A surgeon’s dilemma: Evidence based selection of suturing technique to minimize post-operative complications following lower third molar surgical extraction

Abstract

Background
 Lower third molar extraction is usually associated with multiple stigmae that deters the patients in most cases to postpone or not seek appropriate surgical care. It is also one of the most feared procedure amongst dentists and dental students. However, evidence has been reported suggesting that the choice of suturing technique can have a profound effect on post-operation complications and thereby can improve the overall outlook and comfort of the patient. In the past, multiple techniques like Mattress, Continuous etc have been compared with tissue glues, staples however, a comparative clinical study amongst the simplest and most commonly used suturing techniques have not been reported.
 Material and Methods
 Sixty patients with impacted mandibular third molars fulfilled the inclusion criteria and were randomly divided into three groups of 20 each. All patients underwent third molar extraction and sutures were placed using different techniques – Simple Interrupted (Group A), Continuous (Group B) and Figure of eight (Group C). Patients were evaluated pre-operatively as well post-operatively (at different time points) for five parameters - Pain, Swelling, Trismus, Periodontal health of second molar and Wound infection. Kruskal-Wallis (non-parametric ANOVA) with post-hoc and effect size was used for statistical analysis with P < 0.05 as statistically significant.
 Results
 Statistically significant differences were obtained in terms of pain and trismus between Groups A and C post-operatively (P < 0.05). There were also significant differences in pain between Groups B and C post-surgery (P < 0.05). No significant differences were found between groups for swelling, periodontal health of second molar and wound infection.
 Conclusions
 Figure of eight suturing presents with better patient outlook and is associated with lower pain, swelling and trismus. Continuous and simple interrupted suturing can be preferred as second-in-line techniques. Final choice of technique shall be made based on wound anatomy, patient history and surgeon’s expertise.