Primary and Secondary Closure of the Surgical Wound After Removal of Impacted Mandibular Third Molars

Aim: The present study attempted the evaluation of Primary and secondary closure techniques after removal of impacted third molars in terms of healing, post-operative pain and swelling.

Material And Methods: 60 patients with impacted mandibular third molars were randomly divided into two groups of 30. Panoramic radiographs were taken to assess degree of eruption and to asses 3rd molar angulations to the long axis of 2nd molar. Teeth were extracted, and in Group 1 the socket was closed by hermetically suturing the flap. In group II a 5-6 mm wedge of mucosa distal to the second molar was removed & the flap was repositioned. Interrupted sutures were given, so as to form a triangular opening distal to second molar measuring about 5 × 5 mm. Swelling and pain were evaluated for 7 days after surgery with the VAS scale.

Results: Study results showed that post operative Sequale were comparatively less in secondary closure group than the primary closure group. Pain showed statistically significant difference between two groups. Pain was less in secondary closure group from day 1 to day 7. Swelling & trismus was also significantly less in secondary closure group. Evaluation of the complications of these two techniques showed that delayed wound healing occurred in 66.6% of cases (20 cases out of 30) in secondary closure group where as dehiscence of suture line occurred in 33.33% of cases (10 out of 30) in primary closure group.

Conclusions: The results obtained in the present study enable us to conclude that, in cases of equal intra-operative difficulty, open healing of the surgical wound after removal of impacted third molars produces less post-operative swelling and pain than occurs with closed healing, by hermetically suturing the socket.