[Wound healing after surgical wisdom tooth extraction. Evidence-based analysis]

Abstract

Background: The purpose of this article was to conduct a review of current evidence focusing on parameters influencing wound healing after removal of mandibular third molars.

Selection of publications: For selection of publications, methods of evidence-based dentistry were used. Systematic selection of studies included in this review was performed after search of publications by electronic databases (MEDLINE) concentrating on five keywords ("third molar" or "wisdom teeth" and "evidence," "wound healing," and "incision," respectively) published within the last 15 years. Of the 126 articles found, 56 were included regarding contents and after formal evaluation and 29 after narrative search.

Wound healing: Parameters for the evaluation of the course of wound healing after mandibular third molar removal were postoperative pain (32% of publications), swelling (28%), trismus (18%), and sensory disturbances (13%). The peak of incidences of alveolar ostitis (0.3-35%) and wound infections (1-16.7%) correlated with the age group between 25 and 35 years. The incidence of sensory disturbances (transient disturbances of the inferior alveolar nerve 0.4-0.6% and lingual nerve 0.06-11.5%, permanent disturbances 0.2-1%) was found to be increased above the age of 25 years.

Predictors: Age, duration of operation, primary or secondary wound closure, retention or impaction type, and pathoses associated with the third molar were identified as evident predictors for the postoperative course. Due to the higher incidence of postoperative complications above the age of 25 years, third molars should be removed before this age if indicated. Evidence status of the conclusions drawn varies due to the different quality of studies included, sample sizes, and statistical methods.