Secondary versus primary closure techniques for preventing postoperative complications following removal of impacted mandibular third molars (IMTM): a systematic review and meta-analysis of randomized controlled trials

Background: Different surgical closure techniques after removal of IMTM have been studied. Inconsistencies among the literature and clinical opinions have been detected. No systematic reviews about this topic have been performed.

Objective: To determine whether the use of secondary closure techniques decreases the rate and severity of postoperative complications like pain, facial swelling, trismus, infectious complications and postoperative bleeding after IMTM extraction, compared to primary closure technique, at third and seventh postoperative day.

Search methods: MEDLINE, EMBASE and COCHRANE databases were searched up to the first week of February 2011. Hand searching of the reference lists of included studies, ongoing trial registers, congress abstracts and doctoral and master’s thesis were searched.

Selection criteria: Randomized controlled trials on patients with indication of surgical removal of IMTMs comparing any type of secondary closure versus primary closure technique.

Results: Of a total of 1719 identified citations, 11 studies were included. Mouth opening, measured in millimetres, was higher (MD 3.25, 95% CI 0.91–5.59, p = 0.007), and infectious complications had a lower rate (RR 0.29, 95% CI 0.10–0.81, p = 0.008) when patients received a secondary closure technique. The other outcomes showed no statistically significant differences. Substantial heterogeneity was detected among the trials. Most of the trials were classified as having unclear risk of bias.

Conclusions: The pooled effect estimates, large heterogeneity among the trials, and low quality of the evidence of the outcomes of interest suggest that there may not be a clinical important benefit derived from the use of secondary closure techniques.

Conflict of interest: We declare that we have no conflicts of interest.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Secondary versus primary closure techniques for preventing postoperative complications following removal of impacted mandibular third molars (IMTM): a systematic review and meta-analysis of randomized controlled trials
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