Comparison of Envelope and Modified Triangular Flaps on Incidence of Dry Socket after Surgical Removal of Impacted Mandibular Third Molars: A Double-blind, Split-mouth Study
Hassan Mohajerani, Mohammad Esmaeelinejad, Mehrshad Jafari, Ehsan Amini, Somayeh P Sharabiany
Dry socket, Mandible, Third molar, Wound healing
Citation Information :
Mohajerani H, Esmaeelinejad M, Jafari M, Amini E, Sharabiany SP. Comparison of Envelope and Modified Triangular Flaps on Incidence of Dry Socket after Surgical Removal of Impacted Mandibular Third Molars: A Double-blind, Split-mouth Study. J Contemp Dent Pract 2018; 19 (7):836-841.
Aim: This study aimed to investigate the impact of modified triangular flap (MTF) compared with the envelope flap (EF) on the incidence of dry socket and healing degree after lowerimpacted third molar surgery.
Materials and methods: Present research was executed on 31 patients between the ages 17 and 24 years with the indication of removing impacted mandibular third molars in both sides with similar difficulty. The impacts of MTF and EF on degree of incidence of dry socket and healing on 3rd day and 1 week after surgery were recorded and investigated in a doubleblinded manner. The significant changes in mentioned indices in two groups were statistically judged using Chi-squared and Wilcoxon\'s statistical tests.
Results: Three patients were excluded during the survey and 28 patients (56 samples) remained. The patients’ average age was 20.1 years. Totally, 19 patients were female and 11 of them had academic education. Degree of dry socket incidence in MTF group was 11.76% and it was 41.17% in EF group (p = 0.042). In the follow-up session after 3 days since the surgery, healing degree mean in MTF group was 3.16 ± 1.5 and it was 4.37 ± 1.8 in EF group (p = 0.112). In follow-up session 7 days after the surgery, mean healing degree in MTF group was 0.037 ± 0.6 and it was 0.89 ± 0.73 in EF group (p = 0.005).
Conclusion: Present study indicated that application of MTF may lead to a reduction in dry socket incidence and an increase of healing after 7 days since lower-impacted third molar surgeries.
Clinical significance: Reducing postsurgery complication incidences following third molar surgery is an important issue, which could easily be achieved by designing appropriate flaps.
Benediktsdottir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004 Apr;97(4):438-446.
Torres-Lagares D, Serrera-Figallo MA, Romero-Ruiz MM, Infante-Cossio P, Garcia-Calderon M, Gutierrez-Perez JL. Update on dry socket: a review of the literature. Med Oral Patol Oral Cir Bucal 2005 Jan-Feb;10(1):81-85, 77-81.
Oginni FO, Fatusi OA, Alagbe AO. A clinical evaluation of dry socket in a Nigerian teaching hospital. J Oral Maxillofac Surg 2003 Aug;61(8):871-876.
Sharif MO, Dawoud BE, Tsichlaki A, Yates JM. Interventions for the prevention of dry socket: an evidence-based update. Br Dent J 2014 Jul;217(1):27-30.
Koyuncu BÖ, Çetingül E. Short-term clinical outcomes of two different flap techniques in impacted mandibular third molar surgery. Oral Med Oral Pathol Oral Radiol Endod 2013 Sep;116(3):e179-e184.
Elo JA, Sun H-H, Dong F, Tandon R, Singh HM. Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2016 Aug;122(2):124-133.
Kirk DG, Liston PN, Tong DC, Love RM. Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007 Jul;104(1):e1-e6.
Nusair YM, Younis MH. Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching center. J Contemp Dent Pract 2007 Mar;8(3):53-63.
Yuasa H, Kawai T, Sugiura M. Classification of surgical difficulty in extracting impacted third molars. Br J Oral Maxillofac Surg 2002 Feb;40(1):26-31.
Koerner KR. The removal of impacted third molars. Principles and procedures. Dent Clin North Am 1994 Apr;38(2):255-278.
Chen YW, Lee CT, Hum L, Chuang SK. Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2017 Mar;46(3):363-372.
Briguglio F, Zenobio EG, Isola G, Briguglio R, Briguglio E, Farronato D, Shibli JA. Complications in surgical removal of impacted mandibular third molars in relation to flap design: clinical and statistical evaluations. Quintessence Int 2011 Jun;42(6):445-453.
Singh AS, Mohamed A, Bouckaert MM. A clinical evaluation of dry sockets at the Medunsa Oral Health Centre. SADJ 2008 Oct;63(9):490, 492-493.
Baqain ZH, Al-Shafii A, Hamdan AA, Sawair FA. Flap design and mandibular third molar surgery: a split mouth randomized clinical study. Int J Oral Maxillofac Surg 2012 Aug;41(8):1020-1024.
Yolcu U, Acar AH. Comparison of a new flap design with the routinely used triangular flap design in third molar surgery. Int J Oral Maxillofac Surg 2015 Nov;44(11):1390-1397.
Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc 2007 May;73(4):325.
Jakse N, Bankaoglu V, Wimmer G, Eskici A, Pertl C. Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002 Jan;93(1):7-12.