* Corresponding Author
Do different flap designs have negligible impacts on the removal of mandibular third molars?
https://doi.org/10.22146/majkedgiind.111285 Astrodita Adya Seta(1*), Pingky Krisna Arindra(2), Erdananda Haryosuwandito(3)
(1) Oral and Maxillofacial Surgery Specialist Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
(2) Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
(3) Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
(*) Corresponding Author
Abstract
This study aims to evaluate various flap incision techniques utilized in the mandibular third molar removal surgery. A systematic review with a qualitative approach was conducted. Data were obtained from published journals through manual database searches via Scopus, ScienceDirect, and PubMed covering the period from 2000 to 2024, using predetermined keywords related to the topic. The PRISMA statement guidelines were followed, including the use of the official flow chart. Twenty-one journals were identified and analyzed to compare different flap designs in mandibular third molar extraction procedures, focusing on their relationship with wound healing processes and complication rates. Comparative analysis of flap incision techniques was performed through systematic evaluation of multiple journal data. Both envelope and triangular flaps demonstrated comparable healing times in third molar extraction procedures. The envelope flap, while minimally invasive, showed association with dry socket occurrence. The triangular flap provided superior surgical access and demonstrated pain reduction following mandibular third molar surgery. The pedicle flap showed effectiveness in preventing dry socket and alveolar osteitis. In addition, the Lingual-based triangular flap proved superior to buccal-based triangular flap in controlling postoperative pain, swelling, and trismus while reducing overall complications. This analysis demonstrates that flap design selection significantly influences postoperative outcomes in mandibular third molar surgical procedures. Both triangular and envelope flap can be considered for the procedure of mandibular wisdom teeth removal.
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1. Astrodita AdyaReferences
Dewi FK, Santoso B, Fatmasari D. Pengaruh asuhan kesehatan gigi dan mulut odontektomi dengan general anestesi pada kecemasan dan kepuasan pasien. Quality: Jurnal Kesehatan. 2023; 17(2): 105-111. doi: 10.36082/qjk.v17i2.1320
2. Bailey E, Kashbour W, Shah N, Worthington HV, Renton TF, Coulthard P. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev. 2020; 7: CD004345. doi: 10.1002/14651858.CD004345.pub3
3. Balamurugan R, Zachariah T. Comparison of primary and secondary closure with a buccal mucosal-advancement flap on postoperative course after mandibular impacted third molar surgery. Oral Maxillofac Surg. 2020; 24(1): 37–43. doi: 10.1007/s10006-019-00814-w
4. Higgins JPT, Altman DG, Gatzsche PC, Jani P, Moher D, Oxman AD. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928. doi: 10.1136/bmj.d5928
5. Baqain ZH, Al-Shafii A, Hamdan AA, Sawair FA. Flap design and mandibular third molar surgery: a split mouth randomized clinical study. Int J Oral Maxillofac Surg. 2012; 41(8): 1020-1024. doi: 10.1016/j.ijom.2012.02.011
6. Briguglio F, Zenobio EG, Isola G, Briguglio R, Briguglio E, Farronato D. Complications in surgical removal of impacted mandibular third molars in relation to flap design: clinical and statistical evaluations. Quintessence Int. 2011; 42(6): 445-453.
7. Desai A, Patel R, Desai K, et al. Comparison of two insision designs for surgical removal of impacted mandibular third molar: a randomised comparative clinical study. Contemp Clin Dent. 2014; 5(2): 170-174. doi: 10.4103/0976-237X.132308
8. Erdogan O, Tatli U, Ustun Y, Damlar I. Influence of two different flap designs on the sequelae of mandibular third molar surgery. Oral Maxillofac Surg. 2011; 15(3): 147-152. doi: 10.1007/s10006-011-0268-7
9. Goldsmith SM, De Silva RK, Tong DC, Love RM. Influence of a pedicle flap design on acute postoperative sequelae after lower third molar removal. Int J Oral Maxillofac Surg. 2012; 41(3): 371-375. doi: 10.1016/j.ijom.2011.08.006
10. Jakse N, Bankaoglu V, Wimmer G, et al. Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 93(1): 7-12. doi: 10.1067/moe.2002.119519
11. Korkmaz. Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery? J Oral Maxillofac Surg. 2015; 73(6): 1031-1041. doi: 10.1016/j.joms.2015.01.005
12. Koyuncu BO, Cetingül E. Short-term clinical outcomes of two different flap techniques in impacted mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116(3): 179-184. doi: 10.1016/j.oooo.2011.12.023
13. Mavrodi A, Ohanyan A, Kechagias N, et al. Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications. Medicina Oral, Patologia Oral y Cirugia Bucal. 2015; 20(5): 640-644. doi: 10.4317/medoral.20605
14. Rabi A, Haris PMM, Panickal DM, et al. Comparative evaluation of two different flap designs and postoperative outcome in the surgical removal of impacted mandibular third molar. J Contemp Dent Pract. 2017; 18(9): 807-811. doi: 10.5005/jp-journals-100
15. Renton T, Hankins M, et al. A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg. 2005; 43(1): 7-12. doi: 10.1016/j.bjoms.2004.09.002
16. Rosa AL, Carneiro MG, et al. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 93(4): 404-407. doi: 10.1067/moe.2002.122823
17. Kaya GS, Yavuz GY, Saruhan N. The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: a split-mouth randomized clinical trial. J Oral Rehabil. 2019; 46(9): 828-835. doi: 10.1111/joor.12814
18. Yolcu U, Acar AH. Comparison of a new flap design with the routinely used triangular flap design in third molar surgery. Int J Oral Maxillofac Surg. 2015; 44(11): 1390-1397. doi: 10.1016/j.ijom.2015.07.007
19. Arindra PK, Indrapradana A. Comparison of three flap designs on postoperative complication after third molar surgery. Intisari Sains Medis. 2018; 9(2): 89-94. doi: 10.15562/ism.v9i2.267
20. Zhu J, Yuan X, Yan L, et al. Comparison of postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2019; 78(4): 515-527. doi: 10.1016/j.joms.2019.11.026
21. Xie Q, Wei S, Zhou N, Huang X. Modified envelope flap, a noval incision design, can relieve complications after extraction of fully horizontal impacted mandibular third molar. Journal of Dental Science. 2021; 16(2): 718-722. doi: 10.1016/j.jds.2020.06.022
22. Kumar J, Kumaran S. Evaluation of five different flap designs used in the surgical extraction of the impacted mandibular third molar. International Journal Dental and Medical Science Research. 2021; 3(1): 311-320.
23. Rajendran B. Comparison of buccal based triangular flap and lingual based triangular flap on post operative course after impacted mandibular third molar surgery: a prospective randomized controlled study. J Oral Med Oral Surg. 2023; 29(1): 1-6. doi: 10.1051/mbcb/2023003
24. Zhao J, Zhang Y, Cheng Y, Xie S, Li DD, Zhang PF, Ren XY, Wang X. Effects of modified triangular flap for third molar extraction on distal periodontal health of second molar: a randomized controlled study. Heliyon. 2023; 9(5): 1-9. doi: 10.1016/j.heliyon.2023.e16161
25. Shahi AK, Vishal, Sharma S, Prajapati VK, Prakash O, Khaitan T. Comparison of buccal and lingual-based triangular flap during mandibular third molar extraction for reducing postoperative complications: a randomized controlled trial. J Maxillofac Oral Surg. 2024; 23(3): 574-580. doi: 10.1007/s12663-023-02092-2
26. Ali AS, Benton JA, Yates JM. Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars—A comparison of two techniques and review of the literature. J Oral Rehabil. 2018; 45(3): 250–257. doi: 10.1111/joor.12589
27. Chen YW, Lee CT, Hum L, Chuang SK. Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery. 2017; 46(3): 363 – 372. doi: 10.1016/j.ijom.2016.08.005
DOI: https://doi.org/10.22146/majkedgiind.111285
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