Various wound closure ways after impacted lower wisdom teeth removal: A review.

Objective: Evaluate the influence of different wound closure methods in terms of pain, swelling, trismus, infection and healing time after third molar extraction.

Material and methods: A literature analysis was performed according to PRISMA guidelines in search of clinical trials published between 2015 and 2020. Databases were searched using different combinations of the following keywords: mandibular impacted OR retained wisdom teeth OR third molar removal OR extraction AND surgical removal AND discomfort OR pain OR trismus OR swelling AND drain OR drainage. The literature search resulted in a total of 364 publications. Finally, 12 study articles were used in the present review, following a selection based on the preestablished eligibility criteria.

Results: The significant difference between various wound closure ways and postoperative pain, swelling and trismus has been found in 8 of 12 analyzed articles. Three of five established beneficial effect of drain application. In other articles, examining different wound closure methodologies, significant benefits were found by using buccally based triangular, buccal mucosal-advancement, and modified envelope flap. Suture-less anterior releasing incision and secondary wound closure also could be favorable after removing impacted third molars.

Conclusion: There was no significant effect of a rubber drain on swelling, pain, trismus, or wound infections after removal of the asymptomatic impacted third molar(s). Secondary wound closure was found to ensure lower pain, swelling and trismus ratio with comparison to primary wound closure.