Oral and Maxillofacial Surgery| Volume 93, ISSUE 4, P404-407, April 2002

Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars


      Objective. The aim of this study was to compare the influence of two mucoperiosteal flaps on periodontal healing of adjacent second molars after extraction of impacted mandibular third molars. Study Design. An envelope incision with a releasing incision anterior to the second molar (3-cornered flap) was used on one side and a Szmyd flap on the other side in 14 patients with bilateral impaction of mandibular third molars. The periodontal health of the second molars was evaluated before surgery and at 3 and 6 months postoperatively. A William's periodontal probe was used to measure the pocket depth, clinical attachment level, and bone level of the buccal and mesial surfaces of the second molars. The postoperative measurements were analyzed by using analysis of covariance, with the covariables being the preoperative measurements and variation factors being the type of flap used, the surface measured, and the time since the procedure. Results. No statistically significant differences were found in comparing measurements of probing depth, clinical attachment level, or bone level for the 2 types of flap used or the 2 surfaces measured. However, there was a statistically significant increase in all 3 measurements from the 3-month to the 6-month postoperative time. Conclusion. Independent of the design of the mucoperiosteal flap used in extracting an impacted mandibular third molar, the periodontal condition of the adjacent second molar worsened from 3 to 6 months, although it remained within normal values. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:404-7)
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        • Bergstrom J
        • Henrikson CO
        Quantitative long-term determinations of the alveolar bone mineral mass in man by 125I absorptiometry. II. Following periodontal surgery.
        Acta Radiol Ther Phys Biol. 1974; 13: 489-499
        • Grondahl H
        • Lekholm U
        Influence of mandibular third molars on related supporting tissues.
        Int Oral Surg. 1973; 2: 137-142
        • Kugelberg CF
        • Ahlstrom U
        • Ericson S
        • Hugoson A
        Periodontal healing after impacted lower third molar surgery.
        Int Oral Surg. 1985; 14: 29-40
        • Kugelberg CF
        Periodontal healing two and four years after impacted third molar surgery.
        Int Oral Surg. 1990; 19: 341-345
        • Kugelberg CF
        • Ahlstrom U
        • Ericson S
        • Hugoson A
        • Kvint S
        Periodontal healing after impacted lower third molar surgery in adolescents and adults. A prospective study.
        Int Oral Surg. 1991; 20: 18-24
        • Marmary Y
        • Brayer L
        • Tzukert A
        • Feller L
        Alveolar bone repair following extraction of impacted mandibular third molars.
        Oral Surg Oral Med Oral Pathol. 1985; 60: 324-326
        • Quee TAC
        • 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
        • Scherstein E
        • Lysell L
        • Rohlin M
        Prevalence of impacted third molars in dental students.
        Swed Dent J. 1989; 18: 7-13
        • Schofield IDF
        • Kogon SL
        • Donner A
        Long-term comparison of two surgical flap designs for third molar surgery on the health of the periodontal tissue of the second molar tooth.
        J Can Dent Assoc. 1988; 54: 689-691
        • 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
        • Swol RLV
        • Mejias JE
        Management and prevention of severe osseous defects distal to the second molar following third molar extraction.
        Int J Perio Restor Dent. 1983; 2: 47-57
        • Szmyd L
        Impacted teeth.
        Dent Clin North Am. 1971; 15: 299-318
        • Wood DL
        • Hoag PM
        • Donnenfeld W
        • Rosenfeld LD
        Alveolar crest reduction following full and partial thickness flaps.
        J Periodontol. 1972; 43: 141-144
        • Yaffe A
        • Fine N
        • Binderman I
        Regional accelerated phenomenon in the mandible following mucoperiosteal flap surgery.
        J Periodontol. 1994; 65: 79-83
        • Yaffe A
        • Iztkovich M
        • Earon Y
        • Lilov R
        • Binderman I
        Local delivery of an amino bisphosphonate prevents the resorptive phase of alveolar bone following mucoperiosteal flap surgery in rats.
        J Periodontol. 1997; 68: 884-889