Clinical study on the closure of extraction wounds of partially soft tissue-impacted mandibular third molars

When a mandibular third molar is partially impacted in the soft tissue, it must be determined whether the extraction wound should be left partially open or completely closed. We hypothesize that a blood clot preserving a surgical wound with easily cleanable surfaces by primary closure and drain application would postoperatively minimize dry socket and/or alveolitis development.

Twenty patients requiring bilateral extraction of partially soft tissue-impacted mandibular third molars in a vertical position were included in the study. The existence of dry sockets, alveolitis, pain, facial swelling, and trismus were evaluated on the second, fifth, and seventh days of the postoperative period.

On the second day, pain, trismus, and swelling were higher in the drained group; however, pain reduced progressively in the drained group over time. There were no cases of dry sockets or alveolitis except for a single patient on the seventh day in the drained group over the 7-day study period. On the other hand, in the secondary closure group, the number of dry sockets was 8 (40%) on the second day. The number of alveolitis was 10 (50%) on the fifth day and 4 (20%) on the seventh day.

Closed healing by drain insertion after removal of partially soft tissue-impacted third molars produces less frequent postoperative dry sockets and/or alveolitis development than occurs with open healing of the surgical wound. In cases with a risk of alveolitis development (lack of oral hygiene, immunocompromised patients, etc), it can be avoided with the "kiddle effect" and related undesired complications by implementing closed healing with drain insertion.