A novel method in the removal of impacted mandibular third molar: buccal drainage OPEN (original) (raw)

Food impaction after impacted mandibular third molar extraction is a serious problem that should not be ignored. Incomplete suturing of the distal incision in the conventional method is the main cause of food impaction and delayed wound healing. The present study introduces a novel suture and drainage technology that requires hermetic suturing of the distal incision and rubber drainage for buccal drainage. 76 patients with horizontally/mesially impacted third molars (bilateral) were enrolled in this prospective study. An impacted tooth on one side of each patient was extracted by occlusal drainage using the conventional method, whereas the other side tooth was extracted by buccal drainage using the novel method. The differences in wound healing, facial swelling, bleeding and dry socket between the two sides of each patient were compared postoperatively, and the trends for patient selection of the surgical method were also compared. The results indicated that buccal drainage had obvious advantages in wound healing and reduced the risk of postoperative bleeding, and most patients preferred this technique; there were no significant differences in postoperative facial swelling or pain. Thus, buccal drainage can solve the problem of long-term food impaction induced by traditional incision postoperatively and is worthy of clinical promotion. Impacted teeth are most commonly found among mandibular third molars and lead to clinical diseases including pericoronitis, damage to adjacent teeth and temporomandibular disorders 1. Impaction is also a potential cause of odontogenic cysts and tumours. Therefore, mandibular third molars are often extracted. Among the many types of mandibular third molar impaction, horizontally and mesioangularly impacted teeth are the most difficult to extract, regardless of the exceptional cases 2,3. Complications may occur after extraction. Permanent nerve damage and serious infections are the most severe complications, but the rate of such complications is low 4,5. Pain, tris-mus, dry socket and swelling are the most common postoperative complaints and influence the patients' quality of life in the days 1,6. Suturing is necessary during the extraction of impacted mandibular third molars and is aimed at recovering the soft tissues for better healing. Furthermore, suturing reduces postoperative bleeding and narrows the extraction socket, which can prevent food from entering into it and protect the blood clots 7. The wound should not be sutured too firmly, and the turning point of the incision, which is adjacent to the distal side of the second molar, is often left without stitching, setting up a drainage system through the occlusal surface between the distal side of the second molar and the mesial side of the primary third molar 8. Many experts believe that the creation of such a drainage pathway for inflammatory exudates helps to reduce facial swelling, pain and other postoperative complications 8–10. The main drawback of sutureless techniques is that wound healing may be delayed. In addition, there may be a high potential for the formation of a wedge gap in relation to the adjacent second molar, which may cause food impaction 7,8. We also found that patients treated with such a drain system often complain that they are unwilling to chew with the affected side because of concerns that food will enter the extraction socket.