Complications in surgical removal of impacted mandibular third molars in relation to flap design: clinical and statistical evaluations.

Department of Odontostomatology, University of Messina, Messina, Italy.
Quintessence international (Berlin, Germany: 1985) (Impact Factor: 0.73). 06/2011; 42(6):445-53.
Source: PubMed


The extraction of an impacted mandibular third molar may result in periodontal complications on the distal surface of the adjacent second molar. The purpose of this study was to compare the influence of three full-thickness flaps on the periodontal healing of the adjacent second molar after extraction of impacted mandibular third molars.
Forty-five volunteers with bilateral impaction of the mandibular third molars were selected. Each patient was randomly assigned to one of three groups: group A (envelope flap modified by Thibauld and Parant), group B (Laskin triangular flap), and group C (envelope flap modified by Laskin). The periodontal health of the second molars was evaluated at 3, 6, 12, and 24 months after surgery via clinical measurements.
After 21 days, there was no correlation between postoperative complications (such as edema and alveolitis) and flap design. However, there was a statistically significant reduction of pocket probing depth (PPD) and increase of clinical attachment level (CAL) in group B compared to the other groups (P<.05) 24 months after surgery.
The effect of the type of flap used for mandibular third molar surgery on the periodontal status of the second molars as well as the factors that influence this outcome remains uncertain. Regardless of the flap design, the periodontal conditions of the adjacent second molar deteriorated after 12 and 24 months. The decision to use a certain type of flap should be based on the surgeon's preference.

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Available from: Elton Gonçalves Zenóbio, Oct 27, 2014
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    ABSTRACT: Several conflicting findings have been published in the previous literature regarding the effects of impacted third molar surgery on the periodontal parameters of the adjacent second molar; some authors have shown improvement of periodontal health distal to the adjacent second molar, whilst others have demonstrated loss of attachment level (AL) and reduction of alveolar bone height. The purpose of this study was to evaluate the changes in periodontal health parameters distal to the adjacent second molar following extraction of an impacted third molar. Out of 50 patients participated in the study, 42 patients completed the study. The mean age of the sample was 20.9 (range, 18-25) years. All teeth were mesioangular impacted mandibular third molars categorized at C1 class based on the Pell and Gregory classification. All surgeries were performed by one surgeon and the same surgeon recorded the pre-operative and post-operative measurements of probing depth (PD) and AL on the distobuccal aspect of the second molars. Data analysis were carried out with the SPSS software (version 19), using the paired-samples t-test and one sample t-test. Surgical extraction of impacted mandibular third molar resulted in a significant increase of PD on the distobuccal aspect of the second molars, whereas AL was decreased significantly after surgery (P < 0.05). Unlike plenty of researches that have shown improvement of periodontal parameters of the second molar after extraction of impacted third molar, our study showed a significant increase in PD at the distal aspect of the second molar. Further follow-up on clinical and radiological parameters are required for more profound understanding of the long-term effects of third molar extraction on the periodontal parameters of the adjacent second molar.
    Dental research journal 03/2013; 10(4):523-526.
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    ABSTRACT: The aim of this study was to investigate the effects of two commonly used flap designs (envelope and triangular) used for the removal of mandibular third molars (M3) on postoperative morbidity. 19 patients with bilateral symmetrically impacted mandibular M3 were studied using a split mouth design. Swelling, pain and trismus measures were recorded on days 2, 7 and 14; periodontal indices were recorded on days 7 and 14, one final measure of probing depth on the distal aspect of the mandibular second molar (M2) was taken at the last follow up appointment. Data were analysed using the χ(2) test, the Mann-Whitney U-test and Pearson's correlations. The mean age of the patients was 21.4 ± 2.3 years (± SD). Facial swelling and the reduction in mouth opening were significantly greater in the early postoperative period (P<0.05) with pyramidal flap designs. There was no significant difference in pain scores, plaque accumulation and bleeding on probing indices between the two flap designs (P>0.05). Probing depth was significantly greater with envelope flaps in the early postoperative period (P<0.005). In conclusion, flap design in mandibular M3 surgery has an effect on postoperative recovery.
    International Journal of Oral and Maxillofacial Surgery 03/2012; 41(8):1020-4. DOI:10.1016/j.ijom.2012.02.011 · 1.57 Impact Factor
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    ABSTRACT: Objective: The aim of this study was to estimate the influence of flap design on alveolar osteitis (AO) and postoperative side effects following third molar surgery. Study design: This study was designed as a randomized single-blind clinical trial. The predictor variable was flap type. Envelope flap and modified triangular flap techniques were used. The primary outcome variable was AO. The secondary outcome variables were pain, swelling, and trismus. Descriptive and bivariate statistics were computed. Statistical significance was set at P ≤ .05. Results: Eighty patients with impacted mandibular third molars participated in the study. The envelope flap design was associated with a higher incidence of AO that was not statistically significant. On the second day, postoperative pain and swelling was observed as significantly different with the envelope flap technique. Conclusions: The modified triangular flap had the advantage of less postoperative pain and swelling but had the disadvantage of AO.
    08/2012; 116(3). DOI:10.1016/j.oooo.2011.12.023
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