Comparison of the Effect of Sling and Single Interrupted Sutures on Periodontal Parameters after Surgical Extraction of Impacted Mandibular Third Molars
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Abstract
Objectives: This study aimed to compare the sling and single interrupted sutures regarding dehiscence, probing pocket depth (PPD), and clinical attachment loss (CAL) of adjacent second molars after surgical extraction of impacted or semi-impacted mandibular third molars.
Materials and Methods: This randomized clinical trial, with a split-mouth design, involved 25 patients with similar bilateral impaction of their mandibular third molars. The same surgeon performed surgical procedures, including a triangular flap and osteotomy. After surgical extraction of third molars, the distal surface of the flap was sutured with sling sutures on one side and single interrupted sutures on the other side. The allocation of suture type to the side of the jaw was random, and the patient was blinded to it. Patients were examined for dehiscence after 7 and 14 days. The PPD and CAL were recorded at the baseline and after 17 weeks. Data were analyzed using the Wilcoxon signed-rank test and generalized estimating equation (GEE) regression model.
Results: The sling suture was significantly superior regarding the improvement of PPD (P=0.041) and CAL (P=0.016). The dehiscence was significantly smaller in the single interrupted suture group 7 days postoperatively (P=0.059). This difference was not significant 14 says postoperatively (P=0.852).
Conclusion: The results of this study show that the sling suture was superior to the single interrupted suture regarding PPD and CAL. However, the technique of suturing does not seem to have a significant long-term effect on wound dehiscence.
1. Scherstén E, Lysell L, Rohlin M. Prevalence of impacted third molars in dental students. Swed Dent J. 1989;13(1-2):7-13.
2. Rosa AL, Carneiro MG, Lavrador MA, Novaes AB Jr. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Apr;93(4):404-7.
3. McGrath C, Comfort MB, Lo EC, Luo Y. Changes in life quality following third molar surgery--the immediate postoperative period. Br Dent J. 2003 Mar 8;194(5):265-8; discussion 261.
4. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and non-steroidal anti-inflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 May;107(5):630-40.
5. Üstün Y, Erdoǧan Ö, Esen E, Karsli ED. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Nov;96(5):535-9.
6. Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc. 2007 May;73(4):325.
7. Mohajerani H, Esmaeelinejad M, Sabour S, Aghdashi F, Dehghani N. Diagnostic Factors of Odontogenic Cysts in Iranian Population: A Retrospective Study Over the Past Two Decades. Iran Red Crescent Med J. 2015 Jun 30;17(6):e21793.
8. Pourdanesh F, Esmaeelinejad M, Aghdashi F. Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review. Br J Oral Maxillofac Surg. 2017 Dec;55(10):999-1007.
9. Jakse N, Bankaoglu V, Wimmer G, Eskici A, Pertl C. Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jan;93(1):7-12.
10. Richardson DT, Dodson TB. Risk of periodontal defects after third molar surgery: An exercise in evidence-based clinical decision-making. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Aug;100(2):133-7.
11. Kugelberg CF, Ahlström U, Ericson S, Hugoson A, Thilander H. The influence of anatomical, pathophysiological and other factors on periodontal healing after impacted lower third molar surgery. A multiple regression analysis. J Clin Periodontol. 1991 Jan;18(1):37-43.
12. Pasqualini D, Cocero N, Castella A, Mela L, Bracco P. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Int J Oral Maxillofac Surg. 2005 Jan;34(1):52-7.
13. Khan MA, Ahmad T, Khadija SH. Frequency of dry socket, pain, wound dehiscence and swelling one week after removal of mandibular third molar impaction. J Khyber Coll Dent. 2015 Jun;5(2):20-23.
14. Bello SA, Olaitan AA, Ladeinde AL. A randomized comparison of the effect of partial and total wound closure techniques on postoperative morbidity after mandibular third molar surgery. J Oral Maxillofac Surg. 2011 Jun;69(6):e24-30.
15. Zuhr O, Rebele SF, Thalmair T, Fickl S, Hurzeler MB. A modified suture technique for plastic periodontal and implant surgery--the double-crossed suture. Eur J Esthet Dent. 2009 Winter;4(4):338-47.
16. Akkaya M, Böke F. Shallow localized gingival recession defects treated with modified coronally repositioned flap technique: A case series. Eur J Dent. 2013 Jul;7(3):368-372.
17. Huang LH, Wang HL. Sling and tag suturing technique for coronally advanced flap. Int J Periodontics Restorative Dent. 2007 Aug;27(4):379-85.
18. Pell GJ, Gregory GT. Impacted mandibular third molars: classification and modified technique for removal. Dent Digest. 1933;39:330-8.
19. Greene JC, Vermillion JR. The oral hygiene index: a method for classifying oral hygiene status. J Am Dent Assoc. 1960 Aug;61(2):172-179.
20. Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol. 1967 Nov-Dec;38(6):Suppl:610-6.
21. Cetinkaya BO, Sumer M, Tutkun F, Sandikci EO, Misir F. Influence of different suturing techniques on periodontal health of the adjacent second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Aug;108(2):156-61.
22. Rahpeyma A, Khajehahmadi S, Ilkhani S. Wound Dehiscence after Wisdom Tooth Removal in Mandibular Mesioangular Class IB Impactions: Triangular Transposition Flap versus Envelope Flap. J Dent Res Dent Clin Dent Prospects. 2015 Summer;9(3):175-80.
23. Baqain ZH, Al-Shafii A, Hamdan AA, Sawair FA. Flap design and mandibular third molar surgery: a split mouth randomized clinical study. Int J Oral Maxillofac Surg. 2012 Aug;41(8):1020-4.
24. Nemcovsky CE, Tal H, Pitaru S. Effect of non‐erupted third molars on roots of approximal teeth. A radiographic, clinical and histologic study. J Oral Pathol Med. 1997 Nov;26(10):464-9.
25. Güven O, Keskin A, Akal UK. The incidence of cysts and tumors around impacted third molars. Int J Oral Maxillofac Surg. 2000 Apr;29(2):131-5.
26. Knutsson K, Brehmer B, Lysell L, Rohlin M. Pathoses associated with mandibular third molars subjected to removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Jul;82(1):10-7.
27. Walters H. Reducing lingual nerve damage in third molar surgery: a clinical audit of 1350 cases. Br Dent J. 1995 Feb 25;178(4):140-4.
28. Eliasson S, Heimdahl A, Nordenram Å. Pathological changes related to long-term impaction of third molars: A radiographic study. Int J Oral Maxillofac Surg. 1989 Aug 1;18(4):210-2.
29. Rafetto LK. Managing Impacted Third Molars. Oral Maxillofac Surg Clin North Am. 2015 Aug;27(3):363-71.
2. Rosa AL, Carneiro MG, Lavrador MA, Novaes AB Jr. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Apr;93(4):404-7.
3. McGrath C, Comfort MB, Lo EC, Luo Y. Changes in life quality following third molar surgery--the immediate postoperative period. Br Dent J. 2003 Mar 8;194(5):265-8; discussion 261.
4. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and non-steroidal anti-inflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 May;107(5):630-40.
5. Üstün Y, Erdoǧan Ö, Esen E, Karsli ED. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Nov;96(5):535-9.
6. Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc. 2007 May;73(4):325.
7. Mohajerani H, Esmaeelinejad M, Sabour S, Aghdashi F, Dehghani N. Diagnostic Factors of Odontogenic Cysts in Iranian Population: A Retrospective Study Over the Past Two Decades. Iran Red Crescent Med J. 2015 Jun 30;17(6):e21793.
8. Pourdanesh F, Esmaeelinejad M, Aghdashi F. Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review. Br J Oral Maxillofac Surg. 2017 Dec;55(10):999-1007.
9. Jakse N, Bankaoglu V, Wimmer G, Eskici A, Pertl C. Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jan;93(1):7-12.
10. Richardson DT, Dodson TB. Risk of periodontal defects after third molar surgery: An exercise in evidence-based clinical decision-making. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Aug;100(2):133-7.
11. Kugelberg CF, Ahlström U, Ericson S, Hugoson A, Thilander H. The influence of anatomical, pathophysiological and other factors on periodontal healing after impacted lower third molar surgery. A multiple regression analysis. J Clin Periodontol. 1991 Jan;18(1):37-43.
12. Pasqualini D, Cocero N, Castella A, Mela L, Bracco P. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Int J Oral Maxillofac Surg. 2005 Jan;34(1):52-7.
13. Khan MA, Ahmad T, Khadija SH. Frequency of dry socket, pain, wound dehiscence and swelling one week after removal of mandibular third molar impaction. J Khyber Coll Dent. 2015 Jun;5(2):20-23.
14. Bello SA, Olaitan AA, Ladeinde AL. A randomized comparison of the effect of partial and total wound closure techniques on postoperative morbidity after mandibular third molar surgery. J Oral Maxillofac Surg. 2011 Jun;69(6):e24-30.
15. Zuhr O, Rebele SF, Thalmair T, Fickl S, Hurzeler MB. A modified suture technique for plastic periodontal and implant surgery--the double-crossed suture. Eur J Esthet Dent. 2009 Winter;4(4):338-47.
16. Akkaya M, Böke F. Shallow localized gingival recession defects treated with modified coronally repositioned flap technique: A case series. Eur J Dent. 2013 Jul;7(3):368-372.
17. Huang LH, Wang HL. Sling and tag suturing technique for coronally advanced flap. Int J Periodontics Restorative Dent. 2007 Aug;27(4):379-85.
18. Pell GJ, Gregory GT. Impacted mandibular third molars: classification and modified technique for removal. Dent Digest. 1933;39:330-8.
19. Greene JC, Vermillion JR. The oral hygiene index: a method for classifying oral hygiene status. J Am Dent Assoc. 1960 Aug;61(2):172-179.
20. Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol. 1967 Nov-Dec;38(6):Suppl:610-6.
21. Cetinkaya BO, Sumer M, Tutkun F, Sandikci EO, Misir F. Influence of different suturing techniques on periodontal health of the adjacent second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Aug;108(2):156-61.
22. Rahpeyma A, Khajehahmadi S, Ilkhani S. Wound Dehiscence after Wisdom Tooth Removal in Mandibular Mesioangular Class IB Impactions: Triangular Transposition Flap versus Envelope Flap. J Dent Res Dent Clin Dent Prospects. 2015 Summer;9(3):175-80.
23. Baqain ZH, Al-Shafii A, Hamdan AA, Sawair FA. Flap design and mandibular third molar surgery: a split mouth randomized clinical study. Int J Oral Maxillofac Surg. 2012 Aug;41(8):1020-4.
24. Nemcovsky CE, Tal H, Pitaru S. Effect of non‐erupted third molars on roots of approximal teeth. A radiographic, clinical and histologic study. J Oral Pathol Med. 1997 Nov;26(10):464-9.
25. Güven O, Keskin A, Akal UK. The incidence of cysts and tumors around impacted third molars. Int J Oral Maxillofac Surg. 2000 Apr;29(2):131-5.
26. Knutsson K, Brehmer B, Lysell L, Rohlin M. Pathoses associated with mandibular third molars subjected to removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Jul;82(1):10-7.
27. Walters H. Reducing lingual nerve damage in third molar surgery: a clinical audit of 1350 cases. Br Dent J. 1995 Feb 25;178(4):140-4.
28. Eliasson S, Heimdahl A, Nordenram Å. Pathological changes related to long-term impaction of third molars: A radiographic study. Int J Oral Maxillofac Surg. 1989 Aug 1;18(4):210-2.
29. Rafetto LK. Managing Impacted Third Molars. Oral Maxillofac Surg Clin North Am. 2015 Aug;27(3):363-71.
| Files | ||
| Issue | Vol 17 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v17i15.4178 | |
| Keywords | ||
| Suture Techniques Periodontal Attachment Loss Periodontal Pocket | ||
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How to Cite
1.
Aghdashi F, Roohandeh N, Nemati M, Tabrizi R. Comparison of the Effect of Sling and Single Interrupted Sutures on Periodontal Parameters after Surgical Extraction of Impacted Mandibular Third Molars. Front Dent. 2020;17.
