Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Zhu, Junfei; Yuan, Xuguang; Yan, Li-e; Li, Tianzhu; Guang, Mengkai; Zhang, Ye

doi:10.1016/j.joms.2019.11.026

Cited by 14 publications

(17 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many researchers used different types of surgical flaps trying to provide access with the least possible soft tissue damage ( 12 - 14 ). Incisions should be designed to provide good blood supply, good access to allow adequate vision and space for instrumentation, to protect the soft tissues, minimize trauma and permit repositioning and reattachment of the flap.…”

Section: Introductionmentioning

confidence: 99%

Effect of lingual-based flap design on postoperative pain of impacted mandibular third molar surgery: Split-mouth randomized clinical trial

Hassan¹,

Al‐Khanati²,

Bahhah³

2020

Med Oral

View full text Add to dashboard Cite

Background The extraction of third molars is one of the most common procedures in oral and maxillofacial surgery clinic. Surgical extraction involves the manipulation of both soft and hard tissues, so the patient usually experiences pain, swelling, and trismus in the immediate post-operative period. Several studies have been conducted using different types of surgical flaps to provide access with the least possible damage of soft tissues. Designing and implementing an optimum flap, which provides easier technique, better visibility, minimal post-operative complications, and best healing, is an aspired goal of every oral surgeon. This study aimed to compare lingual-based four-cornered flap with conventional triangular flap, and to evaluate its effect on post-operative pain after surgical extraction of impacted lower third molars. Material and Methods Seventeen patients (age ranged from 19 to 26 years) with bilateral, symmetrical impacted lower third molars (n=34) were included in the study. This was a randomized clinical trial with a split-mouth design. The impacted molars were assigned randomly, by coin flipping, to two groups: Case side with lingual-based four-cornered flap (Group A), and control side with conventional triangular flap (Group B). Away from the incision, the prognosis, surgical intervention, and postoperative procedures were exactly the same for the two groups. Postsurgical pain was assessed for 5 days using visual analogue scale (VAS) and by recording patients need for analgesics on a daily basis. Patients were also evaluated via a self-reporting questionnaire, i.e. Postoperative Symptoms Severity (PoSSe) scale, administered on the seventh postoperative day. Results Pain scores recorded in Group A were found to be significantly lower as compared to pain scores in Group B in the 5 postoperative days ( P <0.05). Total analgesic intake in Group B was significantly higher ( P <0.05). PoSSe scores were lower in Group A, however, this difference was insignificant ( P >0.05). Conclusions According to the data of the current study and within its limits, it appeared that lingual-based four-cornered flap design was superior to the conventional triangular flap regarding the postsurgical discomfort and pain. Key words: Impaction, third molar surgery, flap design, pain, PoSSe scale, split-mouth, RCT.

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of lingual-based flap design on postoperative pain of impacted mandibular third molar surgery: Split-mouth randomized clinical trial

Hassan¹,

Al‐Khanati²,

Bahhah³

2020

Med Oral

View full text Add to dashboard Cite

show abstract

“…To the best of our knowledge, the strongest evidence of TF vs. EF has been reported in three systematic reviews and meta-analyses [15,17,18] . Among them, Zhu et al [15] reported that EF is more effective than TF in reducing postoperative pain and swelling in the subgroup with low di culty. This is because tissue trauma, including vertical incision in the buccal gum, may lead to the release of local in ammatory mediators in TF and sensitize peripheral pain receptors in low di culty [15] , resulting in more postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

“…Among them, Zhu et al [15] reported that EF is more effective than TF in reducing postoperative pain and swelling in the subgroup with low di culty. This is because tissue trauma, including vertical incision in the buccal gum, may lead to the release of local in ammatory mediators in TF and sensitize peripheral pain receptors in low di culty [15] , resulting in more postoperative pain. However, as the invasive procedure of tooth extraction is greater in patients with high di culty, the pain in the tissue trauma caused by vertical incision may not affect the postoperative pain [15] .…”

Section: Discussionmentioning

confidence: 99%

“…This is because tissue trauma, including vertical incision in the buccal gum, may lead to the release of local in ammatory mediators in TF and sensitize peripheral pain receptors in low di culty [15] , resulting in more postoperative pain. However, as the invasive procedure of tooth extraction is greater in patients with high di culty, the pain in the tissue trauma caused by vertical incision may not affect the postoperative pain [15] . Our results suggest that mEF is more effective in reducing postoperative pain in low di culty cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Analysis of Two Flap Designs for the Extraction of Impacted Mandibular Horizontal Third Molars: a Multicenter Randomized Control Trial

Naruse

Rokutanda

Inokuchi³

et al. 2021

Preprint

View full text Add to dashboard Cite

Most patients experience postoperative complications caused by the extraction of impacted mandibular horizontal third molars. The aim of the present study was to compare the effects of two flap designs as a refinement on the reduction of postoperative complications. One hundred eighty-eight patients with impacted mandibular horizontal third molars were included in this single-blind, multicenter, randomized control trial. The allocation was determined using a modified envelope flap (mEF) and triangular flap (TF) at 1:1 by the data manager. Postoperative complications (pain, hemorrhage, nerve paralysis, dry socket, and infection) and operation time were assessed 7 ± 1 days after surgery. In all cases, postoperative pain was significantly lower in the mEF group (P<0.05). In the subgroup analysis, postoperative pain was significantly lower in patients with low difficulty (IA, IIA, IIA, IB), which were classified by G.B. Winter classification (P<0.05). Other factors were not significantly associated with the flap design. Our study suggests that mEF resulted in less postoperative pain with a low difficulty of impacted mandibular horizontal third molars. However, the evidence at present is not sufficient to suggest the use of either flap design.

show abstract

“…A meta‐analysis by Zhu et al (2020) showed that the operation time using an envelope flap was 1.23 minutes faster than using a triangular flap (including the modified triangular flap). This time difference could be attributed to the additional suturing time.…”

Section: Diagnosis and Treatment Planningmentioning

confidence: 99%

Comprehensive review of lower third molar management: A guide for improved informed consent

et al. 2020

View full text Add to dashboard Cite

Lower third molar removal is the most commonly performed dental surgical procedure. Nevertheless, it is difficult to ensure that all the informed consent forms given to patients are based on the best evidence as many newer publications could change the conclusions of previous research. Therefore, the goal of this review article is to cover existing meta‐analyses, randomized control trials, and related articles in order to collect data for improved and more current informed consent.

show abstract

Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Cited by 14 publications

References 31 publications

Effect of lingual-based flap design on postoperative pain of impacted mandibular third molar surgery: Split-mouth randomized clinical trial

Effect of lingual-based flap design on postoperative pain of impacted mandibular third molar surgery: Split-mouth randomized clinical trial

Comparative Analysis of Two Flap Designs for the Extraction of Impacted Mandibular Horizontal Third Molars: a Multicenter Randomized Control Trial

Comprehensive review of lower third molar management: A guide for improved informed consent

Contact Info

Product

Resources

About