School of Dentistry, Post-Graduations Program in Dentistry, University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
Department of Oral and Maxillofacial Surgery, Hospital Universitário Oswaldo Cruz (HUOC/UPE), Recife, Pernambuco, Brazil.
PLoS One. 2023 Jun 23;18(6):e0286413. doi: 10.1371/journal.pone.0286413. eCollection 2023.
Wound closure technique is an operative factor that influences early post-operative complications after third molar surgery. This study investigates and compared the effectiveness of two closure techniques, primary closure and healing by second intention of the oblique incision on postsurgical discomfort after mandibular third molar surgery.
This is a prospective, randomized, double-blind, split mouth controlled trial. Surgical sites were divided into two groups Control group received simple sutures in both alveolar crest incision and oblique incision and intervention group received simple sutures in alveolar crest incision, while the oblique incision healed by second intention. All the patients were instructed to measure pain according to visual analogue scale (VAS) in postoperative period, swelling, mouth opening was assessed at 72h and 7 days after surgery. The wound healing was assessed on day 7.
Thirty-five patients, who had bilateral impacted third molars of similar surgical difficulty, were recruited. Thirty-one successfully completed the study. Patients in the second intention group had significantly less pain at 24h (p < 0.27). and 48h (< 0.001), had significantly less swelling (< 0.001) and trismus (< 0.001) and patients submitted to primary closure had a better evaluation of the Landry index (p < 0.001).
Healing by second intention of the oblique relaxing incision by partial surgical wound closure, in our study, were superior to the primary closure in reduction of post-operative pain, swelling and trismus.
This trial is registered at Brazilian Registry of Clinical Trials-ReBEC -UTN: RBR-5fxbqsf (https://ensaiosclinicos.gov.br/rg/RBR-5fxbqsf).
伤口闭合技术是影响第三磨牙手术后早期术后并发症的手术因素。本研究调查并比较了两种闭合技术，即直接缝合和斜切口二期愈合，对下颌第三磨牙手术后术后不适的影响。
这是一项前瞻性、随机、双盲、分口对照试验。手术部位分为两组：对照组在牙槽嵴切口和斜切口均行单纯缝合，干预组在牙槽嵴切口行单纯缝合，而斜切口二期愈合。所有患者均在术后期间根据视觉模拟评分（VAS）测量疼痛、肿胀、张口度，术后 72h 和 7 天评估。第 7 天评估伤口愈合情况。
共招募了 35 名双侧有类似手术难度的埋伏第三磨牙患者，其中 31 名患者成功完成了研究。二期愈合组患者在 24h（p<0.27）和 48h（p<0.001）时疼痛明显减轻，肿胀（p<0.001）和张口度（p<0.001）明显减轻，行直接缝合的患者Landry 指数评分较好（p<0.001）。
在我们的研究中，斜松弛切口的二期愈合，通过部分手术切口闭合，在减轻术后疼痛、肿胀和张口度方面优于直接缝合。
本试验在巴西临床试验注册中心-ReBEC-UTN 注册：RBR-5fxbqsf（https://ensaiosclinicos.gov.br/rg/RBR-5fxbqsf）。
