Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis

Abstract

Background: To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. Material and methods: An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus. Results: From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs. Conclusions: Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs.

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

“…This result is in line with Glera-Suárez et al . who conducted a meta-analysis and found no clear differences in patient morbidity between different designs of surgical flap ( 30 ). However, PoSSe detailed scores showed significant difference in the answers of one question of the questionnaire that asked the patients to tell the degree the pain affected their lives between the two study groups ( P =0.008).…”

Systemic Use of Arnica Montana for the Reduction of Postsurgical Sequels following Extraction of Impacted Mandibular 3rd Molars: A Pilot Study

“…Surgical extraction of impacted 3 rd molar is a common procedure performed on regular basis in the dental office [ 1 ]. It is estimated that 5 million extraction procedures of 3 rd molars are conducted annually in the US, in which 11000 may experience PSS [ 16 ].…”

“…The list of potential PSS includes pain, bleeding, trismus, bruising, and most importantly extraoral edema. Although most of these secondary complications can be managed efficiently, PSS continue to pose a daily challenge to the dental practitioner due to limitation in armamentarium available to prevent or decrease its severity [ 1 ].…”

“…Postsurgical sequels (PSS) are a group of complications commonly encountered following invasive dental surgical procedures such as periodontal regenerative surgeries, maxillary sinus augmentation, and extraction of impacted 3 rd molars [ 1 ]. These include pain, extraoral bruising, trismus, edema, and few more [ 1 , 2 ].…”

“…Postsurgical sequels (PSS) are a group of complications commonly encountered following invasive dental surgical procedures such as periodontal regenerative surgeries, maxillary sinus augmentation, and extraction of impacted 3 rd molars [ 1 ]. These include pain, extraoral bruising, trismus, edema, and few more [ 1 , 2 ]. The degree and severity of PSS are often associated with several factors such as complexity of the surgical procedure, patient's underlying medical condition, age, procedure duration, and dental practitioner's experience [ 3 ].…”