no infection was present. They also found that sutured patients had a tendency for incomplete closure, even though there were no changes in postoperative swelling, pain, or infection. Following the extraction of an impacted wisdom tooth, subsequent research has compared surgical site closure methods.^4–6. None, however, have assessed quality of life, pain, oedema, trismus, complications, and the use of painkillers after more than seven days following surgery in a sizable cohort. Although the results showed significant heterogeneity because of the variations in the incision techniques used, a meta-analysis of five studies found that secondary closure reduced pain^7. There is currently not enough data to determine whether alveolar osteitis, infection, or bleeding responds better to primary or secondary healing.