The effecTiveness of limiTed flap design in surgical removal of fully impacTed lower Third molars: a comparaTive clinical sTudy

Abstract

Introduction: Surgical removal of impacted lower wisdom teeth is one of the most commonly performed procedures in oral and maxillofacial surgery. Objectives: This study aimed to compare the operative and post-operative outcomes of 2 flap designs (limited vs. extended 2-sided flap) in surgical extractions of lower third molars (M3) regarding fully impacted teeth. Material and methods: A prospective, randomized, controlled split-mouth trial was designed, and included 27 patients with bilateral (symmetrically positioned) impacted M3. Limited 2-sided flap was performed on one side (group 1) and extended 2-sided flap on the other side (group 2). The effect of flap design on intra-operative (visibility, accessibility, and duration of surgery) and post-operative sequelae (pain, trismus, swelling, alveolar osteitis, and wound dehiscence) were analyzed at different post-operative days. Any associated complications or side effects were also recorded. Results: Regarding pain, no significant differences were observed between the two groups (p > 0.05). Trismus and facial swelling were significantly greater in the extended flap group in the early post-operative period (p < 0.05). Pain, trismus, and swelling were significantly correlated with operation time in both the groups (p < 0.01). Wound dehiscence occurred only in 3 cases in group 2. Conclusions: Surgical and post-surgical outcomes obtained from the group 1 flap design are superior to the other group. The study findings indicated that trismus and swelling (not the pain) were significantly affected by the flap design.