Influence of Surgical Flap Design (Envelope and Szmyd) for Removal of Impacted Mandibular Third Molars on Clinical Periodontal Parameters: A Clinical Trial

Abstract

The aim of the study was to assess the influence of flap designs (Envelope flap (EF) and Szmyd flap (SF)) for impacted mandibular third molar extraction, on periodontal pocket depth (PPD), clinical attachment loss (CAL) and bone levels (BL) of second molar. Sixty patients indicated for third molar extractions with healthy second molars were allocated into two groups: EF and SF (n = 30). Third molars were assessed for angulation, root patterns, depth of impactions and relation with ramus (Pell and Gregory classification). Extraction of third molars was performed and PPD, CAL and BL around second molars at 0, 3 and 6 month (mon) follow-ups (FU) were assessed clinically and radiographically. ANOVA, Chi-square and Fisher’s exact test were employed to compare periodontal factors between EF and SF groups, considering p ≤ 0.05 as significant. Sixty participants with a mean age of 23.22 ± 3.17 were included in the study. Based on angulation, the most common impaction in the EF and SF groups was mesio-angular (EF, 50%; SF, 36.7%). Buccal and distal PPD showed a significant increase (p < 0.001) in both EF and SF patients from baseline to 6 mon. EF patients showed significantly higher distal and buccal CAL (6.67 ± 0.18 mm; 6.91 ± 0.17 mm) and BL (7.64 ± 0.16 mm; 7.90 ± 0.15 mm) as compared to SF patients (CAL, 6.76 ± 0.26 mm; 6.91 ± 0.17 mm-BL, 7.42 ± 0.38 mm; 7.34 ± 0.34 mm) at 6 mon FU. SF showed better soft tissue attachment (PPD and CAL) and bone stability (less bone loss) around second molars compared to EF after third molar extractions regardless of the patient, tooth and operator factors.

Tunneled Envelope Flap—Novel Flap Modification for Removal of Impacted Lower Third Molars

“…The authors attributed that to the lack of buccal incision and unavailable drainage options causing elevated pressure in the wound due to the hematoma. Ahmad et al 6 launched a similar theory supposing that the increased pressure at the envelope flap caused nonoptimal wound healing and respectively a greater probing depth of the 7th tooth up to 6 months after the surgery.…”

“…Each one of them has its own specifics, as well as advantages and disadvantages. 5,6 The minimal soft-tissue trauma is important for the reduced postoperative swelling and pain.…”

Comparison of Alveolar Osteitis (AO) occurrence after impacted mandibular third molar removal with and without post-extraction socket irrigation

“…It's fairly uncommon to recommend removing impacted mandibular third molars for several medical and aesthetic reasons, although definitive indications and contraindications have yet to be determined. [6][7][8] AO is one of the most prevalent post-surgical inflammatory complications following When patients complain of an excruciating extraction socket, researchers have found that they have AO when the socket is empty or the clot has dissolved, leaving denuded bone and a foul stench. 9,14,15 The current investigation, on the other hand, looked at the same postoperative symptoms on days three, five, and seven.…”

Outcome Assessment after Reconstruction of Tumor-Related Mandibular Defects Using Free Vascularized Fibular Flap—A Clinical Study

“…The resultant complex soft-and hard-tissue defect mandates restoration with a flap that contains vascularized bone muscles and skin for optimal esthetics and function [1][2][3]. The main objective of the reconstruction of maxillofacial defects is immediate repair in one single-stage operation with well-vascularized tissue and a low complication rate [3,4].…”