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Randomized Controlled Trial
. 2017 Jan;21(1):71-83.
doi: 10.1007/s00784-016-1751-1. Epub 2016 Feb 27.

Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial

H Ghaeminia  1 , Th J M Hoppenreijs  2 , T Xi  3 , J P Fennis  2 , T J Maal  3 , S J Bergé  3   4 , G J Meijer  3   5
Affiliations
Randomized Controlled Trial

Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial

H Ghaeminia et al. Clin Oral Investig. 2017 Jan.

Abstract

Objectives: The primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal.

Material and methods: A multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject® Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher's exact test.

Results: A total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject® group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal.

Conclusion: Irrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications.

Clinical relevance: Water is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal.

Keywords: Drinking water; Irrigation; Oral health impact profile; Pain; Prevention; Quality of life; Risk factors; Trismus.

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Conflict of interest statement

Compliance with ethical standards This study was part of a multicenter randomized controlled clinical trial investigating the efficacy of CBCT prior to mandibular third molar removal from which the trial and the clinical protocol were approved by the Institutional Review Board (CCMO Arnhem-Nijmegen, NL nr.: 40492.091.12). Conflict of interest The authors declare that they have no conflict of interest. Funding The work was supported by the Department of Oral & Maxillofacial Surgery of Radboud University Medical Centre. The BOOA Research Foundation of the Dutch Society of the Oral and Maxillofacial Surgery furthermore supported this study. Informed consent All patients were informed about the study and a written informed consent was obtained.

Figures

Fig. 1
Fig. 1
Irrigation of the surgical site with a curved tip Monoject® syringe. Surgical site immediately following the removal of the 38 (a). According to the web-based randomization, the patient was assigned into the Monoject® group, and instruction on the use of the syringe was provided (b). The surgical site (38) of a patient with normal healing 1 week after surgery (c). Following irrigation of the surgical site, no debris was found (d). A surgical site (38) of an alveolar osteitis (e). After irrigation, a high amount of debris was assessed (f)
Fig. 2
Fig. 2
diagram with flow of patients (number of third molars). n number, ITT intention to treat, TR treatment received
Fig. 3
Fig. 3
Pain scores from day 1 to day 7 after removal of the third molar for patients with normal healing and inflammatory complications
See this image and copyright information in PMC

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