Oral and Maxillofacial Surgery| Volume 93, ISSUE 1, P7-12, January 2002

Primary wound healing after lower third molar surgery: Evaluation of 2 different flap designs


      Objectives: Wound dehiscences after lower third molar surgery potentially extend the time of postsurgical treatment and may cause long-lasting pain. It was the aim of this prospective study to evaluate the primary wound healing of 2 different flap designs. Methods: Sixty completely covered lower third molars were removed. In 30 cases, the classic envelope flap with a sulcular incision from the first to the second molar and a distal relieving incision to the mandibular ramus was used, whereas the other 30 third molars were extracted after preparation of a modified triangular flap first similarly described by Szmyd. Wound healing was controlled on the first postoperative day, as well as 1 and 2 weeks after surgery. Results: The overall result was a total of 33% wound dehiscence. In the envelope-flap group, wound dehiscences developed in 57% of the cases. This represents a relative risk ratio of 5.67, with a 95% CI from 1.852 to 12.336. With the modified triangular-flap technique, only 10% of the wounds gaped during wound healing. Conclusion: This study confirms evidence that the flap design in lower third molar surgery considerably influences primary wound healing. The modified triangular flap is significantly less conducive to the development of wound dehiscence. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:7-12)
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        • Ash MM
        • Costich ER
        • Hayward JR.
        A study of periodontal hazards of third molars.
        Periodontol. 1962; 33: 209-219
        • Szmyd L.
        Impacted teeth.
        Dent Clin North Am. 1971; 15: 299-318
        • Stephens RJ
        • App GR
        • Foreman DW.
        Periodontal evaluation of two mucoperiosteal flaps used in removing impacted mandibular third molars.
        J Oral Maxillofac Surg. 1983; 41: 719-724
        • Quee TA
        • Gosselin D
        • Millar EP
        • Stamm JW.
        Surgical removal of the fully impacted mandibular third molar. The influence of flap design and alveolar bone height on the periodontal status of the second molar.
        J Periodontol. 1985; 56: 625-630
        • Kugelberg CF
        • Ahlström U
        • Ericson S
        • Hugoson A
        • Kvint S.
        Periodontal healing after impacted lower third molar surgery in adolescents and adults. A prospective study.
        Int J Oral Maxillofac Surg. 1991; 20: 18-24
        • Sands T
        • Pynn BR
        • Nenniger S.
        Third molar surgery: current concepts and controversies. Part 2.
        Oral Health. 1993; 83 (21-2, 27-30): 19
        • Pajarola GF
        • Jaquiery C
        • Lambrecht JT
        • Sailer HF.
        Die Entfernung unterer retinierter Weisheitszähne (II).
        Schweiz Monatsschr Zahnmed. 1994; 104: 1521-1530
        • Klatil L.
        Komplikationen bei der Entfernung von Weisheitszähnen [doctoral thesis].
        KF-University Graz, 1998
        • Thoma KH.
        The management of malposed inferior third molars.
        J Dent Res. 1932; 12: 175-180
        • Szmyd L
        • Hester WR.
        Crevicular depth of the second molar in impacted third molar surgery.
        J Oral Surg Anesth Hosp Dent Serv. 1963; 21: 185-188
        • Berwick WA.
        Alternative method of flap reflection.
        Br Dent J. 1966; 121: 295-296
        • Groves BJ
        • Moore JR.
        The periodontal implications of flap design in lower third molar extractions.
        Dent Pract Dent Rec. 1970; 20: 297-304
        • Magnus WW
        • Castner DV
        • Hiatt WR.
        An alternative method of flap reflection of mandibular third molars.
        Mil Med. 1972; 137: 232-233
        • Woolf RH
        • Malmquist JP
        • Wright WH.
        Third molar extractions: periodontal implications of two flap designs.
        Gen Dent. 1978; 26: 52-56
        • Papassotiriou A.
        Parodontalbefunde nach Zahnfleischrandschnitt zur Weisheitszahnentfernung.
        Zahnärztliche Praxis. 1991; 6: 206-211
        • Norusis MJ.
        SPSS for Windows: Base system user's guide, Release 5.0.
        in: : SPSS Inc, Chicago1992: 211
        • Tavtigian R.
        The height of facial radicular alveolar crest following apically positioned flap operations.
        J Periodontol. 1970; 41: 412-418
        • Motamedi MH.
        A technique to manage gingival complications of third molar surgery.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90: 140-143
        • Silverstein P.
        Smoking and wound healing.
        Am J Med. 1992; 93: S22-S24