A surgeon’s dilemma: Evidence based selection of suturing technique to minimize post-operative complications following lower third molar surgical extraction

Selecting Suitable Suturing Technique

  • Shivani Jain Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Center, SriGanganagar, Rajasthan, India https://orcid.org/0000-0002-0648-745X
  • Nupur Saxena Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Center, SriGanganagar, Rajasthan, India
  • Raj Singh Rana Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Center, SriGanganagar, Rajasthan, India
  • Nityanand Jain Faculty of Medicine, Rīga Stradiņš University, Riga, Latvia https://orcid.org/0000-0002-7918-7909
Keywords: Mandibular third molar, Post-operative complications, Primary closure, Surgical extraction, Suture



Lower third molar extraction is usually associated with multiple stigmae that deters the patients in most cases to postpone or not seek appropriate surgical care. It is also one of the most feared procedure amongst dentists and dental students. However, evidence has been reported suggesting that the choice of suturing technique can have a profound effect on post-operation complications and thereby can improve the overall outlook and comfort of the patient. In the past, multiple techniques like Mattress, Continuous etc have been compared with tissue glues, staples however, a comparative clinical study amongst the simplest and most commonly used suturing techniques have not been reported.

Material and Methods

Sixty patients with impacted mandibular third molars fulfilled the inclusion criteria and were randomly divided into three groups of 20 each. All patients underwent third molar extraction and sutures were placed using different techniques – Simple Interrupted (Group A), Continuous (Group B) and Figure of eight (Group C). Patients were evaluated pre-operatively as well post-operatively (at different time points) for five parameters - Pain, Swelling, Trismus, Periodontal health of second molar and Wound infection. Kruskal-Wallis (non-parametric ANOVA) with post-hoc and effect size was used for statistical analysis with P < 0.05 as statistically significant.


Statistically significant differences were obtained in terms of pain and trismus between Groups A and C post-operatively (P < 0.05). There were also significant differences in pain between Groups B and C post-surgery (P < 0.05). No significant differences were found between groups for swelling, periodontal health of second molar and wound infection.


Figure of eight suturing presents with better patient outlook and is associated with lower pain, swelling and trismus. Continuous and simple interrupted suturing can be preferred as second-in-line techniques. Final choice of technique shall be made based on wound anatomy, patient history and surgeon’s expertise.

Author Biography

Shivani Jain, Department of Oral and Maxillofacial Surgery, Maharaja Ganga Singh Dental College and Research Center, SriGanganagar, Rajasthan, India

Professor and Head of the Department 


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How to Cite
Jain, S., Saxena, N., Singh Rana, R., & Jain, N. (2021). A surgeon’s dilemma: Evidence based selection of suturing technique to minimize post-operative complications following lower third molar surgical extraction. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 7(1). Retrieved from https://ujds.in/index.php/ujds/article/view/351