Mandibular Third Molar Removal in Young Patients: An Evaluation of 2 Different Flap Designs

Monaco, Giuseppe; Daprile, Giuseppe; Tavernese, Loredana; Corinaldesi, Giuseppe; Marchetti, Claudio

doi:10.1016/j.joms.2007.05.032

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 1 , Pages 15-21, January 2009

Mandibular Third Molar Removal in Young Patients: An Evaluation of 2 Different Flap Designs

Giuseppe Monaco, DMD
- Visiting Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Bologna, Bologna, Italy
Giuseppe Daprile, DMD
- Visiting Professor, Department of Periodontology, School of Dentistry, University of Bologna, Bologna, Italy
Loredana Tavernese, DMD
- Clinical Fellow, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Bologna, Bologna, Italy
Giuseppe Corinaldesi, MD, DMD
- Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Bologna, Bologna, Italy
Claudio Marchetti, MD, DDS
- Professor and Chief, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Bologna, Bologna, Italy
- Address correspondence and reprint requests to Dr Marchetti: Department of Oral Surgery, School of Dentistry, Via S Vitale 59, 40125 Bologna, Italy

Purpose

To evaluate the influence of 2 different flap designs on periodontal healing and postoperative complications, after inferior third molar removal in young patients.

Patients and Methods

Twenty-four mandibular third molars were extracted from 12 patients with an average age of 16 years. Patients were included in the study when radiographs at the time of surgery showed that only the crown of the germ was formed. Each patient underwent 2 extractions, using a triangular flap on one side and an envelope flap on the other. Periodontal probing was recorded at the preoperative visit, and 7 days, 3 months, and 6 months after extraction. Postoperative complications were recorded using a questionnaire completed by the patient for the week after the extraction.

Results

The examination performed 7 days after the extraction demonstrated a deeper probing depth in all teeth examined. This increase was statistically greater (P < .05) for the first and second molars when an envelope flap was used. After 3 months, the probing depths returned to preoperative values. No significant differences were seen between the 2 flap designs when postoperative complications were considered. The average operating time was 30.66 minutes with the triangular flap, versus 35.66 minutes with the envelope flap. This difference was not significant. After 6 months, the 2 flap designs resulted in no difference in periodontal healing or complications, but 30% of the surgical extractions resulted in a debilitating postoperative period for the patients treated.

Conclusions

Although we observed statistically significant differences in probing depth between triangular and envelope flaps 7 days after the extraction of third molars with no root development, this was not important from a clinical perspective, because periodontal healing at 3 and 6 months was comparable. We believe that this is also the case with the extraction of third molars with fully formed roots. Another important finding was the presence of a debilitating postoperative period in most of the patients who underwent extraction, contrary to the beliefs of many surgeons.