Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis

Chen, Y. W.; Lee, Chun‐Teh; Hum, Lauren; Chuang, Sung Kiang

doi:10.1016/j.ijom.2016.08.005

Cited by 59 publications

(58 citation statements)

References 27 publications

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“…There is still no consensus concerning whether or not the flap design applied in third molar surgery affects the post‐operative period . Although some authors have reported that post‐operative comfort and wound healing are directly correlated with the flap design applied, Briguglio et al suggested that flap design has no impact on the post‐operative period and that the decision concerning which flap design should be the discretion of the surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…There is still no consensus concerning whether or not the flap design applied in third molar surgery affects the post-operative period. 27,28 Although some authors have reported that post-operative comfort and wound healing are directly correlated with the flap design applied, 27 Briguglio et al 29 that although flap design had no direct effect on pain, the incidence of alveolar osteitis was higher in patients receiving envelope flaps, who therefore had higher VAS scores. In agreement with previous studies, 4,17,32 our findings show that the envelope flap design caused higher pain levels than the modified triangular flap.…”

Section: Discussionmentioning

confidence: 99%

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The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split‐mouth randomised clinical trial

Kaya

Yavuz

Saruhan

2019

J of Oral Rehabilitation

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Background Surgical removal of impacted mandibular third molar is one of the most frequently performed interventions in oral and maxillofacial surgery. Objectives To compare two different flap designs in terms of sequelae and quality of life following surgical removal of impacted third molars. Methods This prospective, randomised, split‐mouth clinical study involved patients referred for surgical removal of bilateral symmetrical impacted mandibular third molars. Envelope flap and modified triangular flap techniques were used. The effects of flap design on trismus, swelling, wound dehiscence, alveolar osteitis, haematoma, infection and quality of life were evaluated on post‐operative days 3 and 7. Pain levels were assessed on post‐operative days 1, 3 and 7. Results Significant differences were determined between the two groups in terms of trismus, pain and wound dehiscence scores on post‐operative day 3. However, on post‐operative day 7, this difference was observed only in trismus. Statistically significant differences were also determined between the two groups on post‐operative day 3 for social isolation and eating subscale scores as well as total quality of life score. Conclusion Based on the study findings, the modified triangular flap may be superior to the envelope flap in terms of pain, trismus, and wound dehiscence in the first 3 days after impacted third molar surgery and may have a better impact on quality of life during this process.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split‐mouth randomised clinical trial

Kaya

Yavuz

Saruhan

2019

J of Oral Rehabilitation

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“…In this study, PD at T0 was 9.5 ± 1.3 mm and 9.3 ± 1.3 mm for the dPTFE group and the silk mat group, respectively (Table 1). To prevent postoperative periodontal pathology, flap design, suture technique, and periodontal care for the second molar were considered, but there is controversy about their effect on prevention [16]. GBR with a collagen membrane or PTFE membrane is a reliable method and beneficial in reducing PD compared with a non-regenerative/non-graft procedure [35].…”

Section: Discussionmentioning

confidence: 99%

“…Probing depth is more than 7 mm in 43.3% of adjacent second molars after surgical extraction of the mandibular third molar [8,15]. To prevent periodontal pocket formation and promote uneventful bony healing, grafting with biomaterials can be considered [16,17]. Autogenous bone is generally considered the gold standard for bone graft, and synthetic materials such as hydroxyapatite are considered an alternative for the reconstruction of the extraction socket [18].…”

Section: Introductionmentioning

confidence: 99%

Clinical Study for Silk Mat Application into Extraction Socket: A Split-Mouth, Randomized Clinical Trial

Kim

et al. 2019

Applied Sciences

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Silk mat originates from the cocoon of the silkworm and is prepared by a simple method. The material has been used for guided bone regeneration (GBR) in animal models. In this study, the silk mat used for a clinical application was compared with a commercially available membrane for GBR. A prospective split-mouth, randomized clinical trial was conducted with 25 patients who had bilaterally impacted lower third molars. High-density polytetrafluoroethylene (dPTFE) membrane or silk mat was applied in the extraction socket randomly. Probing depth (PD), clinical attachment level (CAL), and bone gain (BG) were measured at the time of extraction (T0) and then at three months (T1) and six months after extraction (T2). There was no missing case. GBR with silk mat was non-inferior to GBR with dPTFE for PD reduction at T1 and T2 (pnon-inferiority < 0.001). PD and CAL were significantly decreased at T1 and T2 when compared with those at T0 in both membrane groups (p < 0.001). BG at T2 was 3.61 ± 3.33 mm and 3.56 ± 3.30 mm in the silk mat group and dPTFE group, respectively. There was no significant complication from the use of silk mat for the patients. The results for patients undergoing GBR with silk mat for third-molar surgery were non-inferior to GBR with dPTFE for PD reduction.

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“…8,10 Recent study reported that Szmyd and paramarginal flap designs were most effective in reducing the probing depth in impacted third molar extraction, and the envelope flap may be the least effective. 11 Kirtiloğlu et al demonstrated that Szmyd flap can leaves an intact gingiva around the second molar which will provide a better primary periodontal healing. 12 However, the extent of periodontal effects was sometimes severe enough to prompt the development of special techniques to manage the resultant defects.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study

Chiramel¹,

Chammanam²,

Kalliath³

et al. 2018

Int Surg J

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Background: Manipulation of both hard and soft tissues during the surgical removal of mandibular third molars is usually associated with a number of postoperative complications. This study was aimed to compare the effects of two types of flap designs used during the impacted mandibular third molar removal and the consequences of choosing Szmyd incision over envelope incision in terms of primary wound healing and periodondal healing.Methods: A prospective, randomized study was conducted in healthy 50 patients with partially or completely impacted mandibular third molars were selected. The patients were divided into two groups of 25 each. In one group envelope flap design was used and in the other group Szmyd flap design was used. The influence of these incisions on accessibility to third molar, primary wound healing and periodontal healing was evaluated and compared.Results: The incidence of wound dehiscence at 7th day follow-up is more in envelop incision (p=0.123) and 20% more at 14th day follow-up (p=0.087) when compared to Szmyd design. Significant differences were noted with respect to the periodontal healing distal to adjacent second molar. Distal periodontal pocket depth was significantly lower for the Szmyd incision as compared to the Envelop incision. Effect size of Envelop flap is 1.84 times more than Szmyd flap.Conclusions: The Szmyd flap design makes primary wound healing easier, less wound dehiscence and periodontal complication than envelop flap design.

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Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis

Cited by 59 publications

References 27 publications

The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split‐mouth randomised clinical trial

The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split‐mouth randomised clinical trial

Clinical Study for Silk Mat Application into Extraction Socket: A Split-Mouth, Randomized Clinical Trial

Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study

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