Semkin V A, Gurin A N, Vitrenko D V, Levchenko D D
Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.
Stomatologiia (Mosk). 2022;101(3):38-43. doi: 10.17116/stomat202210103138.
Inflammatory complications are the most prevalent problems after surgical extraction of mandibular third molars. The main options for prevention are prophylactic antibiotics usage before surgery or in the postoperative period; a method of postoperative management of a tooth socket, implying healing by primary or secondary closure. Each of the postoperative management types has advantages and disadvantages.
The aim of the study was to compare complete suturing versus iodoform gauze packing of tooth socket for prevention of inflammatory complications after mandibular third molar removal.
A retrospective cohort study was performed. The medical records of 273 patients who underwent mandibular third molar extraction for orthodontic indications were analyzed. Data of 100 patients were included, in 50 cases the postoperative management was carried out using iodoform packing, in other 50 cases complete suturing was performed. Depending on the type of data and distribution, we used the chi-squared test, Fisher's exact test, Student's -test, Mann-Whitney U test. A <0.05 was needed to achieve statistical significance.
Alveolitis developed in 8 % cases of iodoform gauze packing and 34% cases of suturing. The differences are statistically significant (=0.003). The total rehabilitation period (days) in patients with no alveolitis using iodoform gauze packing was 8 (7; 31) (Me (Q1; Q3)), using complete socket suturing was 7 (7; 8) (Me (Q1; Q3)), the differences are statistically significant (=0.003).
The best option for the prophylaxis of alveolitis after surgical extraction of mandibular third molar is secondary closure using iodoform gauze packing. However, in the cases with no alveolitis when complete suturing was performed, healing occurred much faster, which justifies the development of an alternative method for third molar socket healing.
炎症并发症是下颌第三磨牙手术拔除后最常见的问题。预防的主要选择是在手术前或术后使用预防性抗生素；一种牙槽窝术后管理方法，即通过一期或二期缝合促进愈合。每种术后管理类型都有其优缺点。
本研究的目的是比较完全缝合与碘仿纱条填塞牙槽窝预防下颌第三磨牙拔除后炎症并发症的效果。
进行一项回顾性队列研究。分析了273例因正畸适应证接受下颌第三磨牙拔除术患者的病历。纳入100例患者的数据，其中50例术后采用碘仿纱条填塞进行管理，另外50例进行完全缝合。根据数据类型和分布情况，我们使用了卡方检验、Fisher精确检验、Student's检验、Mann-Whitney U检验。需要P<0.05才能达到统计学显著性。
碘仿纱条填塞组8%的病例发生干槽症，缝合组为34%。差异具有统计学显著性（P=0.003）。未发生干槽症的患者中，使用碘仿纱条填塞的总康复期（天）为8（7；31）（中位数（第一四分位数；第三四分位数）），采用牙槽窝完全缝合的为7（7；8）（中位数（第一四分位数；第三四分位数）），差异具有统计学显著性（P=0.003）。
下颌第三磨牙手术拔除后预防干槽症最好的选择是使用碘仿纱条填塞进行二期缝合。然而，在进行完全缝合且未发生干槽症的病例中，愈合速度要快得多，这为开发一种替代的第三磨牙牙槽窝愈合方法提供了依据。
