The effects of primary and secondary wound closure following surgical extraction of lower third molars on post-operative morbidity: A prospective randomized clinical trial

The aim of this study was to compare the effects of primary and secondary wound closure on post-operative pain, swelling, and acute alveolar ostietis (AO) after surgical extraction of partially impacted lower third molars. A prospective randomized parallel clinical trial was conducted on 60 patients. Exclusion criteria included pericoronal infection and uncontrolled systemic diseases. Pain was estimated preoperatively. Facial measurements (FM) were obtained using a measuring tape for three lines between five defined points on the face. A single extraction with envelope flap was performed. Two types of wound closures were adopted, primary in Group 1 (G1) and secondary in Group 2 (G2). Pain, FM, and AO were evaluated on days 3 and 7. In both groups, FM and pain significantly increased on day 3, and then decreased on day 7. The amount of increase in FM, pain, and empty socket was higher in G1 than in G2. Tenderness and halitosis were more prevalent in G2 than in G1 on day 3. Five cases of AO were found in G1 (16.7%) and 4 cases in G2 (13.3%).  No significant differences were found between the two groups regarding these variables. When the envelope flap is used, secondary wound closure has insignificant advantages over primary closure with respect to swelling, pain, and AO.   Key words: Primary closure, secondary, third molar, extraction.