Journal of Peking University(Health Sciences) >
Effect of triangular flap design and healing procedure on the sequelae after extraction of impacted lower third molars
Received date: 2018-10-09
Online published: 2019-10-23
Objective:To evaluate the effect of different triangular flap design and healing procedure on the sequelae after extraction of impacted lower third molars. Methods: In this prospective, split-mouth study, 60 healthy patients with bilateral, symmetrically fully impacted lower third molars (LM3) were included, of whom 30 patients with totally bony impacted LM3 were allocated into group A, while the other patients with partially bony impacted LM3 were allocated into group B. All the teeth were extracted by the same surgeon. Triangular flap was used on one side, and the wound was primarily closed with two sutures (TF-P). On the other side, modified triangular flap was used with a triangular region of mucosa posterior to LM2 removed during operation, and a triangular soft tissue defect was left for drainage after suture (MTF-S). The patients were followed up on postoperative days 1, 3 and 7. Clinical parameters included postoperative pain, swelling, and trismus. Distal probing depth of adjacent second molar was assessed 6 months after extraction. Doctors responsible for the evaluation did not know the group and flap design. Paired sample t test was used to analyze the differences of postoperative sequelae between the two strategies. Results: In group A, MTF-S strategy could reduce postoperative pain, ibuprofen consumption, and swelling significantly compared with TF-P strategy on the postoperative 1st and 3rd days (P<0.05). Besides, the trismus in the patients with TF-P strategy was more serious than that with MTF-S strategy on the postoperative 1st, 3rd and 7th days (P<0.05). However, statistic difference between the two strategies in pain, swelling and trismus was not detected in group B. Additionally, the VAS score in the patients with MTF-S strategy in group B increased slightly on the postoperative 4th day. The probing depth of the adjacent second molar was evaluated 6 months after extraction. Statistic difference was not detected between MTF-S strategy and TF-P strategy in the both groups. Conclusion: Modified triangular flap with secondary healing procedure could effectively reduce the postoperative complications of totally bony impacted LM3. However, the difference between the two strategies in the probing depth of the adjacent second molar was not statically significant 6 months after extraction.
Wei QI , Jian-nan LI , Jing-ren ZHAO , Hai-xia XING , Jie PAN . Effect of triangular flap design and healing procedure on the sequelae after extraction of impacted lower third molars[J]. Journal of Peking University(Health Sciences), 2019 , 51(5) : 949 -953 . DOI: 10.19723/j.issn.1671-167X.2019.05.026
| [1] | Farish SE, Bouloux GF . General technique of third molar removal[J]. Oral Maxillofac Surg Clin North Am, 2007,19(1):23-43. |
| [2] | Cetinkaya BO, Sumer M, Tutkun F , et al. Influence of different suturing techniques on periodontal health of the adjacent second molars after extraction of impacted mandibular third molars[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009,108(2):156-161. |
| [3] | Sanchis Bielsa JM, Hernández-Bazán S, Peáarrocha Diago M . Flap repositioning versus conventional suturing in third molar surgery[J]. Med Oral Patol Oral Cir Bucal, 2008,13(2):E138-142. |
| [4] | Baqain ZH, Al-Shafii A, Hamdan AA , et al. Flap design and mandibular third molar surgery: a split mouth randomized clinical study[J]. Int J Oral Maxillofac Surg, 2012,41(8):1020-1024. |
| [5] | Barone A, Marconcini S, Giacomelli L , et al. A randomized clinical evaluation of ultrasound bone surgery versus traditional rotary instruments in lower third molar extraction[J]. J Oral Maxillofac Surg, 2010,68(2):330-336. |
| [6] | Pasqualini D, Cocero N, Castella A , et al. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study[J]. Int J Oral Maxillofac Surg, 2005,34(1):52-57. |
| [7] | Erdogan O, Tatl? U, Ustün Y , et al. Influence of two different flap designs on the sequelae of mandibular third molar surgery[J]. Oral Maxillofac Surg, 2011,15(3):147-152. |
| [8] | Bello SA, Olaitan AA, Ladeinde AL . A randomized comparison of the effect of partial and total wound closure techniques on postoperative morbidity after mandibular third molar surgery[J]. J Oral Maxillofac Surg, 2011,69(6):e24-30. |
| [9] | Cerqueira PR, Vasconcelos BC, Bessa-Nogueira RV . Comparative study of the effect of a tube drain in impacted lower third molar surgery[J]. J Oral Maxillofac Surg, 2004,62(1):57-61. |
| [10] | Jakse N, Bankaoglu V, Wimmer G , et al. Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002,93(1):7-12. |
| [11] | Kugelberg CF, Ahlstr?m U, Ericson S , et al. Periodontal healing after impacted lower third molar surgery in adolescents and adults. A prospective study[J]. Int J Oral Maxillofac Surg, 1991,20(1):18-24. |
| [12] | Sandhu A, Sandhu S, Kaur T . Comparison of two different flap designs in the surgical removal of bilateral impacted mandibular third molars[J]. Int J Oral Maxillofac Surg, 2010,39(11):1091-1096. |
| [13] | Haraji A, Motamedi MH, Rezvani F . Can flap design influence the incidence of alveolar osteitis following removal of impacted mandibular third molars[J]. Gen Dent, 2010,58(5):e187-189. |
| [14] | Kirk DG, Liston PN, Tong DC , et al. Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007,104(1):e1-6. |
| [15] | Briguglio F, Zenobio EG, Isola G , et al. Complications in surgical removal of impacted mandibular third molars in relation to flap design: clinical and statistical evaluations[J]. Quintessence Int, 2011,42(6):445-453. |
| [16] | Dodson TB . Is there a role for reconstructive techniques to prevent periodontal defects after third molar surgery[J]. Oral Maxillofac Surg Clin North Am, 2007,19(1):99-104. |
| [17] | Pe?arrocha Diago M, Galán Gil S, Peáarrocha Diago M . Vestibular bone window for the extraction of impacted lower third molars: four case reports[J]. Med Oral Patol Oral Cir Bucal, 2008,13(8):E508-510. |
| [18] | Dodson TB . Management of mandibular third molar extraction sites to prevent periodontal defects[J]. J Oral Maxillofac Surg, 2004,62(10):1213-1224. |
| [19] | Leung WK, Corbet EF, Kan KW , et al. A regimen of systematic periodontal care after removal of impacted mandibular third molars manages periodontal pockets associated with the mandibular second molars[J]. J Clin Periodontol, 2005,32(7):725-731. |
| [20] | Chen YW, Lee CT, Hum L , et al. Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Surg, 2017,46(3):363-372. |
| [21] | Rosa AL, Carneiro MG, Lavrador MA , et al. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002,93(4):404-407. |
/
| 〈 |
|
〉 |