To Compare Standard Incision and Comma Shaped Incision and Its Influence on Post–Operative Complications in Surgical Removal of Impacted Third Molars

Abstract

Objectives: To compare standard incision and comma shaped incision and its influence on post operative complications in surgical removal of impacted third molar.Methods: This was a cross-over trial. Twenty subjects with bilateral impacted mandibular third molars were recruited for the study. A standard incision was made on one side of the lower jaw and a comma incision was made on the other side to reflect the mucoperiosteal flap, after which the common steps for removal of impacted third molars were followed. The postoperative parameters were recorded immediately on the post -operative days 1, 3 and 7 respectively. Results:The pain scores which were recorded on days 1, 3 and 7 in the surgical area with comma incisions were found to be significantly lower as compared to the pain scores in the area where standard incisions were made. Similarly, swelling was lesser with comma incisions than with standard incisions. There was a significant difference in mouth opening between the two incisions on day 1, but no significance was seen on days 3 and 7. All these findings showed significant statistical differences. Conclusion:The results of the study showed that the new incision design was preferable over the conventional method, considering the lesser degree of post-operative complications. The cross-over design of the study greatly enhanced its statistical power and validity. InTROduCTIOnThird molars are present in 90% of the population with 33% having at least one impacted third molar. Thus, surgical removal of impacted third molar is the most frequently performed procedure [1]. Impacted lower third molar extraction produces a series of side effects, which include pain, inflammation, and trismus [2].Flap design is one important factor which influences the severity of these complications [3]. Flap design is important, not only for allowing optimal visibility and access to the impacted tooth, but also for subsequent healing of the surgically created defect. With so many objectives, the actual design of a flap sometimes becomes a compromise between peri-and post-operative considerations [4].The aim of this study was to compare two different flap designs in extraction of impacted mandibular third molars, by assessing their post-operative complications. In this study, pain, swelling, mouth opening and pocket depth were selected as parameters for comparing the two flap designs. MATeRIAl And MeThOdSThis study was a hospital based, experimental study with a "cross-over" design, which was done on thirty patients. Patients with bilateral, completely impacted, mandibular third molars or partially erupted third molars, without any symptoms of pain or swelling, who had good oral hygiene, were included in the study. Dentistry SectionPatients who were on any medications, lady patients who were pregnant, patients with severe pericoronitis, patients with soft tissue impaction and patients who were medically compromised were excluded from study.Thirty patients who satisfied the inclusion criteria were enrolled in the study aft...

Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars: A randomized prospective study

“…Indeed, many studies have reported a worst postoperative course when extended flaps are applied. 8 - 13 In the present study, however, no differences were found in symptoms and signs in terms of flap design, consistent with other studies reported in the literature. 15 - 18 …”

“…Many studies found a different postoperative course in terms flap design, with the less extended flap generally being the one with fewer complaints. 5 - 13 However, some studies failed to find any differences in postoperative symptoms and signs using different flaps. 14 - 18 …”

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

“…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.…”

Piezoelectric Versus Conventional Rotary Techniques for Impacted Third Molar Extraction

“…Impacted third molars are frequently encountered in clinical work, with a prevalence of 33% to 58.7%. 1 – 4 It has been well documented that impacted third molars, either partial or complete, are associated with several complications, including pericoronitis, regional pain, odontogenic abscesses, trismus, distal caries, cysts, tumors, and arch crowding. 5 – 8 Therefore, symptomatic or asymptomatic impacted third molars are often extracted to reduce the above-mentioned clinical symptoms.…”