Flapless Surgical Approach to Extract Impacted Inferior Third Molars: A Retrospective Clinical Study

Abstract

This study aimed to compare a flapless surgical approach (FSA) with a traditional envelope flap (traditional approach (TA)). Every patient was treated with two approaches: TA and FSA. The primary outcome variables were both the discomfort during the post-operative convalescence and the correct final recovery of the impacted area. The secondary outcome variable was the average duration of the surgery. Post-operative pain and oedema were recorded. The measurements of soft tissue interface toward the distobuccal edge of the second molar were taken by periodontal probe before surgery (baseline) and 8 weeks after surgery. Statistical software was used to evaluate the data; a p-value < 0.05 was considered statistically significant. Twenty-four teeth of 12 patients (six Caucasian males and six Caucasian females, aged 23 ± 4 (17–30) years) with both lower impacted third molars (Ms3) were analysed. Considering an alpha error 0.05 that sample size allows power from 0.80 to 0.90, depending on the variable evaluated. Concerning attached gingiva, oedema and pain, the linear mixed model resulted in a statistically significant difference between the TA and FSA (p = 0.003; p < 0.01; and p = 0.018, respectively). Conversely, the model did not show a difference (p = 0.322) if pocket probing depth was considered. The FSA procedure was faster (p < 0.05) than the TA procedure (17 min and 8 s (± 6 s) vs. 28 min and 6 s (± 4 s), respectively). The results suggest that the FSA could be a suitable option for improving the surgical removal of lower Ms3. However, additional randomized controlled trial studies are necessary to confirm the reliability of our procedure and to verify its suitability in more complex Ms3 classifications.

The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy

“…During the described process, 4 fibrin clots were obtained. A-PRF was dissected by scissors from red corpuscle base at the bottom, 2 mm below connection between layers, because this area is rich in platelets [ 3 ]. A-PRF clots were removed from the blood tubes and were put in special PRF Box.…”

“…These symptoms can be observed particularly frequently as a consequence of surgical removal of mandibular third molars—a procedure considered to be the one of the most difficult and time-consuming among all oral surgery procedures. At the same time, it constitutes one of the most frequently performed procedures within this specialty [ 1 , 2 , 3 , 4 ]. The factors that determine the difficulty of the surgical procedure of avulsion of the third molar are depth and space available for removal of the impacted mandibular third molar, the angulation of the tooth, root spacing, size of the bone septum, presence or absence of a dilated tooth follicle, periodontal space, bone density, and the relation to the inferior alveolar nerve.…”

Prevention of Dry Socket with Ozone Oil-Based Gel after Inferior Third Molar Extraction: A Double-Blind Split-Mouth Randomized Placebo-Controlled Clinical Trial

“…A traditional envelope flap approach was performed [ 39 , 40 , 41 ]. This classical technique consists of a first distal incision starting from the 2M distal surface in the attached gingiva and moving distobuccally 45° for around 10 mm.…”

Evaluation of a New Simplified Approach for Upper Superficial Impacted Wisdom Teeth Extraction. A Retrospective Split-Mouth Clinical Study

“…Sutures stabilize the mobilized flap in its original position, guarantee proper hemostasis, and close possible oral antral communication that might occur after the extraction when the upper wisdom teeth are in direct contact with the maxillary sinus. Based on the previously described flap for removing mandibular impacted wisdom teeth [23], a new flap design was created to remove maxillary impacted wisdom teeth. The extension of bone exposure was reduced by this flap, which could possibly reduce the negative effects of postoperative swelling and pain.…”