Comparison of two different flap designs in the surgical removal of bilateral impacted mandibular third molars

The purpose of this study was to compare the effects of flap design on the postoperative sequelae of pain, swelling, trismus and wound dehiscence after surgical removal of bilateral impacted mandibular third molars (M3). 20 patients aged 20–30 years who required removal of bilateral impacted M3 were included in the study. Maximum interincisal opening and facial measurements were recorded preoperatively. Bayonet flap was used on one side and envelope flap on the other side for the removal of impacted M3. The effect of flap design on pain, swelling, trismus and wound dehiscence was evaluated postoperatively. Pain and wound dehiscence were significantly greater in the envelope flap group compared with the bayonet flap group (P < 0.05). No significant difference in postoperative swelling and trismus was found in either group (P > 0.05). The bayonet flap was superior to the envelope flap for postoperative pain and wound dehiscence. There was no difference in postoperative swelling and trismus between the two groups.     

Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs.

OBJECTIVES: Wound dehiscences after lower third molar surgery potentially extend the time of postsurgical treatment and may cause long-lasting pain. It was the aim of this prospective study to evaluate the primary wound healing of 2 different flap designs. METHODS: Sixty completely covered lower third molars were removed. In 30 cases, the classic envelope flap with a sulcular incision from the first to the second molar and a distal relieving incision to the mandibular ramus was used, whereas the other 30 third molars were extracted after preparation of a modified triangular flap first similarly described by Szmyd. Wound healing was controlled on the first postoperative day, as well as 1 and 2 weeks after surgery. RESULTS: The overall result was a total of 33% wound dehiscence. In the envelope-flap group, wound dehiscences developed in 57% of the cases. This represents a relative risk ratio of 5.67, with a 95% CI from 1.852 to 12.336. With the modified triangular-flap technique, only 10% of the wounds gaped during wound healing. CONCLUSION: This study confirms evidence that the flap design in lower third molar surgery considerably influences primary wound healing. The modified triangular flap is significantly less conducive to the development of wound dehiscence.     

Review of flap design influence on the health of the periodontium after mandibular third molar surgery

The purpose of this study is to review the effect of flap design in terms of periodontal status of the preceding second molar after lower third molar surgery. Impacted lower third molar surgery may result in periodontal complications on the distal surface of the adjacent second molar. Flap design that is used during impacted third molar surgery is important to prevent those complications. Several different flap techniques, mainly envelope, triangular (vertical) flaps, and their modifications have been developed to minimize those complications. Each technique has some advantages as well as disadvantages. It is also reported that the selection of a flap design does not seem to have a lasting effect on the health of periodontal tissue. The effect of the type of flap used for lower third molar surgery on the periodontal status of the second molar, as well as the factors that may influence this outcome, has been uncertain. The decision to use on one or the other of the flaps should be based on surgeon's preference.     

Influence of a pedicle flap design on acute postoperative sequelae after lower third molar removal

Pain, swelling, trismus, and alveolar osteitis often occur after removal of impacted third molar teeth. To minimize these complications a number of mucoperiosteal flap designs have been advocated, but, to date, a pedicle flap design has not been evaluated. In a randomized prospective split mouth study, 52 participants had bilateral symmetrically impacted mandibular third molars removed over two sessions. A buccal envelope or pedicle flap was randomly assigned to the left or right third molar site. Pre-and postoperative pain and swelling were recorded using a standardized visual analogue scale, trismus was measured as the maximum inter-incisal opening distance in millimetres and dry socket was assessed clinically. Greater continuous pain, pain on maximum opening, and oro-facial swelling were recorded with the pedicle flap design. Continuous pain resolved significantly faster with this flap design (p<0.05). Trismus was similar for both flap designs (p>0.05). Five cases of alveolar osteitis occurred with the envelope flap whilst no cases developed with the pedicle flap, but the incidence was too small for statistical analysis. The pedicle flap improved some aspects of postoperative pain experience and reduced the incidence of alveolar osteitis, but further investigation with a larger sample size is required to evaluate its significance.     

Postoperative morbidity with mandibular third molar surgery: a comparison of two techniques

The postoperative pain and swelling that followed the removal of symmetrically impacted mandibular third molars by the split bone and bur techniques was studied in 30 patients. Removal by the split bone technique produced noticeably less pain and swelling. Interdependence was noted between pain and swelling.     

Lingual exposure during mandibular third molar surgery.

The necessity for surgical exposure of the lingual aspect of mandibular third molars will vary according to the severity of the impaction and the surgical technique adopted. A retractor is described for use in those cases when major lingual retraction is required. The retractor provides optimum access to the mandibular third molar area with adequate protection for the lingual nerve, tongue retraction and enhanced illumination by light reflection. It can be used under both local and general anaesthesia.     

Electro-acupuncture efficacy on pain control after mandibular third molar surgery

The aim of this study was to evaluate the efficacy of electro-acupuncture (EAC) on postoperative pain control after mandibular third molar surgery. Twenty four young patients (12 male and 12 female) with symmetrically impacted mandibular third molars were selected. Each patient was submitted to two separate surgical procedures under local anesthesia. At one side, extraction was carried out employing both prior (24h) and immediately postoperative application of EAC, while on the contralateral side surgery was carried out without any treatment. EAC was applied on 6 bilateral systemic and 2 auricular points with a WQ10Dl appliance using 40-60Hz frequency for 20 min and individually adjusted intensity. Postoperative pain intensity was rated on a 100 mm visual analog scale (VAS) between 2 and 72 h and recording the amount of analgesics intake after surgery. Statistical analysis was performed using theWilcoxon test. Postoperative pain VAS scores were significantly lower for the EAC group (p<0.05) and analgesic intake decreased (p<0.05) for all evaluated periods (p<0.05). Under the tested conditions EAC therapy is efficient was proved controlling postoperative pain following mandibular third molar surgical removal.     

Comparison of 2 flap designs in the periodontal healing of second molars after fully impacted mandibular third molar extractions.

PURPOSE: This investigation compared the effects of different flap designs on the periodontal health status of the mandibular second molar after the extraction of the adjacent impacted third molar. PATIENTS AND METHODS: Eighteen patients aged 16 to 32 years who required removal of bilateral impacted mandibular third molars were included in this study. The periodontal health of the second molar was evaluated preoperatively and at 1 week, 2 weeks, 4 weeks, and 12 months postoperatively. The third molars were removed by using the 3-cornered flap on the left side of the jaw and modified Szmyd flap on the right side. RESULTS: The mean probing depth (PD) at distal and buccal sites was significantly different between the flaps at 1 week, 2 weeks, and 4 weeks postoperatively (P < .05). There were no significant differences in preoperative and 1 year postoperative mean PD between the 2 flaps (P > .05). There was no significant difference in mean clinical attachment level between the flap sites at 1 year (P > .05). CONCLUSION: The modified Szmyd flap, which leaves intact gingiva around the second molar, has better primary periodontal healing than the 3-cornered flap after surgical removal of the fully impacted mandibular third molar.     

改良三角瓣对下颌第三磨牙拔除术后并发症的影响及其临床应用

目的 通过对比改良三角瓣与传统三角瓣对下颌近中阻生第三磨牙拔除术后并发症的影响,探讨改良三角瓣的临床应用.方法 选取110例门诊就诊需要拔除第三磨牙的患者,随机分为2组:改良三角瓣组和传统三角瓣组,记录患者术后2、7d的疼痛程度、肿胀程度和张口受限程度,进行组间比较.结果 术后2d,改良三角瓣组的肿胀程度(Z=-3.432)和张口受限程度(t=19.188)均小于传统三角瓣组,其差异有统计学意义(P＜0.05),但术后7d无此差别(P＞0.05).而在疼痛程度方面,两者在术后2d和术后7d均未看到明显差异(P＞0.05).结论 与传统三角瓣相比,改良三角瓣早期并发症更轻,熟练掌握后操作更容易,值得推广.     

Sensory nerve impairment following mandibular third molar surgery.

PURPOSE: This prospective study reports the rate and factors influencing sensory impairment of the inferior alveolar and lingual nerves after the removal of impacted mandibular third molars under local anesthesia. PATIENTS AND METHODS: There were 741 patients with 741 mandibular third molars removed under local anesthesia during a 3-year period from 1994 to 1997. Standardized data collection included the patient's name, age and gender, side of operation, angulation of the tooth, lingual flap elevation, use of vertical or horizontal tooth division, the experience of the operator, and the occurrence of lingual and/or inferior alveolar nerve paresthesia. RESULTS: Postoperative lingual nerve paresthesia occurred in 19 patients (2.6%). There was a highly significant increase in the incidence associated with raising of a lingual flap (P <.001). The incidence of inferior alveolar nerve paresthesia was (3.9%). It was highest in the under 20-year-old age group (9.8%), and there was a highly significant relationship to the experience of the operator (P <.001). Statistical analyses revealed that both lingual and inferior alveolar nerve paresthesia were unrelated to the other variables. CONCLUSIONS: The elevation of lingual flaps and the experience of the operator are significant factors contributing to lingual and inferior alveolar nerve paresthesia, respectively.     

Patient flows in the care process of mandibular third molar surgery

Our aim was to describe patient flows in mandibular third molar surgery at oral and maxillofacial specialist units. Our hypothesis was that there are variations in how care is delivered and that the variations could be explained by inter-individual variations in surgeons' practice, the quality of the radiographs appended to the referral, and the staffing of the specialist units. A flow chart was constructed to simulate all possible patient flows in the care process. The chart begins with treatment planning, which was drawn up based on documents from the referring dentist or another caregiver; continues with the care process at the oral and maxillofacial surgery unit, including surgical consultations and radiological examinations; and ends with surgery. Surgeons at four oral and maxillofacial surgery units in the National Health Service in southern Sweden participated. The intention was to collect data on at least 100 patients who had undergone mandibular third molar surgery at each unit. Data on 361 patients were collected. The radiographs appended to the referral were judged to be inappropriate for the majority of the patients (61%). For 13% of these patients, supplementary radiographic examinations were made at the radiology clinic included in the unit, whilst 48% were examined at the oral and maxillofacial surgery clinic. There were eight different patient flow patterns. In one unit with three surgeons, eight different flow patterns were recorded, indicating an interindividual variation among the surgeons. In a second unit, six different flow patterns were recorded. In the last two units, the patient flows appeared to be the same at each unit, although the predominant patient flows in these two units differed. The number of patient visits to the specialist units ranged between one and three. In three specialist units, most patients were called twice whilst in one specialist unit most patients were called only once, to have the third molar removed. Differences existed in the care process. Overall, the number of patient visits seemed not to depend on whether the preoperative radiographic examination was judged to be appropriate or whether the additional radiographs were made at the radiology clinic.     

Factors predictive of difficulty of mandibular third molar surgery.

AIM: Historically the difficulty of third molar surgery has been judged using radiologically assessed dental factors specifically tooth morphology and position. This study investigated additional factors that have a bearing on the difficulty of extraction. STUDY DESIGN: A prospective study undertaken by three clinical assistant grade surgeons who removed 354 single mandibular third molar teeth under day case anaesthesia over the 4-year period (1994-1998). METHOD: Data relating to patient, dental and surgical variables were collected contemporaneously as the patients were treated. The difficulty of extraction was estimated by the surgeons pre-operatively using dental radiographic features and compared by the same surgeon within the actual surgical difficulty encountered at surgery. Operation time strongly related to both pre and post treatment assessments of difficulty and proved to be the best measure of surgical difficulty. RESULTS: Univariate analysis identified increased patient age, ethnic background, male gender, increased weight, bone impaction, horizontal angulation, depth of application, unfavourable root formation, proximity to inferior alveolar canal and surgeon as factors increasing operative time. Multivariate analysis showed that increasing age (P = 0.014), patient weight (P = 0.024), ethnicity (P = 0.019), application depth (P = 0.001), bone impaction (p=0.008) and unfavourable root formation (P = 0.009) were independent predictors for difficulty of extraction. CONCLUSIONS: Half of the six independent factors that predicted surgical difficulty of third molar extraction were patient variables.