Comparison of Two Different Flap Designs for Bilateral Impacted Mandibular Third Molar Surgery
Condition: Impacted Third Molar Tooth
MeSH terms: Tooth, Impacted
Study type: Interventional

Summary: 
      The aim of this study was to compare the effects of lingually-based triangle flap design and
      buccally based triangular flap design on postoperative swelling, trismus pain after
      mandibular third molar surgery.
    

Detailed description: 
      Investigators planned a prospective and split mouth study. Thirty patients is randomly
      selected. Inclusion criteria is being older than 18 of age, having asymptomatic bilateral
      mesioangular impacted mandibular third molar (Pell and Gregory class II, position B) fully
      covered with mucosa and bone, and being otherwise medically healthy. Exclusion criteria is as
      follows: Alcohol abuse, smoking, pregnancy and acute severe periodontitis.

      All surgeries will be carried out by the same surgeon. For each patient, the impacted teeth
      will be extracted in two sessions using the two different flap design.One side of the
      patients was selected and labeled as "experimental group". In this group, investigators will
      use lingually-based triangle flap design while investigators extract the impacted third molar
      teeth. Other side was accepted as "control group" and in this group, investigators will use
      buccally based triangular flap design.

      In the experimental group, an incision was made adjacent to the distal surface of the
      mandibular second molar, and extended along the sulcus to the distobuccal corner of the
      mandibular second molar. An oblique vestibular incision was made and extended into the
      vestibular fornix of the mandible, aligned with the mesiobuccal cusp of the second molar. It
      was continued posterosuperiorly towards the anterior border of mandibular ramus. In the
      control group, an incision will be made from the anterior border of the mandibular second
      molar. It will be extended along the sulcus to the distobuccal corner of the second molar
      crown. The incision will be continuous with vertical incision.

      A mucoperiosteal flap will be raised, a conventional rotary handpiece will be used under
      irrigation for removing the third molar.Primary wound closure was accomplished using 4-0 silk
      sutures. The patients will be invited after one week for removing the sutures.

      After the surgery, the patients will be prescribed a 5-day course of 100 mg flurbiprofen
      twice daily, 1 gr amoxicillin twice daily and chlorhexidine gluconate- benzydamine
      hydrochloride antiseptic mouthwash every 8 h.There will be at least one month between two
      surgeries.

      The duration of each procedure from the start of the incision to the time of last suture
      placement will be noted.

      Patients are recalled on days 2, 7, 14 postoperative pain, facial swelling, maximum mouth
      opening, wound dehiscence. For the assesment of the pain, pain scale will be used. For the
      swelling evaluation, measurement will be done from the different three region on the face.

        -  Tragus-Pogonion

        -  Tragus-Labial Commissura

        -  Angulus Mandible-Lateral canthus

      Maximum mouth opening will be noted before and after (one week later) the surgery.
    

Intervention name(s): lingually-based triangle flap design; buccally based triangular flap design
Intervention type(s): Procedure; Other
Intervention description(s): A mucoperiosteal lingually-based triangle flap will be raised, a conventional rotary handpiece will be used under irrigation for removing the third molar.Primary wound closure will be accomplished using 4-0 silk sutures. The patients will be invited after one week for removing the sutures.; A mucoperiosteal buccally based triangular flap will be raised, a conventional rotary handpiece will be used under irrigation for removing the third molar.Primary wound closure will be accomplished using 4-0 silk sutures. The patients will be invited after one week for removing the sutures.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: lingually-based triangle flap design buccaly-based triangular flap design
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: trismus; pain; edema; flap design