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Title The Type of Suture Used in Third Molar Extraction Does Not Matter in Post-Surgical Infection and Pain
Clinical Question For patients getting third molar extractions, does the use of antimicrobial sutures, compared to the use of silk sutures, result in a decrease of infection and post- operative pain?
Clinical Bottom Line The use of different suture types, such as silk, polypropylene, or antimicrobial Monocryl Plus shows no statistical difference in post-operative infection or pain. While there is little evidence to show that antimicrobial sutures have fewer microorganisms 72 hours after placement, there is no evidence that shows they have fewer microorganisms 7 days after placement when compared to other sutures.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 28955553Selvi/ 201620 male ratsNon-randomized controlled trial
Key resultsIn this study, four different sutures were used to compare differences in healing. The sutures used were silk, polypropylene, coated polyglactin 910 and polyglecaprone 25. Twenty rats were divided into two groups to observe post-operative healing on the 1st and 7th day. Four longitudinal incision wounds, each 1 cm in size, were created on the dorsum of each rat and primarily closed with the four different sutures. Overall, there were no significant complications regarding the suture type; however, the presence of cells of chronic infections were found to be statistically higher at the 7th day compared to the 1st day (P=0.020; P=0.035). Also, the presence of cells of acute infections was found to be statistically higher at the 7th day compared to the 1st day (P=0.002; P=0.011; P=0.003; P=0.0001). There was no statistically significant difference between the groups at the 7th post-operative day (P=0.365). In the end, the authors agreed there was no significant complications, but determined that more clinical and experimental studies were needed.
#2) 26615503Sala-Perez/ 201620 patients Randomized Controlled Trial
Key resultsIn this study, 20 patients needed surgical removal of impacted 3rd molars. Each side of the mouth was then randomly sutured with Monocryl Plus or silk suture. Then each suture was removed for microbiological study 72 hours and 7 days after surgery. The presence of surgical site infection, wound bleeding, and the degree of discomfort (scored by Visual analog scale) were evaluated. As a result, the wound bleeding upon removal was slightly greater after 72 hours and 7 days with black silk suture; however, it was not statistically significant (P=0.752; P=0.113). Patient discomfort was similar for both materials (P=0.861). The antibacterial suture showed the presence of fewer microorganisms (P<0.001 at 72 hours and P=0.033 at 7th day). This study showed significant antibacterial effects of Monocryl Plus suture occurring in the first 3 days; however, it does not seem to substantially improve the rate of surgical site infection. The authors also agreed that a clinical study with a larger sample of patients would be needed to determine the effectiveness of surgical site infections.
Evidence Search “Suture types, Oral surgery”
Comments on
The Evidence
While both studies demonstrated that suture selection resulted in no difference in post-operative pain and infection, both studies had small patient pools. Selvi et al. conducted their study on the dorsal side rats, meaning this isn’t a true representation of the oral mucosa. The oral cavity has conditions such as moisture by saliva, the ingestion of food and different microorganisms meaning that a suture placed in the oral cavity is affected differently than a suture placed elsewhere in the body. Sample size was also a limitation in both studies, as both studies used 20 test subjects. Perspective: I believe that a resorbable 4-0 Chromic gut suture is appropriate in the oral cavity for extraction of teeth. The patient tends to enjoy resorbable sutures better because they don’t have to get them removed.
Applicability Suture selection comes down to the providers' decision on what he/she would like to use. The different types of sutures show no long-term difference in post-operative sensitivity and pain. Different sutures may be more difficult to work with or be more technique sensitive. While resorbable vs non-resorbable sutures may present differences (such as patient comfort or inflammatory response) the studies about showed no significant difference between the two. Clinicians should be aware of these differences in the types of sutures, but there is no evidence to support that there is a superior suture type.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Suture Types, Oral surgery, Third molar extractions
ID# 3514
Date of submission: 11/30/2022spacer
E-mail otgonbayar@uthscsa.edu
Author Eva Otgonbayar
Co-author(s) Renee Smith
Co-author(s) e-mail smithr13@livemail.uthscsa.edu
Faculty mentor/Co-author Soo Cheol Jeong
Faculty mentor/Co-author e-mail jeongs2@uthscsa.edu
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