Methods
carious lesions, cellulites, abscess
ACUTE PERICORONITIS, IMPACTED TOOTH, ABSCESS, ORAL CONTRACEPTIVES, SECONDARY, BLIND, PLAQUE, CREST
This prospective, randomized controlled study included patients with vertical or mesioangular partially impacted 3Ms. Patients were excluded if they had medical illnesses or took medication that could influence the course of postoperative wound healing. The clinical study was registered by the Australian New Zealand Clinical Trials Registry, with the trial number ACTRN12618001551280. Patients between the ages of 18 and 30 were included. Patients were excluded from randomization if they had acute pericoronitis, a pre-existing abscess or cellulites, any restorations or carious lesions on the distal surfaces of the 2Ms, or pathological conditions associated with the 3Ms.Oral contraceptive users and smokers were also excluded.This study’s parameters included gender, duration of surgery, surgical difficulty and the position of the 3Ms. Surgical difficulty was recorded immediately after the procedure and evaluated using a four-class difficulty scale, as follows: 1) extraction requiring forceps only; 2) extraction requiring osteotomy; 3) extraction requiring osteotomy and coronal sectioning; and 4) complex extraction(root sectioning) [In this study methodology, the groups were selected randomly and results were evaluated by another researcher blinded to the groups. Patients were randomized to three groups by the opaque envelope method for blind selection. With this method, a total of 30 Group cards, 10 for each group, was prepared and sealed in opaque envelopes. After each impacted tooth was extracted, one envelope was randomly selected to determine the patient’s operative group. The tissue was closed and sutured according to the patient’s group. These groups were the secondary closure (SC) group, distinguished by partial closure of the extraction site to provide secondary healing; the primary closure (PC) group, distinguished by sliding the flap and suturing primarily to total closure of the extraction site; and the membrane-based primary closure (MBPC) group, distinguished by placing a collagen membrane and sliding the flap to total closure of the extraction site.Surgical operations were carried out by a single surgeon with each patient under local anesthesia, which was achieved with up to4 mL of Articaine-HCl and a 1:100,000 ratio of epinephrine (Ultracaine D-S Forte, Aventis). An incision was made from the anterior border of the mandibular ramus, extending to the distal surface and the buccal gingivodental sulcus of the 2 M. The incision was continuous, with vertical incision oblique into the mandibular vestibular fornix, aligned with the2M’s mesiobuccal cusp. A full-thickness mucoperiosteal triangular flap was elevated. If necessary, osteotomy was performed under constant irrigation.The wound closure was performed with atraumatic silk sutures, depending on the group. In the SC group, the flap was positioned to its former position by a single suture distal to the 2 M, leaving a gap. If necessary, a wedge of mucosa was removed. In the PC group, the sliding flap was sutured. In the MBPC group, the extraction socket was closed with a resorbable collagen membrane (Evolution, Osteobiol-Tecnoss, Italy), and the sliding flap was sutured primarily.The patients were given standard postoperative medication; antibiotics (amoxicillin + clavulanic acid) for five days, nonsteroidal anti-inflammatory drugs (dexketoprofen trometamol) for 3 days and mouthwash (with 0.12% chlorhexidine) for two weeks, according the body mass of each patient. Additionally, an oral health education intervention was presented. The sutures were removed after seven days.The postoperative measurements and the study’s outcomes were examined and determined by another researcher blinded to the group of patients. One of the outcome variables was the periodontal status of the 2Ms. Periodontal measurements were performed preoperatively (T1) and three months postoperatively (T2). The pocket depths and plaque index scores of the2M’s distobuccal (DB), distolingual (DL), midbuccal (MidB) and midlingual (MidL) surfaces were recorded. All periodontal pocket depth (PPD) measurements were performed in millimetres, using William’s periodontal probe (Aesculap AG&Co., Tuttlingen, Germany).To assess the periodontal plaque index (PPI) scores, the Silness&Löe plaque index was registered on the distal aspects of the 2Ms,and the mean values were used.To evaluate the difference in bone level, which was the other outcome variable, digital panoramic radiographs in standardized position were obtained preoperatively and three months postoperatively by a single panoramic x-ray device. Cemento-enamel junctions (CEJs) were used as reference points, and the distances between the CEJ and the alveolar bone crest on the distal aspect of the adjacent 2M were measured in millimeters using calibrated radiograph measurement software (MedData Medical Software, Ankara, Turkey). All radiological measurements were performed twice and independently by another two clinicians who were not involved in this study, and mean values were recorded preoperatively (T1) and three months postoperatively (T2). Among this study’s primary outcomes were the differences (positive or negative) between the pre-and postoperative radiographic measurements.