Abstract
Aims/objectives: The aim was to compare the performance of knotless sutures (3-0 V-loc™ 90) against conventional suture closure (3-0 Vicryl Rapide™) in the surgical removal of bilateral similarly impacted mandibular third molars. Specific objectives were to determine advantages in wound closure speed, postoperative pain, irritation and swelling.
Methods: The study was a single-blind, randomised controlled clinical trial using a split-mouth design. 70 participants were recruited from a source population of patients referred to the oral surgery service at the Dunedin School of Dentistry, University of Otago or to Southland Hospital Dental Unit, Te Whatu Ora Southern (formerly SDHB) by their primary care provider. The left or right mandibular third molars were randomly allocated to the proposed intervention (knotless sutures) and the control (conventional suture) to the other. A symptom diary was provided to record pain and irritation scores on each side using a 100mm visual analogue scale. Six pairs of scores were recorded over the first 48 hours by participants. Three facial measurements were taken to determine postoperative swelling: between the tip of the tragus and soft tissue pogonion (A); tragus and lateral corner of the mouth (B); lateral corner of the eye and the angle of the mandible (C) (Figure 9, p. 44). Changes between successive measurements of [(A + B + C)/3], were expressed as a percentage (%). These were taken at baseline (Day 0), day 2 and day 7 postoperatively.
Results: The mean closure time for knotless sutures was 1 minute 23 seconds faster than for conventional sutures [F (1, 62) = 262.8, p < .001], and the study average was 3 minutes. There were no statistically significant findings for postoperative pain, irritation and swelling.
Conclusion: Knotless sutures confer some performance benefits, but this needs to be weighed against the increased material cost. It is a promising approach to intraoral wound closure, due to its superior intraoperative handling and comparable postoperative performance.