Comparative analysis of two flap designs for the extraction of horizontally impacted mandibular third molars: A multicenter randomized controlled trial

Abstract

Objective

Most patients experience postoperative complications caused by the extraction of horizontally impacted mandibular third molars. The present study aimed to compare the effects of two flap designs on the reduction of postoperative complications.

Methods

A total of 188 patients with horizontally impacted mandibular third molars were included in this single-blind, multicenter, randomized control trial. The patients were assigned to either the modified envelope flap (mEF) or triangular flap (TF) group in a 1:1 ratio. The operation time and postoperative complications (pain, hemorrhage, neurosensory changes, dry socket [alveolar osteitis], and infection) were assessed for 7 ± 1 days postoperatively.

Results

In all cases, postoperative pain was significantly lower in the mEF group (P = 0.033). In the subgroup analysis, postoperative pain was significantly lower in cases of low difficulty (Pell and Gregory classification IA, IIA, IIA, IB; P = 0.018). Other factors were not significantly associated with the flap design.

Conclusions

Our study suggested that mEF resulted in less postoperative pain in cases of low difficulty of extracting horizontally impacted mandibular third molars. However, the current evidence is inadequate to recommend either flap design.