I’ve halved my day-two pain calls on mandibular third molars over the last 3 months by insisting on truly tension-free mucoperiosteal closure and switching to 4–0 PTFE instead of chromic. Are you seeing the same bump in recovery when flap stability is perfect and the post-op instructions are enforced to the letter — cleaner sockets, fewer dry sockets at 48 hours?
And same here — true “tension-free” only happened for me after routine periosteal scoring with a 15C and a sliding horizontal mattress to offload the distal; 4–0 PTFE beat chromic and my 48‑hr calls tanked. Small caveat: PTFE is more plaque‑retentive in my hands, so I pull at day 5 and push CHX rinses or a monojet — otherwise the tissue looks cranky. Curious if you’re scoring or just extending the triangle.
One tweak that cut my day‑two calls: I lightly bevel the distal wedge and polish the DB line angle of the second molar with a fine diamond so the 4–0 PTFE isn’t sawing the flap; if I skip it, I see more erythema. @cwilson73 do you leave a short tag or bury your knots?
I saw the same drop once I started laying a thin PRF membrane over the distal and tucking it under the flap — it cushions the tissue so the suture isn’t doing all the work. If PRF’s not handy, a tiny collagen plug under the distal flap has been a solid runner‑up for me. @cwilson73 are you burying your knots buccally?