How Does Lingual Split Chisel Mallet Technique for Wisdom Tooth Removal Surgery Fare in Comparison to the Bur Technique in Terms of Postoperative Pain?

Background As much as “contempt for what is old” philosophy is detrimental, it may be a necessity to use old surgical techniques occasionally. Purpose To evaluate differences in surgical outcomes of wisdom tooth removal surgery between the lingual split chisel mallet technique (Group I) and the bur technique (Group II). Study Design, Setting, and Sample A randomized controlled non-inferiority trial was conducted at a tertiary care hospital in India, in an outpatient clinic. Patients aged 18-50 with impacted mandibular third molars (Pell and Gregory position A and B) without associated pathology were included ( n = 40). Smokers, pregnant women, and those unable to follow-up were excluded. Predictor Variables Treatment assigned (Groups I and II). Covariates Age, gender, chief complaint, duration of complaint, side, Winter’s class, Pell and Gregory class and position, Pederson difficulty index, pre-existing temporomandibular dysfunction, and trismus. Outcome Variables Primary: Postoperative day 1 pain score. Secondary: Postoperative pain on days 3 and 7, trismus (mouth opening <30 mm), dry socket, paresthesia, infection, and dehiscence. Analyzes Categorical variables were analyzed by chi-square or Fisher’s exact test, and continuous variables by t -test and Wilcoxon rank sum test. The level of statistical significance was set at P value <.05, and the non-inferiority limit at δ of ±1 for the visual analogue scale (VAS) on day 1. Results Forty patients were eligible and included, 20 in each group. No statistical differences were found in demographics and preoperative variables. Mean pain-scores on day 1, 3, and 7 in Group I were 4.15 (±1.7), 2.5 (±1.9), and 1.05 (±1.2), respectively. The same in Group II were 4.3 (±1.9), 2.6 (±1.1), and 1.65 (±1.0). For the primary outcome variable, the P value was .94 [95% CI, (−0.82) −1.12]. Trismus by day 7 in Group I was 15% ( n = 3) and in Group II was 45% ( n = 9). Temporary sensory disturbance was noted in one patient in each group. There was no incidence of dry socket or infection. Conclusion Lingual split technique in third molar surgery gives comparable postoperative outcomes in terms of postoperative pain, trismus, infection, and paresthesia to the bur technique; however, the latter remains the gold standard.