Comparative study of the effect of a tube drain in impacted lower third molar surgery

doi:10.1016/S0278-2391(03)00675-X

Journal of Oral and Maxillofacial Surgery

Volume 62, Issue 1, January 2004, Pages 57-61

https://doi.org/10.1016/S0278-2391(03)00675-X Get rights and content

Abstract

Purpose: Postoperative variables such as pain, swelling, and trismus after surgery of the impacted lower third molars are the main concerns of dental clinicians and surgeons. Many authors claim that the use of a drain could help control these variables. The purpose of this study was to evaluate the effect of the use of a tube drain in impacted lower third molar surgery.

Materials and Methods: Fifty-three patients of both genders with bilateral impacted lower third molars comprised our comparative study. The patients were divided into 2 groups: in the first the suture procedure was accomplished using a drain, and in the second the suture procedure was accomplished without a drain. The postoperative pain, swelling, and trismus were evaluated at 24 hours, 72 hours, 7 days, and 15 days.

Results: In the group in which the drain was used, the control of the swelling variable was statistically significant at 24 and 72 hours (P < .001) in comparison with the group in which the drain was not used. However, pain and trismus were not statistically significant at the evaluation period.

Conclusion: The use of the drain helps to control swelling. However, it had no effect on pain or trismus.

Section snippets

Materials and methods

This research was a split mouth study, and the initial sample comprised 70 patients of both genders with impacted lower third molars. Initially, 5 patients underwent the surgical removal of teeth with the purpose of calibrating the surgical technique. These 5 patients and 12 additional patients were excluded because they proved to be unsuitable for the study. The final sample was therefore composed of 53 patients, who were operated on by the same surgeon (P.R.F.C.). The evaluation was carried

Results

Fifty-three patients participated in this evaluation, of whom 16 (30.2%) were male and 37 (69.8%) were female. Ages varied from 14 to 30 years (mean, 21.49 ± 4.77 years) and 50% of the third molars were in the vertical position, 41.5% were in the mesioangular position, and 8.5% were in the distoangular position. Intensity of the pain in most of the patients was mild in accordance with a visual analog scale. In the control group (suture), the percentage of pain was higher than the experimental

Discussion

Surgery of impacted third molars is one of the most frequent procedures in oral and maxillofacial surgery and can lead to immediate and postoperative discomfort.6, 7 Many authors report that the postoperative quality of life in this type of surgical intervention is a quite interesting topic, because discomforts such as pain, swelling, and trismus are well known and lead to a transitory functional alteration in the mastication function.2, 3, 4, 5, 10, 11, 12 These postoperative discomforts may

References (21)

C.S. Beeman
Third molar management A case for routine removal in adolescent and young adults orthodontic patients
J Oral Maxillofac Surg
(1999)
S.M. Conrad et al.
Patient’s perception of recovery after third molar surgery
J Oral Maxillofac Surg
(1999)
P. Earl
Patients’ anxieties with third molar surgery
Br J Oral Maxillofac Surg
(1994)
J. Savin et al.
Third molar surgery-A preliminary report on aspects affecting quality of life in the early postoperative period
Br J Oral Maxillofac Surg
(1997)
S. Rakprasitkul et al.
Mandibular third molar surgery with primary closure and tube drain
Int J Oral Maxillofac Surg
(1997)
D.D. Dubois et al.
Comparison of primary and secondary closure techniques after removal of impacted mandibular third molars
J Oral Maxillofac Surg
(1982)
J.G. Meechan et al.
The use of third molar surgery in clinical pharmacology
Br J Oral Maxillofac Surg
(1993)
R.A. Seymour et al.
An investigation into post-operative pain after third molar surgery under local analgesia
Br J Oral Maxillofac Surg
(1985)
C.S. Holland et al.
The influence of closure or dressing of third molar sockets on postoperative swelling and pain
Br J Oral Maxillofac Surg
(1984)
E. Esen et al.
Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery
J Oral Maxillofac Surg
(1999)

There are more references available in the full text version of this article.

Cited by (66)

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
2022, Journal of the American Dental Association
Citation Excerpt :
Objective outcomes were judged as low risk, irrespective of blinding. The most common issues for selective outcome reporting were the absence of measures of variability7,8,28,32,33,37,40,41,50,58,60 or discrepancies between the study’s methods and results (for example, failing to report results for all outcomes).10,32,37,42,43,50 There were sufficient data to conduct a meta-analysis for all outcomes of interest; summary of findings tables can be found in Table and eTable 2 (available online at the of this article).
The aim of this systematic review was to determine whether secondary closure (SC) or primary closure (PC) is better at preventing postoperative complications after impacted mandibular third-molar extraction.
The authors sought randomized controlled trials comparing the effects of PC and SC on pain, swelling, trismus, infection, and bleeding after impacted mandibular third-molar extraction. Screening, data extraction, and risk of bias assessments were conducted independently and in duplicate. The reviewers pooled results across studies using a random-effects meta-analysis and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
This review identified 785 unique citations and included 40 trials. Compared with PC, SC was found to have trivial benefits for pain at day 7 and trismus within 1 week (moderate certainty). The incidence of infection and bleeding did not differ importantly between techniques (moderate certainty). However, SC is probably associated with less swelling on day 1 (standardized mean difference, –0.98; 95% CI, –1.22 to –0.73; moderate certainty) and day 3 (standardized mean difference, –0.87; 95% CI, –1.16 to –0.59; moderate certainty). There was very low certainty evidence for pain on days 1 and 3 and low certainty evidence for swelling on day 7.
Clinicians choosing between closure techniques should be aware that SC probably imparts an important benefit only for swelling at days 1 and 3. There seems to be a trivial difference between the techniques in other outcomes.
Third molar surgery: Past, present, and the future
2021, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
Wound closure had no effect on the periodontal health of the second molar. Many papers have reported that a drain can reduce postoperative facial swelling.38-40 Collectively, these studies show that allowing drainage following the removal of the third molar has a positive effect in reducing facial swelling.
Third molar surgery is the most common ambulatory procedure done by oral and maxillofacial surgeons. Surgical approaches for the removal of third molars have been published since the 20th century. This article reviews the history and development of extraction techniques through a literature review. The literature was selected through a search of an electronic database. Key words for the Medline search were “mandibular/maxillary third molar,” “impacted mandibular/maxillary third molar,” “mandibular/maxillary third molar flap design,” and “mandibular/maxillary third molar incision.” The search was restricted to English-language articles. Additionally, a manual search in the major oral surgery journals and books was performed. The aim of this article is to examine the evolution of third molar surgery, recognize pioneering techniques, and compare these techniques to current approaches. Common approaches employed today are discussed and treatment philosophies with thoughts for future therapies are provided.
Advanced–PRF: Clinical evaluation in impacted mandibular third molar sockets
2021, Journal of Stomatology, Oral and Maxillofacial Surgery
This prospective study evaluated the efficacy and healing potential of modified formulation of PRF, commonly known as Advanced PRF (A-PRF) in impacted mandibular third molar extraction sockets.
20 patients with bilateral impacted mandibular third molars were included in this study. Surgical disimpactions were done at 3–4 weeks interval in opposing quadrants of patient. One quadrant received A-PRF while the opposing quadrant in same patient was taken as control. Comparative evaluation was done in terms of pain assessment, analgesics required, swelling, soft tissue healing and trismus on 1st, 3 and 7day follow-up. Comparative assessment of bone healing was also done on 1st, 3and 6month follow-up.
This study involved 12 female and 8 male patients with in age range of 18–35 years. The evaluation of pain, swelling, trismus and soft tissue healing on 3rd postoperative day revealed considerable improvement on A-PRF sites as compared to control sites. The outcomes were found to be statistically significant with p values 0.008, 0.031, 0.0001, 0.05 respectively. Even the analgesic consumption was remarkably less when A-PRF was used (P = 0.004). Bone healing evaluation in A-PRF sites on 1st, 3and 6month has shown significantly improved results with P < 0.05.
Our study infers that A-PRF has enhanced the healing potential of soft tissue as well as bone in extraction socket. Apart from that it has also shown promising results in relief of immediate postoperative symptoms like pain, swelling and trismus which improves the comfort and acceptability of surgical procedures by patients. Enhanced healing and patient comfort in cost effective manner are the highlighting features of A-PRF.
Comparison of Surgical Drain Placement With Use of Kinesiologic Tape on Postoperative Pain, Swelling, and Trismus in Impacted Mandibular Third Molar Surgery
2020, Journal of Oral and Maxillofacial Surgery
The aim of this prospective study was to compare the effects of a surgical tube drain with kinesiologic tape (KT) application on postoperative complications such as trismus, swelling, and pain after impacted third molar surgery.
This single-center, randomized study included 90 patients divided into 3 groups. After impacted third molar removal, 30 patients were treated with a tube drain (drain group), 30 patients were treated with KT application (KT group), and 30 patients were treated with a routine surgical operation and no extra procedure (control group).
A total of 29 male and 61 female patients were included. Mouth opening was greatest in the drain group over a period of 7 days. Patients in the control group had more pain than those in the drain and KT groups. No statistically significant difference was found in terms of pain and swelling between the drain and KT groups over the 7-day period of the study. The tube drain was found to improve patients' quality-of-life compared with the KT and control groups.
Although the effects of a tube drain and KT in terms of pain and swelling were similar, the tube drain was more effective in reducing postoperative complications.
Efficacy of secondary closure technique after extraction of third molars: a meta-analysis
2019, British Journal of Oral and Maxillofacial Surgery
The purpose of this study was to assess the influence of two suture methods on the postoperative complications of extraction of mandibular third molars (M3M). We searched the MEDLINE (PubMed), Cochrane Library, and Web of Science databases until 18 May 2018 for randomised controlled trials (RCT) that evaluated the influence of any suture techniques on postoperative complications after the removal of impacted M3M. Pain, facial swelling, and trismus were measured for both the early stage (2–3 days) and late stage (5–7 days) after extraction. We identified 655 records, of which five were assessed for eligibility. All trials included had a moderate risk of bias. The analysis showed that the patients whose wounds had been closed primarily had significantly more pain than those whose wounds were closed secondarily (a wedge of mucosa) during the early stage (standardised mean difference (SMD), −0.49; 95% CI −0.71 to −0.27; P < 0.0001) and the late stage (SMD −0.36; 95% CI −0.54 to −0.19; P < 0.0001) after the removal of impacted M3M. Patients whose wounds were closed secondarily had less swelling (mm) at the postoperative early stage (SMD −1.12; 95% CI −1.57 to −0.66; P < 0.00001) and late stage (SMD −0.51; 95% CI −0.68 to −0.33; P < 0.00001). There was more trismus in the primary closure group than in the secondary group during both stages. Our findings suggest that secondary closure causes less pain, facial swelling, and trismus in both early and late stages of surgical removal of impacted M3M, and therefore it improves the quality of life by reducing postoperative discomfort.
Alveolar Iodine Tampon Packing Reduces Postoperative Morbidity After Third Molar Surgery
2019, Journal of Oral and Maxillofacial Surgery
The aim of this study was to assess the efficacy of an iodine tampon after mandibular third molar surgery on oral health–related quality of life (OHRQoL), use of painkillers, postoperative sequelae, and self-care behaviors in the first postoperative week.
This prospective, crossover, randomized controlled study included patients undergoing surgical removal of bilateral symmetrically, horizontally impacted mandibular third molars. The surgical site was randomly allocated to receive an iodine tampon after surgery or wound closure and rinsing with a Monoject syringe (Tyco/Healthcare-Kendall, Mansfield, MA). The primary outcomes measured each day during the first postoperative week were the Oral Health Impact Profile 14 score and postoperative sequelae, including pain, swelling, limited mouth opening, postoperative infection, and alveolar osteitis. The secondary outcome measures were several self-care behaviors. Data were analyzed using repeated-measures analysis of variance and paired-samples t tests.
A total of 54 patients (25 men and 29 women; mean age, 25.1 years) were enrolled, with a total of 108 surgically removed impacted mandibular third molars. The use of an iodine tampon resulted in a significantly lower impact on OHRQoL (mean of 21.5 [standard deviation (SD), 9.6] vs 26.5 [SD, 10.6]) on the first postoperative day, which was observable until the seventh postoperative day. In addition, after removal of the impacted third molar, patients with the iodine tampon condition reported less pain (mean of 5.2 [SD, 1.9] vs 6.1 [SD, 2.1] on day 1, lasting throughout the week), less use of painkillers, less limited mouth opening, fewer problems chewing, less swelling, and earlier recovery.
The use of postoperative iodine packing after the removal of impacted mandibular third molars significantly reduces OHRQoL and postoperative sequelae.

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Clinical articleComparative study of the effect of a tube drain in impacted lower third molar surgery

Abstract

Section snippets

Materials and methods

Results

Discussion

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Oral Maxillofac Surg

Clinical article
Comparative study of the effect of a tube drain in impacted lower third molar surgery