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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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          Abstract

          Objective:

          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.

          Results:

          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).

          Conclusion:

          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 references33

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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.
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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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              Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study.

              Primary and secondary closure techniques after removal of impacted third molars were compared in terms of post-operative pain and swelling. Two hundred patients with impacted third molars were randomly divided into two groups of 100. Panoramic radiographs were taken to assess degree of eruption and angulation of third molars. Teeth were extracted, and in Group 1 the socket was closed by hermetically suturing the flap. In Group 2 a 5-6 mm wedge of mucosa adjacent to the second molar was removed to obtain secondary healing. Swelling and pain were evaluated for 7 days after surgery with the VAS scale. The statistical analysis (*analysis of variance for repeated measures, P < 0.05) showed that pain was greater in Group 1, although it decreased over time similarly in the two groups (P = 0.081, F(6,198) = 3.073*). Swelling was significantly worse in Group 1 (P < 0.001, F(6,198) = 44.30*). In Group 1, dehiscence of the mucosa was present in 33% of patients at day 7, and 2% showed signs of re-infection with suppurative alveolitis at 30 days. Pain and swelling were less severe with secondary healing than with primary healing.
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                Author and article information

                Journal
                Niger J Surg
                Niger J Surg
                NJS
                Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society
                Medknow Publications & Media Pvt Ltd (India )
                1117-6806
                2278-7100
                Jul-Dec 2014
                : 20
                : 2
                : 59-63
                Affiliations
                [1] 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@ 123456yahoo.co.uk
                Article
                NJS-20-59
                10.4103/1117-6806.137288
                4141446
                d40d86e5-af54-4b55-bf4e-0987ce2acc5a
                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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                Categories
                Original Article

                dressing,primary closure,randomized,surgery,third molars
                dressing, primary closure, randomized, surgery, third molars

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