A Prospective Clinical Study on Effects of Two Kinds of Gingival Flap Suture on The Complications After Extraction of Bone Embedded Third Molar

doi:10.13701/j.cnki.kqyxyj.2025.08.007

Abstract

Abstract: Objective: To evaluate the effect of two kinds of gingival flap suture on the complications after extraction of bone embedded mandibular third molar (BeM3M). Methods: 376 BeM3M were divided into two groups in a prospective, randomized controlled, and single-blind design. In the control group, 197 BeM3M were extracted, and the gingival flap was closed suture (primary closure). In the experimental group, 179 BeM3M were removed, part of the gingival flap tissue was removed, and open drainage suture (secondary closure) was performed. Postoperative bleeding and infection, postoperative reaction, delayed infection, and distal periodontal probing depth of mandibular second molar (M2M) 6 months after surgery were recorded. Results: There was no statistically significant difference in the postoperative bleeding, infection, pain, and distal periodontal probing depth of M2M between two groups (P>0.05). The swelling and opening limitation in the experimental group were less than those in the control group (P<0.05). The incidence of delayed-onset infection in the experimental group (2.8%) was lower than that in the control group (11.2%), and the difference between the two groups was statistically significant (P<0.05). Conclusion: Gingival flap secondary closure could alleviate BeM3M postoperative complications, reduce the incidence of delayed-onset infection, and had no adverse effect on distal periodontal probing depth of M2M.

Key words: closure, bone embedded third molar, tooth extraction, postoperative complications, bacterial infections

LIU Xiangqi, WU Jiashun, LIU Yuhao, CHEN Jianghai, LUO Xueting, YANG Xin, KUANG Shijun. A Prospective Clinical Study on Effects of Two Kinds of Gingival Flap Suture on The Complications After Extraction of Bone Embedded Third Molar[J]. Journal of Oral Science Research, 2025, 41(8): 679-684.

References

[1] Kiencało A, Jamka-Kasprzyk M, Pana M, et al. Analysis of complications after the removal of 339 third molars [J]. Dent Med Probl, 2021, 58(1):75-80.
[2] Farhadi F, Emamverdizadeh P, Hadilou M, et al. Evaluation of infection and effective factors in impacted mandibular third molar surgeries: A cross-sectional study [J]. Int J Dent, 2022, 2022:8934184.
[3] Rodrigues ÉDR, Martins-de-Barros AV, Loureiro AMLC, et al. Comparison of two suture techniques on the inflammatory signs after third molars extraction-A randomized clinical trial [J]. PLoS One, 2023, 18(6):e0286413.
[4] Sen A, Dhupar V, Akkara F. Analysing inflammatory responses after mandibular third molar extraction: a comparison of suture-less and multiple suture techniques [J]. Oral Maxillofac Surg, 2024, 28(4):1587-1594.
[5] Mariani P, Menditti D, Russo D, et al. Evaluation of the effectiveness of tube drain on postoperative discomfort in mandibular third molar surgery: prospective randomized split-mouth study [J]. Acta Odontol Scand, 2023, 81(7):528-533.
[6] Monaco G, Gatto MRA, Pelliccioni GA. Incidence of delayed infections after lower third molar extraction [J]. Int J Environ Res Public Health, 2022, 19(7):4028.
[7] Azab M, Ibrahim S, Li A, et al. Efficacy of secondary vs primary closure techniques for the prevention of postoperative complications after impacted mandibular third molar extractions: A systematic review update and meta-analysis [J]. J Am Dent Assoc, 2022, 153(10):943-956.
[8] Takadoum S, Douilly G, de Boutray M, et al. Sutureless socket technique after removal of third molars: a multicentric, open, randomized controlled trial [J]. BMC Oral Health, 2022, 22(1):256-265.
[9] Nayak SS, Arora A, Shah A, et al. The influence of the suture-less anterior releasing incision in a triangular flap design on postoperative healing following surgical removal of impacted mandibular third molars [J]. J Int Soc Prev Community Dent, 2020, 10(3):262-268.
[10] Pachipulusu PK, Manjula S. Comparative study of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars [J]. Oral Maxillofac Surg, 2018, 22(3):261-266.
[11] Petronis Ž, Zigmantaviius J, Gervickas A. Various wound closure ways after impacted lower wisdom teeth removal: A review [J]. Stomatologija, 2020, 22(4):107-115.
[12] Maria A, Malik M, Virang P. Comparison of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars [J]. J Maxillofac Oral Surg, 2012, 11(3):276-283.
[13] 王静娟,胡开进,刘平,等.拔牙窝止血类覆盖及充填材料的选择及应用[J].中国实用口腔科杂志,2017,10(10):586-589.
[14] Pang SL, Leung KPY, Li KY, et al. Factors affecting periodontal healing of the adjacent second molar after lower third molar surgery: a systematic review and meta-analysis [J]. Clin Oral Investig, 2023, 27(4):1547-1565.
[15] Kaposvári I, Körmöczi K, Csurgay K, et al. Delayed-onset infections after lower third molar surgery: a Hungarian case-control study [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2021, 132(6):641-647.
[16] Brunello G, De Biagi M, Crepaldi G, et al. An observational cohort study on delayed-onset infections after mandibular third-molar extractions [J]. Int J Dent, 2017, 2017:1435348.
[17] Figueiredo R, Valmaseda-Castellon E, Laskin DM, et al. Treatment of delayed-onset infections after impacted lower third molar extraction [J]. J Oral Maxillofac Surg, 2008, 66(5):943-947.
[18] Pardo A, Signoriello A, Corrà M, et al. Six-month soft tissues healing after lower third molar extraction: Comparison of two different access flaps [J]. J Clin Med, 2023, 12(22):7017.
[19] Ahmad M, Khan ZA, Khan TU, et al. Influence of surgical flap design (envelope and szmyd) for removal of impacted mandibular third molars on clinical periodontal parameters: A clinical trial [J]. Int J Environ Res Public Health, 2021, 18(9):4465.
[20] Rosa AL, Carneiro MG, Lavrador MA, et al. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002, 93(4):404-407.