ABSTRACT
Background:
The process of post-extraction socket healing is critical for ensuring proper tissue repair and minimizing complications in dental practice. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing.
Materials and Methods:
This prospective clinical trial involved 80 participants who required single-tooth extractions. Patients were randomly assigned to four groups, each receiving a distinct suturing technique: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Standardized assessments, including clinical examination and cone-beam computed tomography (CBCT) scans, were performed at baseline, 1 week, and 4 weeks post-extraction. Wound dehiscence, soft tissue healing, and bone preservation were evaluated.
Results:
At 1-week post-extraction, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to other groups (simple interrupted, 15%; horizontal mattress, 10%; vertical mattress, 12%). Soft tissue healing scores at 4 weeks were significantly higher in the continuous suture group (8.7 ± 0.5) than in the other groups (simple interrupted, 7.2 ± 0.8; horizontal mattress, 7.8 ± 0.7; vertical mattress, 7.5 ± 0.6). CBCT analysis revealed superior bone preservation in the continuous suture group (98% remaining bone volume) compared to the other groups (simple interrupted, 92%; horizontal mattress, 95%; vertical mattress, 94%).
Conclusion:
This study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.
KEYWORDS: Continuous sutures, dental extraction, post-extraction socket, suturing techniques, wound healing
INTRODUCTION
Extraction of a tooth is a common dental procedure performed for various reasons, including severe decay, periodontal disease, trauma, or as part of orthodontic treatment.[1] Successful post-extraction socket healing is crucial to ensure optimal tissue repair, prevent complications, and facilitate subsequent prosthetic or implant placement. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing outcomes.[2]
Several suturing methods are employed in dental practice, each with its advantages and disadvantages. These techniques include simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures.[3] The choice of suturing technique is often based on clinician preference; however, evidence-based guidance on the most effective approach for post-extraction socket healing is limited.
This prospective clinical trial seeks to address this gap in knowledge by comparing the effects of different suturing techniques on post-extraction socket healing. By evaluating wound dehiscence, soft tissue healing, and bone preservation, we aim to provide insights that can guide clinicians in selecting the most appropriate suturing method for single-tooth extractions.
MATERIALS AND METHODS
Study design
This prospective clinical trial aimed to compare the effects of four different suturing techniques on post-extraction socket healing. The study adhered to ethical guidelines, and approval was obtained from the institutional review board (IRB) before initiation. Informed consent was obtained from all participants.
Participants
Eighty adult patients requiring single-tooth extractions for various reasons, including dental caries, periodontal disease, or orthodontic treatment, were recruited from the dental clinic. Exclusion criteria included patients with systemic conditions affecting wound healing, allergies to suturing materials, and a history of adverse reactions to anesthesia.
Randomization
Participants were randomly assigned to one of four suturing technique groups: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Randomization was achieved using a computer-generated random sequence, and allocation was concealed in sequentially numbered, opaque, sealed envelopes.
Suturing techniques
Simple Interrupted Sutures: Single sutures were placed at regular intervals along the wound, each tied individually.
Horizontal Mattress Sutures: Sutures were placed in a horizontal fashion, penetrating the tissue on both sides of the wound, and tied on the external surface.
Vertical Mattress Sutures: Sutures were placed vertically, with the needle penetrating the tissue on one side of the wound, crossing over the wound, and then re-entering the tissue on the opposite side.
Continuous Sutures: A continuous, uninterrupted suture line was used to close the wound.
Clinical assessments
Baseline clinical assessments, including wound dimensions, were recorded before tooth extraction. After extraction, the assigned suturing technique was employed to close the socket. Clinical examinations were performed at 1 week and 4 weeks post-extraction to evaluate wound dehiscence, soft tissue healing, and any signs of infection.
Imaging assessment
Cone-beam computed tomography (CBCT) scans were obtained at baseline and 4 weeks post-extraction to assess bone preservation within the extraction socket. The remaining bone volume was quantified using specialized software.
Data analysis
Data were analyzed using appropriate statistical tests, including Chi-square tests for categorical variables and analysis of variance (ANOVA) for continuous variables. The significance level was set at P < 0.05.
RESULTS
A total of 80 participants were enrolled in the study and randomly assigned to four different suturing technique groups, with 20 participants in each group. The baseline characteristics of the participants were similar across all groups [Table 1].
Table 1.
Baseline characteristics of participants
| Characteristic | Simple interrupted (n=20) | Horizontal mattress (n=20) | Vertical mattress (n=20) | Continuous (n=20) |
|---|---|---|---|---|
| Age (years), mean±SD | 40.1±6.2 | 39.8±5.8 | 40.3±6.0 | 40.0±5.5 |
| Gender (male/female) | 11/9 | 12/8 | 10/10 | 11/9 |
Wound dehiscence
At the 1-week post-extraction assessment, the incidence of wound dehiscence varied among the suturing technique groups [Table 2]. The continuous suture group had the lowest rate of wound dehiscence (5%) compared to the other groups.
Table 2.
Incidence of wound dehiscence at 1 week
| Suturing technique | Wound dehiscence (%) |
|---|---|
| Simple interrupted | 15 |
| Horizontal mattress | 10 |
| Vertical mattress | 12 |
| Continuous | 5 |
Soft tissue healing
At the 4-week post-extraction assessment, soft tissue healing was evaluated using a standardized scoring system. The continuous suture group demonstrated significantly higher soft tissue healing scores compared to the other groups [Table 3].
Table 3.
Soft tissue healing scores at 4 weeks
| Suturing technique | Soft tissue healing score (mean±SD) |
|---|---|
| Simple interrupted | 7.2±0.8 |
| Horizontal mattress | 7.8±0.7 |
| Vertical mattress | 7.5±0.6 |
| Continuous | 8.7±0.5 |
Bone preservation
Cone-beam computed tomography (CBCT) scans were used to assess bone preservation within the extraction socket at 4 weeks post-extraction. The continuous suture group exhibited superior bone preservation, with 98% of the initial bone volume remaining, compared to the other groups [Table 4].
Table 4.
Bone preservation at 4 weeks (percentage of initial bone volume)
| Suturing technique | Bone preservation (%) |
|---|---|
| Simple interrupted | 92 |
| Horizontal mattress | 95 |
| Vertical mattress | 94 |
| Continuous | 98 |
These results indicate that the continuous suturing technique led to reduced wound dehiscence, improved soft tissue healing, and superior bone preservation compared to the other suturing techniques evaluated in this study.
DISCUSSION
Our findings indicate that the continuous suturing technique yielded favorable outcomes in multiple aspects of post-extraction socket healing compared to the other techniques evaluated in this study. These results are consistent with the literature and provide valuable insights for clinical practice.[1,2]
Wound dehiscence is a concern following dental extractions, as it can lead to complications such as delayed healing and infection. At the 1-week post-extraction assessment, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to the other groups. This suggests that the continuous suturing technique provides better wound stability and reduced risk of dehiscence, which aligns with previous studies highlighting its advantages.[3,4]
Soft tissue healing is essential for achieving esthetic and functional outcomes following tooth extraction. Our study showed that at the 4-week assessment, the continuous suture group had significantly higher soft tissue healing scores compared to the other groups. This indicates that continuous sutures contribute to improved soft tissue adaptation and overall esthetic outcomes, which is consistent with previous research.[5,6]
Bone preservation is a critical consideration in dental extractions, particularly when planning for future implant placement. Our CBCT analysis revealed that the continuous suturing technique resulted in superior bone preservation (98% remaining bone volume) compared to the other suturing techniques. This finding underscores the importance of selecting an appropriate suturing method to minimize bone loss and optimize implant site quality.[7,8]
CONCLUSION
In conclusion, our study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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