J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 7, July 2019, pages 489-494

Postoperative Pain Perception and Patient’s Satisfaction After Mandibular Third Molar Surgery by Primary Closure With Distal Wedge Surgery

Figure 1. (a) Drawing picture of landmarks used for clinical measurements; gingival margin (A), cusp tip of mandibular second molar (B), cemento-enamel junction (C) and bottom of gingival pocket (D). (b) Intraoral photograph for the measurement of the distance from cusp tip to gingival margin using UNC15 probe.

**Table 1.** Patient’s Inclusion and Exclusion Criteria Including Withdrawal Criteria
Inclusion criteria	Exclusion criteria	Withdrawal criteria
Age between 18 - 25 years; having good systemic health; no smoking; having symmetrically positioned MTMI on both sides; not allergic to 4% articaine with 1:100,000 adrenaline; understanding and carrying out the instructions given by the investigators; having given written informed consent for the study	Pregnant or lactating mother; having serious medical conditions such as hypertension; cardiovascular problems, renal and/or liver failure, or smoking habit; inability to attend the periodic examinations; taking any medication during the previous 5 days prior to the surgery that would alter their pain perception (e.g. analgesics, antidepressants)	Patients could leave the study at any time depending on their own decisions and will

Table 1. Patient’s Inclusion and Exclusion Criteria Including Withdrawal Criteria

Inclusion criteria

Exclusion criteria

Withdrawal criteria

Age between 18 - 25 years; having good systemic health; no smoking; having symmetrically positioned MTMI on both sides; not allergic to 4% articaine with 1:100,000 adrenaline; understanding and carrying out the instructions given by the investigators; having given written informed consent for the study

Pregnant or lactating mother; having serious medical conditions such as hypertension; cardiovascular problems, renal and/or liver failure, or smoking habit; inability to attend the periodic examinations; taking any medication during the previous 5 days prior to the surgery that would alter their pain perception (e.g. analgesics, antidepressants)

Patients could leave the study at any time depending on their own decisions and will

**Table 2.** Distribution of Class, Position and Angulation of MTMI
Classification	Position B	Position C	Total
Class I	6 (13.6%)	12 (27.3%)	4 (9.1%)	10 (22.7%)	0	32 (72.7%)
Class II	0	2 (4.55%)	0	8 (18.2%)	2 (4.55%)	12 (27.3%)
Total	6 (13.6%)	14 (31.85%)	4 (9.1%)	18 (40.9%)	2 (4.55%)	44 (100%)

Table 2. Distribution of Class, Position and Angulation of MTMI

Classification

Position B

Position C

Total

Vertical

Mesioangular

Horizontal

Vertical

Mesioangular

Horizontal

Class I

6 (13.6%)

12 (27.3%)

4 (9.1%)

10 (22.7%)

32 (72.7%)

Class II

2 (4.55%)

8 (18.2%)

2 (4.55%)

12 (27.3%)

Total

6 (13.6%)

14 (31.85%)

4 (9.1%)

18 (40.9%)

2 (4.55%)

44 (100%)

**Table 3.** The Mean Difference (Mean ± SD, mm) of CT-GM Between Baseline and the Third Month, the Mean CEJ-GM and PD at the Third Month
Group	Disto-buccal	Mid-distal	Disto-lingual
P < 0.05, P < 0.01 and **P < 0.001. CT-GM: from cusp tip to gingival margin; CEJ-GM: from cemento-enamel junction to gingival margin; PD: probing depth.
CT-GM between baseline and the third month
Control	1.27 ± 1.12	0.82 ± 0.79	0.72 ± 0.94
Study	2.0 ± 0.98	2.95 ± 1.17	1.77 ± 0.75
P value	0.002**	0.000***	0.001***
CEJ-GM at the third month
Control	-0.91 ± 1.36	-2.45 ± 1.37	-1.68 ± 1.17
Study	-0.18 ± 0.50	-1.27 ± 0.98	-0.73 ± 0.88
P value	0.02*	0.004**	0.000***
PD at the third month
Control	3.00 ± 0.87	3.50 ± 0.67	3.00 ± 0.62
Study	2.59 ± 0.59	3.09 ± 0.53	2.91 ± 0.68
P value	0.029*	0.013*	0.589

Table 3. The Mean Difference (Mean ± SD, mm) of CT-GM Between Baseline and the Third Month, the Mean CEJ-GM and PD at the Third Month

Group

Disto-buccal

Mid-distal

Disto-lingual

*P < 0.05, **P < 0.01 and ***P < 0.001. CT-GM: from cusp tip to gingival margin; CEJ-GM: from cemento-enamel junction to gingival margin; PD: probing depth.

CT-GM between baseline and the third month

Control

1.27 ± 1.12

0.82 ± 0.79

0.72 ± 0.94

Study

2.0 ± 0.98

2.95 ± 1.17

1.77 ± 0.75

P value

0.002**

0.000***

0.001***

CEJ-GM at the third month

Control

-0.91 ± 1.36

-2.45 ± 1.37

-1.68 ± 1.17

Study

-0.18 ± 0.50

-1.27 ± 0.98

-0.73 ± 0.88

P value

0.02*

0.004**

0.000***

PD at the third month

Control

3.00 ± 0.87

3.50 ± 0.67

3.00 ± 0.62

Study

2.59 ± 0.59

3.09 ± 0.53

2.91 ± 0.68

P value

0.029*

0.013*

0.589

**Table 4.** The Mean VAS Score at the Seventh Day and Third Month (Mean ± SD)
Symptoms	The seventh day (VAS)	The third month (VAS)
Pain
Control	1.35 ± 1.52	0
Study	1.76 ± 1.56	0
P value	0.147	1.000
Swelling
Control	1.11 ± 1.37	0.01 ± 0.04
Study	1.17 ± 1.14	0
P value	0.195	0.317
Bleeding
Control	0.60 ± 0.71	0.01 ± 0.02
Study	1.20 ± 1.74	0
P value	0.73	0.317
Food impaction
Control	2.24 ± 3.01	0.14 ± 0.06
Study	2.73 ± 3.11	0
P value	0.643	0.317
Trismus
Control	1.14 ± 1.57	0.01 ± 0.04
Study	1.38 ± 1.72	0.01 ± 0.04
P value	0.195	1.000
Irritation
Control	1.76 ± 2.64	0.05 ± 0.22
Study	2.20 ± 2.50	0.01 ± 0.04
P value	0.295	0.317
Overall symptom
Control	1.52 ± 1.62	0.01 ± 0.02
Study	1.52 ± 1.73	0.01 ± 0.02
P value	0.295	1.000
Eating
Control	1.98 ± 2.09	0.01 ± 0.02
Study	1.90 ± 2.21	0.02 ± 0.11
P value	0.658	0.317
Chewing
Control	1.78 ± 1.79	0.01 ± 0.04
Study	1.67 ± 1.86	0
P value	0.554	0.317
Talking
Control	1.09 ± 1.23	0.01 ± 0.06
Study	0.93 ± 1.08	0.01 ± 0.06
P value	0.615	1.000
Smiling or laughing
Control	1.19 ± 1.63	0.01 ± 0.02
Study	1.16 ± 1.82	0.01 ± 0.04
P value	0.776	0.317
Daily activities
Control	0.83 ± 1.29	0.01 ± 0.02
Study	1.19 ± 1.81	0.01 ± 0.04
P value	0.348	0.317

Table 4. The Mean VAS Score at the Seventh Day and Third Month (Mean ± SD)

Symptoms

The seventh day (VAS)

The third month (VAS)

Pain

Control

1.35 ± 1.52

Study

1.76 ± 1.56

P value

0.147

1.000

Swelling

Control

1.11 ± 1.37

0.01 ± 0.04

Study

1.17 ± 1.14

P value

0.195

0.317

Bleeding

Control

0.60 ± 0.71

0.01 ± 0.02

Study

1.20 ± 1.74

P value

0.73

0.317

Food impaction

Control

2.24 ± 3.01

0.14 ± 0.06

Study

2.73 ± 3.11

P value

0.643

0.317

Trismus

Control

1.14 ± 1.57

0.01 ± 0.04

Study

1.38 ± 1.72

0.01 ± 0.04

P value

0.195

1.000

Irritation

Control

1.76 ± 2.64

0.05 ± 0.22

Study

2.20 ± 2.50

0.01 ± 0.04

P value

0.295

0.317

Overall symptom

Control

1.52 ± 1.62

0.01 ± 0.02

Study

1.52 ± 1.73

0.01 ± 0.02

P value

0.295

1.000

Eating

Control

1.98 ± 2.09

0.01 ± 0.02

Study

1.90 ± 2.21

0.02 ± 0.11

P value

0.658

0.317

Chewing

Control

1.78 ± 1.79

0.01 ± 0.04

Study

1.67 ± 1.86

P value

0.554

0.317

Talking

Control

1.09 ± 1.23

0.01 ± 0.06

Study

0.93 ± 1.08

0.01 ± 0.06

P value

0.615

1.000

Smiling or laughing

Control

1.19 ± 1.63

0.01 ± 0.02

Study

1.16 ± 1.82

0.01 ± 0.04

P value

0.776

0.317

Daily activities

Control

0.83 ± 1.29

0.01 ± 0.02

Study

1.19 ± 1.81

0.01 ± 0.04

P value

0.348

0.317