Flap design affects recovery from wisdom tooth surgery

By Sarah Guy, MedWire Reporter

The design of the mucoperiosteal flap created during surgical removal of impacted mandibular third molars (M3) can affect patient recovery, show study findings.

Facial swelling and the incidence of trismus (the ability to open the mouth) were significantly greater in the immediate postoperative period for patients with triangular flap designs compared with their counterparts who had envelope (gingival) flaps, report the researchers.

However, triangular flaps allowed for a faster return to the preoperative probing depth on the distal aspect of the neighboring second molar, they add in the International Journal of Oral and Maxillofacial Surgery.

"The decision about which flap to use for M3 surgery in young patients should be according to the surgeon's preference, taking into consideration the patient's needs and oral hygiene. The latter has a strong influence on postoperative probing depth," say Zaid Baqain and colleagues from the University of Jordan in Amman.

Pain, measured using a visual analog scale, was comparable for the two flap types, possibly ‑ as previous research has indicated ‑ because greater pain scores are associated with longer operations, and there was no significant difference in mean operative time between the gingival flap group (11.8 min) and the triangular flap group (13.3 min).

The "split mouth" study cohort included 19 patients with bilateral impacted mandibular M3 who underwent both flap repairs, randomly assigned to one or the other side of the mouth.

At 2 days postsurgery, significantly more swelling was evident in the triangular flap side of patients' faces, at 7.77% versus 6.25% in the gingival side, and this difference remained at 1 week after surgery, at a respective 2.42% versus 1.74%. After 14 days, the difference was no longer significant, say the authors.

The triangular flap design also resulted in a significantly greater reduction in the patients' maximum inter-incisal mouth opening at postoperative days 7 (19.57 trismus vs 12.52%) and 14 (4.01 trismus vs 0.46%) compared with the gingival flap design.

By contrast, gingival flap designs resulted in a significant increase in pocket depth, an indication of poor oral hygiene, at 1 and 2 weeks after surgery compared with triangular flaps, at 2.57 versus 1.32 mm, and 1.30 versus 0.54 mm, respectively.

In view of the frequency at which this surgery is performed, Baqain and co-workers suggest that minimizing postoperative morbidity would have "a significant impact medically, legally, and economically when national health care providers are under financial strain."

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