Comparative evaluation of the healing of extraction socket with and without suture after removal of impacted mandibular third molars-A Randomised clinical trial.

NEED FOR THE STUDY:

The removal of an impacted third molar is the most common surgical procedure performed by oral surgeons 1. These teeth generally erupt between the ages of 17 and 21 years. It has also been reported that the third molar eruption varies with races, such as in Nigeria mandibular third molars may erupt as early as 14 years and in Europe it may erupt up to the age of 26 years. Factors such as the nature of the diet that may lead to attrition, reduced mesiodistal crown diameter, degree of use of the masticatory apparatus and genetic inheritance also affect the timing of third molar eruption2.

Impacted tooth is defined as a tooth that is prevented from erupting into position  within the expected time  due to a physical barrier within the path of eruption . 3rd molar impactions are associated with several acute or chronic pathological changes, such as pain, infection, caries, periodontal disease, root resorption, bone loss, cyst formation, and benign tumors, justifying its removal. Pain, swelling, decreased mouth opening and temporary inability to work are the generally accepted inevitable postoperative consequences following surgical extraction. This is further associated with a significant deterioration in oral health related quality of life in the immediate postoperative period  and an increase in the total expenditure for removal of third molars 3.

One of the factors most closely linked to the intensity of post-operative pain and swelling is the type of healing of the surgical wound. In secondary healing, the socket remains in communication with the oral cavity; in primary healing, the socket is covered and sealed hermetically by a mucosa flap4. Damage to the capillary vessels and the release of inflammatory cytokines as a result of the trauma lead to increased permeability of vessels, which results in accumulation of serosanguinous fluid and exudates.5

Conflicting opinions have been expressed in the literature concerning these two types of healing. Some authors are in favour of closed healing, whereas other authors report that primary healing frequently causes greater pain and swelling than secondary healing. Other authors are of the opinion that postoperative progress does not differ in the two types of healing 4.

The present study is intended to compare the pain , swelling , trismus and healing of extraction socket with suture and without suture   after  removal of impacted mandibular third  molar .