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A Prospective Randomized Clinical Study of the Influence of Primary Closure or Dressing on Post-operative Morbidity after Mandibular Third Molar Surgery

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      The aim of the following study is to determine the effect of primary closure or dressing on post-operative morbidity after impacted lower third molar surgery.

      Materials and Methods:

      This was a randomized clinical study of 72 patients who had surgical extraction of impacted mandibular third molars. The subjects were divided into two groups of A and B. Group A had total closure (primary closure) and Group B had whitehead varnish dressing of the socket. Pain, swelling and trismus were evaluated pre-operatively using visual analogue scale, flexible tape measuring method and inter-incisal distance measurement with Vernier Callipers respectively as well as post-operatively on 1 st, 2 nd, 3 rd, 5 th and 7 th day.


      The study participants consisted of 27 males and 45 females in a ratio 1:1.7. With a mean age of 24.7 ± 4.9 years (range 19-33 years) for Group A and 25.5 ± 4.3 years (range 20-39 years) for Group B. Post-operative pain was not significantly affected by the closure techniques ( P > 0.05). Dressing was found to significantly reduce the degree of swelling and trismus peaking on the 2 nd day ( P = 0.0207 and P = 0.010 respectively).


      The use of dressing was more effective than primary closure to reduce the degree of swelling and trismus though its effect on post-operative pain reduction was not significant.

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      Most cited references 34

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      The visual analogue scale: its use in pain measurement.

      Use of pain rating scales, especially the visual analogue scale (VAS), has increased dramatically in the last decade. Consideration of the VAS in terms of its physical structure and the patient's behaviour when confronted with the scale, casts doubt on its validity. It is non-linear and prone to bias which limits its use as a serial measure of pain severity. Measuring pain intensity alone imposes further limitations. The McGill Pain Questionnaire measuring several dimensions of pain appears to be a better alternative.
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        Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery.

        The aim of this study was to compare the effects of intravenous administration of 1.5 mg/kg and 3 mg/kg of methylprednisolone sodium succinate (MP) on pain, swelling, and trismus after third molar surgery. Twenty-six healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, cross-over study. Either 1.5 mg/kg or 3 mg/kg of MP was administered by intravenous route one hour prior to the first operation. At the second operation the other dose was applied. Trismus was determined by measuring maximum interincisal opening and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analogue scale and recording the number of pain pills taken. There was no statistically significant difference in trismus, facial swelling, and pain between the two groups. No clinical benefit of the higher dose of MP was demonstrated.
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          Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal.

          Sixty patients with bilaterally symmetrical impacted third molars participated in this double-blind, within-subject study to quantify the effects of 4 mg of dexamethasone on reducing postsurgical sequelae. Each patient's surgery was staged by mouth side and completed in two appointments 5 to 6 weeks apart. A preoperative dose of dexamethasone given intravenously was randomized to mouth side and surgical appointment; sterile water served as a control. Major areas assessed in this study were facial swelling, pain, and trismus. No difference in swelling and daily pain was noted. However, trismus and global pain were significantly affected by the steroid. Patients had a daily postsurgical increase in incisal opening of 4 to 6 mm over the control side during the examination period. Patients evaluated pain by choosing the least painful side. By a greater than 4:1 margin, patients chose the steroid side as the least painful side. No increase in the rate or type of complications was detected between control and steroid sides.

            Author and article information

            Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
            Author notes
            Address for correspondence: Dr. Peter E Egbor, Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. E-mail: peteregbor@
            Niger J Surg
            Niger J Surg
            Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society
            Medknow Publications & Media Pvt Ltd (India )
            Jul-Dec 2014
            : 20
            : 2
            : 59-63
            4141446 NJS-20-59 10.4103/1117-6806.137288
            Copyright: © Nigerian Journal of Surgery

            This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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