Influence Of Three Different Flap Designs on The Sequelae Of Impacted Mandibular Third Molar Removal

Abstract

Aim: This study aimed to compare the influence of envelope, triangular, and lingually-based flaps on pain, facial swelling, and trismus after mandibular third molar surgery.

Study Design: The randomized prospective comparative study included 60 patients with impacted mandibular third molars. Three flap designs, namely the envelope flap (Koener's incision) (n=20), the triangular flap (Ward's incision) (n=20) and lingually based flap (n = 20), were used. The pain was determined using a visual analogue scale (VAS), trismus was determined by measuring the maximum interincisal opening, and facial swelling was evaluated using the Laskin method. Intraoperative time was measured from the time of giving the incision to the completion of the closure of the flap.

 Results: The VAS scores and facial swelling measurements were lowest in the envelope flap group and highest in the lingually-based flap (P<0.05). The lingually-based flap group had the highest mean intraoperative time (P<0.05). There was no significant difference between the envelope flap and the triangular flap in intraoperative time (P > 0.05). There was no significant difference between the flap designs in the maximum interincisal opening.

Conclusion: In impacted mandibular third molar removal, The envelope flap design causes less pain and swelling than triangular flap and lingually based flap. Lingually-based flap design caused the highest pain, swelling and intraoperative time.