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

Jakse, Norbert; Bankaoglu, Vedat; Wimmer, Gernot; Eskici, A; Pertl, Christof

doi:10.1067/moe.2002.119519

Cited by 96 publications

(109 citation statements)

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“…[2][3][4] Other important complications may occasionally include dysaesthesia, dry socket, infection, or fracture . [4][5][6] Protocols evaluated to improve such adverse postoperative sequelae have included different medications, 4,7 different flap designs, 9,10 and the use of rotary rather than hand instruments for bone removal (osteotomy). [11][12][13] Piezosurgery is an osteotomy technique utilizing micro-vibrations at ultrasonic frequency to perform efficient bone cutting.…”

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confidence: 99%

A Split-Mouth Randomized Clinical Trial to Evaluate the Performance of Piezosurgery Compared With Traditional Technique in Lower Wisdom Tooth Removal

Mantovani

Arduino

Schierano

et al. 2014

Journal of Oral and Maxillofacial Surgery

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This is an author version of the contribution published on:Questa è la versione dell 'autore dell'opera: J Oral Maxillofac Surg. 2014 Oct;72(10):1890-7. doi: 10.1016/j.joms.2014 AbstractPurpose: The surgical removal of mandibular third molars is frequently accompanied by significant post-surgical sequelae, and different protocols have been described to improve such adverse events. The aim of this study was to investigate the performance of piezosurgery compared with traditional rotating instruments during mandibular third molar removal. Methods:A single-centre, randomized, split-mouth study was performed using a consecutive series of unrelated healthy Caucasian patients, attending the Oral Surgery Unit of the University of Turin, for surgical removal of bilateral mandibular third molar teeth. Each patient was treated, at the same appointment, using bur removal on one side of the mandible and a piezoelectric device on the contralateral side. The primary outcomes reported were postoperative pain, objective orofacial swelling and the duration of surgical time; secondary outcomes were sex, age and possible adverse events. Anova or paired t-test were used as appropriate to test any significant differences at baseline according to each treatment subgroups and categorical variables were analysed by χ2 test.Results: The study sample consisted of 100 otherwise healthy patients. The mean pain evaluation reported by patients who underwent surgery with the piezosurgery was significantly lower than that experienced after bur (conventional) removal, reaching a statistical difference after 4 days (P=0.043). The clinical value of orofacial swelling at 7th day, normalized to baseline, was lower in the piezosurgery group (P<0.005).The average time of surgery was significantly lower in the bur than piezosurgery group (P<0.05).Three patients having bur removal experienced short-term complications (two dry sockets and one temporary paraesthesia): both totally resolved by 4 weeks. Conclusions:To date, this prospective investigation is the largest reported split-mouth study on piezosurgery for lower third molar tooth removal, also comparing surgeons with different 3 degrees of experience. It is evident that using a piezoelectric device can enhance the patient experience and reduce post-operative pain and swelling.

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confidence: 99%

A Split-Mouth Randomized Clinical Trial to Evaluate the Performance of Piezosurgery Compared With Traditional Technique in Lower Wisdom Tooth Removal

Mantovani

Arduino

Schierano

et al. 2014

Journal of Oral and Maxillofacial Surgery

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“…Every gaping along the entire incision line was defined as a dehiscence. 6 These gapings are usually seen at the distobuccal gingival rim of the adjacent second molar where the distal incision leads in to sulcular incision. After suturing there will be soft tissue tensions resulting from hematoma and masticatory movements which will induse rupture of wound margins.…”

Section: Discussionmentioning

confidence: 99%

“…It gives wide exposure to the surgical field and the osseous defects can be safely covered after the removal of the molar. 6 The disadvantage being the growing activity of osteoclasts in the area of the alveolar process, inducing loss of alveolar bone due to stripping of mucoperiosteum over a wide area. 6 Every sulcular incision is an intervention to the periodondal ligament and may lead to periodontal damage.…”

Section: Discussionmentioning

confidence: 99%

“…6 The disadvantage being the growing activity of osteoclasts in the area of the alveolar process, inducing loss of alveolar bone due to stripping of mucoperiosteum over a wide area. 6 Every sulcular incision is an intervention to the periodondal ligament and may lead to periodontal damage. Alternatively, paragingival and vestibular tongue shaped flap designs, which aim at sparing the periodontal ligament of the adjacent molar, have been described.…”

Section: Discussionmentioning

confidence: 99%

“…5 The envelop flap causes wound dehiscence at the distofacial edge of adjacent second molar are very frequent in first phase of wound healing, which will extend the time of post-surgical healing. 6 The modified triangular flap design, termed as Szmyd flap preserves a strip of mucoperiosteum on the buccal surface of second molar, thus minimizing bone resorption leading to pocket formation distal to second molar. 1 Thus this modification in flap design precludes the need for detachment of the buccal gingival fibers around the first and second molars, the amount of periosteum to be reflected is there by reduced markedly and also achieves adequate accessibility.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study

Chiramel¹,

Chammanam²,

Kalliath³

et al. 2018

Int Surg J

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Background: Manipulation of both hard and soft tissues during the surgical removal of mandibular third molars is usually associated with a number of postoperative complications. This study was aimed to compare the effects of two types of flap designs used during the impacted mandibular third molar removal and the consequences of choosing Szmyd incision over envelope incision in terms of primary wound healing and periodondal healing.Methods: A prospective, randomized study was conducted in healthy 50 patients with partially or completely impacted mandibular third molars were selected. The patients were divided into two groups of 25 each. In one group envelope flap design was used and in the other group Szmyd flap design was used. The influence of these incisions on accessibility to third molar, primary wound healing and periodontal healing was evaluated and compared.Results: The incidence of wound dehiscence at 7th day follow-up is more in envelop incision (p=0.123) and 20% more at 14th day follow-up (p=0.087) when compared to Szmyd design. Significant differences were noted with respect to the periodontal healing distal to adjacent second molar. Distal periodontal pocket depth was significantly lower for the Szmyd incision as compared to the Envelop incision. Effect size of Envelop flap is 1.84 times more than Szmyd flap.Conclusions: The Szmyd flap design makes primary wound healing easier, less wound dehiscence and periodontal complication than envelop flap design.

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Surgical techniques for the removal of mandibular wisdom teeth

Coulthard

Bailey

Esposito

et al. 2014

Cochrane Database of Systematic Reviews

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The thirty-five included trials looked at a range of different surgical techniques. The comparisons related to seven broad aspects of the surgical procedures for impacted mandibular third molars: type of surgical flap raised, use of retractors, techniques for bone removal, wound irrigation, wound closure, wound drainage, and complete/incomplete tooth removal. The quality of the body of evidence for each of these comparisons was very low to moderate due to the small number of trials and patients, and the majority of the trials being at high risk of bias (65%) with the remainder at unclear risk of bias.The evidence for making changes to surgical practice is therefore limited. However, it is useful to describe the state of the research evidence supporting practice so that surgeons can make an informed choice in adopting new techniques, or continuing with established techniques.

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

Cited by 96 publications

References 10 publications

A Split-Mouth Randomized Clinical Trial to Evaluate the Performance of Piezosurgery Compared With Traditional Technique in Lower Wisdom Tooth Removal

A Split-Mouth Randomized Clinical Trial to Evaluate the Performance of Piezosurgery Compared With Traditional Technique in Lower Wisdom Tooth Removal

Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study

Surgical techniques for the removal of mandibular wisdom teeth

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