Comparison Between Primary and Secondary Method of Closing Surgical Wound After Tooth Extraction: A Split-Mouth Study

Vipin  Aggarwal; Meenaxi  Umarani; Shridhar D.  Baliga; Rakhi  Issrani; Namdeo  Prabhu

Authors

Vipin Aggarwal
Meenaxi Umarani
Shridhar D. Baliga
Rakhi Issrani
Namdeo Prabhu

Keywords:

Surgery, Oral, Pain, Postoperative, Suture Techniques, Trismus

Abstract

Objective: To compare and assess the primary and secondary closure techniques following extraction of impacted third molars for post-operative complications. Material and Methods: In total, 30 patients ranging between 18-30 years of age and of either sex who had bilaterally impacted mandibular third molars were randomly selected. Split mouth study method was used so that the participants served as their own control. Group 1 consisted of primary closure of left mandibular impacted third molars and Group 2 consisted of secondary closure of right mandibular impacted third molars. Basement evaluations were recorded for each patient along with subjective and objective evaluations for postoperative 7 days. Data analysis was carried out by SPSS 17.0 software using Mann-Whitney U test, Wilcoxon matched-pairs test and t-test. A p-value ≤ 0.05 was assigned as statistically significant. Results: When compared to group 1, group 2 revealed statistically less pain and swelling following the secondary closure of wound from day 1 to 7. There was a significant improvement in mouth opening in Group 2 at day 1 (p=0.0005) and at day 7 (p=0.00001). Conclusion: Secondary wound closure after disimpaction of mandibular third molar results in better postoperative recovery than primary closure.

References

Balakrishnan G, Narendar R, Kavin T, Venkataraman S, Gokulanathan S. Incidence of trismus in transalveolar extraction of lower third molar. J Pharm Bioallied Sci 2017; 9(Suppl 1):S222-S227. https://doi.org/10.4103/jpbs.JPBS_161_17

Vallerand WP, Vallerand AH, Heft MJ. The effects of postoperative preparatory information on the clinical course following third molar extraction. Oral Maxillofac Surg 1994; 52(11):1165-70. https://doi.org/10.1016/0278-2391(94)90536-3

Pasqualini D, Cocero N, Castella A, Mela L, Bracco P. Primary and secondary closure of the surgical wound after removal of impacted third molars: a comparative study. Int J Oral Maxillofac Surg 2005; 34(1):52-7. https://doi.org/10.1016/j.ijom.2004.01.023

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(2):112-7. https://doi.org/10.1007/s12663-011-0216-y

Al-Samman AA. A review of wound closure technique-patient morbidity relationship after wisdom tooth surgery. Iraqi Dent J 2016; 38(3):154-9. https://doi.org/10.26477/idj.v38i3.101

Rakprasitkul S, Pairuchvej V. Mandibular third molar surgery with primary closure and tube drain. Int J Oral and Maxillofac Surg 1997; 26(3):187-90. https://doi.org/10.1016/s0901-5027(97)80817-x

Dinah F, Adhikari A. Gauze packing of open surgical wounds: Empirical or evidence-based practice? Ann R Coll Surg Engl 2006; 88(1):33-6. https://doi.org/10.1308/003588406X83014

Winter GB. Impacted Mandibular Third Molar. St. Louis: American Medical Book; 1926.

Pell GJ, Gregory BT. Impacted mandibular third molars: Classification and impacted mandibular third molars: Classification and modified technique for removal. Dent Digest 1933; 39:330-8.

Deliverska EG, Petkova M. Complications after extraction of impacted third molars - Literature review. J IMAB 2016; 22(3):1202-11. https://doi.org/10.5272/jimab.2016223.1202

Alvira-Gonzalez J, Gay-Escoda C. Compliance of postoperative instructions following the surgical extraction of impacted lower third molars: a randomized clinical trial. Med Oral Patol Oral Cir Bucal 2015; 20(2):e224-e230. https://doi.org/10.4317/medoral.20121

Wells N, Pasero C, McCaffery M. Improving the Quality of Care Through Pain Assessment and Management. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. Chapter 17. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2658/. [Accessed on July 20, 2020].

Suddhasthira T, Chaiwat S, Sattapongsda P. The comparison study of primary and secondary closure technique after removal of impacted mandibular third molars. Thai J Oral Maxillofac Surg 1991; 5:67-73.

Peterson LJ. Principles of Management of Impacted Teeth. In: Peterson LJ, Ellis E III, Hupp JR, Tucker MR, editors. Contemporary Oral and Maxillofacial Surgery. 4th.ed. St Louis: CV Mosby; 2003.

Berge TI. Inability to work after surgical removal of mandibular third molars. Acta Odontol Scand 1997; 55(1):64-9. https://doi.org/10.3109/00016359709091944

Pippi R. Post-surgical clinical monitoring of soft tissue wound healing in periodontal and implant surgery. Int J Med Sci 2017; 14(8):721-8. https://doi.org/10.7150/ijms.19727

Dubois DD, Pizer ME, Chinnis RJ. Comparison of primary and secondary closure techniques after removal of impacted third molars. J Oral Maxillofac Surg 1982; 40(10):631-4. https://doi.org/10.1016/0278-2391(82)90111-2

Holland CS, Hindle MO. The influence of closure or dressing of third molar sockets on post-operative swelling and pain. Br J Oral Maxillofac Surg 1984; 22(1):65-71. https://doi.org/10.1016/0266-4356(84)90011-1