Single-Suture versus Multiple-Suture Techniques Regarding Postoperative Pain, Trismus, Edema, Ecchymosis, and Operative Time in Surgical Removal of Impacted Mandibular Wisdom Teeth: A Clinical Trial.

Background: Surgical removal of impacted mandibular wisdom teeth may be associated with postoperative complications such as infection, bleeding, edema, pain, ecchymosis and trismus. It seems that the number of sutures and the duration of surgery for impacted wisdom teeth are among the factors affecting the aforementioned complications.

Purpose: This study aimed to compare single-suture versus multiple-suture techniques regarding postoperative pain, trismus, edema, ecchymosis, and operating time in surgical removal of impacted mandibular wisdom teeth by envelope flap surgery.

Materials and method: This double-blind split-mouth randomized controlled clinical trial was conducted on 30 patients requiring bilateral surgical extraction of impacted wisdom teeth with the same level of impaction through an envelope flap. In each patient, wisdom teeth of one randomly selected quadrant was extracted through an envelope flap and single-suture technique (experimental group) while the wisdom teeth of the other quadrant was extracted through an envelope flap by multiple-suture technique (control group). The two groups were compared regarding operative time, and also pain score, trismus (mouth opening), edema, and ecchymosis at 1, 3 and 7 days postoperatively using paired t-test (alpha= 0.05).

Results: The two groups had no significant difference in pain score, edema, and ecchymosis at any time point (p> 0.05). The operative time (p= 0.005) was significantly longer, and mouth opening at 1, 3 and 7 days postoperatively (p< 0.05) was significantly smaller in the multiple-suture group.

Conclusion: In the present study, postoperative trismus was significantly lower in the single-suture group than multiple-suture group, and the multiple-suture group had significantly longer operative time. Thus, single-suture technique appears to be superior to multiple-suture technique, and may be suggested for surgical removal of impacted mandibular wisdom teeth.