Abstract
Objectives: The purpose of this clinical trial is to assess the efficiency of 3-0 knotless barbed suture (polydioxanone) with 4-0 polyglactin 910 (vicryl) in wound closure following impacted mandibular third molar surgery.
 Methods: The split-mouth study involved 20 patients who were referred to the Oral Surgery Clinic at the Department of Oral and Maxillofacial Surgery for bilateral mandibular third molar impaction with equal difficulty index. Simple randomization was used to distribute the samples. Following extraction, the wounds were closed with 3-0 knotless sutures for the study group and 4-0 polyglactin 910 (vicryl) for the control group. Following surgical extraction in relation to infected mandibular molars under local anesthesia, the clinical outcome parameters that were measured were (1) time taken to achieve wound closure and hemostasis, and (2) post-operative wound healing using "Landry's wound healing index" on the 1st, 3rd, and 7th post-operative days.
 Results: In this study, we discovered that the average time taken to approximate a wound was 2.69 minutes for the study group and 4.27 minutes for the control group. The research and control groups had a statistically significant difference in suturing time (p-value< 0.05). On all postoperative review days, wound healing in the study group was shown to be better and statistically significant than in the control group (p-value <0.05).
 Conclusion: Within the limitations of the present study, knotless barbed suture is a promising alternative to conventional sutures for intra-oral wound closure as it reduces suturing time and facilitates effective wound closure following surgical removal of impacted mandibular third molars.
Highlights
To bind the suture material to the tissues and maintain proper tension at the approximated wound boundary, traditional suturing needs the application of knots [1,2]
The following goals should be achieved with intraoral suturing in maxillofacial surgery: readaptation and maintenance of surgical flaps in normal anatomical position to facilitate wound healing, providing water-tight closure to avoid contamination of the surgical site by saliva and food debris, and preventing implant exposure, [5,6,7] as well as providing enough resistance to the dynamic peri-oral muscles [7]
The'split-mouth study' was used in the investigation, with one side of the mouth assigned to Knotless suture and the contra-lateral side to polyglactin 910 suture
Summary
To bind the suture material to the tissues and maintain proper tension at the approximated wound boundary, traditional suturing needs the application of knots [1,2]. Suturing after maxillofacial surgery procedures has a number of technical challenges, including limited access, equipment issues, and knot securing difficulties [4]. Surgical knots can cause a variety of knot-related problems, such as infection and soft tissue irritation since they act as a nidus for food debris to collect. Suturing after mandibular third molar surgery, on the other hand, poses the following technical challenges: restricted access, instrumentation challenges, and knot securing challenges [7]. Several knot-related problems, such as the collection of food debris leading to infection and soft tissue irritation, have been recorded in the literature [7,9] the knots may create ischemia as a result of the added pressure, making the wound more susceptible to infection. Suturing errors can lead to wound dehiscence, infection, and postoperative discomfort [10]
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