第三大臼歯抜歯後の炎症徴候に対する2つの縫合法の比較-無作為化臨床試験

Comparison of two suture techniques on the inflammatory signs after third molars extraction-A randomized clinical trial.

抄録

目的:

創閉鎖手技は第三大臼歯抜歯術後の術後早期合併症に影響を及ぼす手術因子である。本研究では、下顎第三大臼歯手術後の術後不快感に対する一次閉鎖と斜切開の第二意図による治癒という2つの閉鎖手技の有効性を検討し比較した。

PURPOSE: Wound closure technique is an operative factor that influences early post-operative complications after third molar surgery. This study investigates and compared the effectiveness of two closure techniques, primary closure and healing by second intention of the oblique incision on postsurgical discomfort after mandibular third molar surgery.

材料と方法:

これは前向き無作為化二重盲検分割口対照試験である。手術部位を2群に分け、対照群には歯槽堤切開と斜切開の両方に単純縫合を行い、介入群には歯槽堤切開に単純縫合を行い、斜切開はsecond intentionで治癒させた。術後72時間と7日目に腫脹、開口度を評価した。創傷治癒は7日目に評価した。

MATERIALS AND METHODS: This is a prospective, randomized, double-blind, split mouth controlled trial. Surgical sites were divided into two groups Control group received simple sutures in both alveolar crest incision and oblique incision and intervention group received simple sutures in alveolar crest incision, while the oblique incision healed by second intention. All the patients were instructed to measure pain according to visual analogue scale (VAS) in postoperative period, swelling, mouth opening was assessed at 72h and 7 days after surgery. The wound healing was assessed on day 7.

結果:

同様の手術難易度の両側第三大臼歯内反症患者35名を募集した。31人がこの研究を成功裏に終了した。Second intention群では、24時間後（p＜0.27）および48時間後（＜0.001）の疼痛が有意に少なく、腫脹（＜0.001）およびトライズムス（＜0.001）が有意に少なく、一次閉鎖を行った患者ではLandry indexの評価が良好であった（p＜0.001）。

RESULTS: Thirty-five patients, who had bilateral impacted third molars of similar surgical difficulty, were recruited. Thirty-one successfully completed the study. Patients in the second intention group had significantly less pain at 24h (p < 0.27). and 48h (< 0.001), had significantly less swelling (< 0.001) and trismus (< 0.001) and patients submitted to primary closure had a better evaluation of the Landry index (p < 0.001).

結論:

部分的な外科的創傷閉鎖による斜弛緩切開の第二意図による治癒は、術後の疼痛、腫脹およびトリスムスの軽減において一次閉鎖より優れていた。

CONCLUSION: Healing by second intention of the oblique relaxing incision by partial surgical wound closure, in our study, were superior to the primary closure in reduction of post-operative pain, swelling and trismus.

試験登録:

本試験はBrazilian Registry of Clinical Trials-ReBEC -UTNに登録された：RBR-5fxbqsf (https://ensaiosclinicos.gov.br/rg/RBR-5fxbqsf)に登録されている。

TRIAL REGISTRATION: This trial is registered at Brazilian Registry of Clinical Trials-ReBEC -UTN: RBR-5fxbqsf (https://ensaiosclinicos.gov.br/rg/RBR-5fxbqsf).