Third molar surgery: the effect of primary closure, wound dressing and metronidazole on postoperative recovery.
One hundred and forty eight patients with bilateral symmetrically impacted lower third molars entered a clinical crossover trial to compare the effects on postoperative recovery of a Bismuth Iodoform Paraffin Paste (BIPP) socket dressing, primary closure using a resorbable suture (Softgut) and to ascertain if prophylactic metronidazole influenced the outcome. The results reaffirm the surgical principle that contaminated surgical wounds such as third molar sockets are best kept open with a dressing. Attempts at primary closure should be resisted if there is no intention to prescribe antibiotic cover. However, if a suitable antibiotic is taken then primary closure using a resorbable suture can be carried out with confidence. This may reduce the need for outpatient follow up.