Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study

Authors

  • Siji J. Chiramel Department of Oral and Maxillofacial Surgery, Amala Institute of Medical Sciences, Amala Nagar, Thrissur, Kerala, India
  • Shaju Chammanam Department of Oral and Maxillofacial Surgery, Royal Dental College, Iron Hills, Chalissery, Palakkad, Kerala, India
  • Ranjith Kalliath Department of Oral and Maxillofacial Surgery, Royal Dental College, Iron Hills, Chalissery, Palakkad, Kerala, India
  • Arjun Gopinath Department of Oral and Maxillofacial Surgery, Kannur Dental College, Anjarakandy Integrated Campus, Anjarakandy, Kannur, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20182781

Keywords:

Envelope flap design, Flap design, Periodontal healing, Periodontal pocket depth, Primary wound healing, Szmyd flap design, Third molar, Wound dehiscence

Abstract

Background: Manipulation of both hard and soft tissues during the surgical removal of mandibular third molars is usually associated with a number of postoperative complications. This study was aimed to compare the effects of two types of flap designs used during the impacted mandibular third molar removal and the consequences of choosing Szmyd incision over envelope incision in terms of primary wound healing and periodondal healing.

Methods: A prospective, randomized study was conducted in healthy 50 patients with partially or completely impacted mandibular third molars were selected. The patients were divided into two groups of 25 each. In one group envelope flap design was used and in the other group Szmyd flap design was used. The influence of these incisions on accessibility to third molar, primary wound healing and periodontal healing was evaluated and compared.

Results: The incidence of wound dehiscence at 7th day follow-up is more in envelop incision (p=0.123) and 20% more at 14th day follow-up (p=0.087) when compared to Szmyd design. Significant differences were noted with respect to the periodontal healing distal to adjacent second molar. Distal periodontal pocket depth was significantly lower for the Szmyd incision as compared to the Envelop incision. Effect size of Envelop flap is 1.84 times more than Szmyd flap.

Conclusions: The Szmyd flap design makes primary wound healing easier, less wound dehiscence and periodontal complication than envelop flap design.

References

Rosa AL, Carneiro MG, Lavrador MA, Novaes Jr AB. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars. Oral Surg Oral Pathol Oral Radiol Endod. 2002; 93:404-7.

Gores RJ. Technique for removal of mandibular unerupted third molars. J Oral Surg Anesth Hosp Dent Serv. 1962;20:457-66.

Koerner KR. The removal of impacted third molars. Principles and procedures. Dent Clin North Am. 1994;38:255-78.

Kugelburg CF, Ahlstrom U, Ericson S, Hugoson A, Kuint S. Periodontal healing after impacted lower third molar surgery in adolescents and adults-A prospective study. J Oral MaxillofacialSurg.1991;20;18-24.

Magnus WW, Castner DV Jr, Hiatt WR. An alternative method of flap reflection for mandibular third molars. Mil Med. 1972;137:232-3.

Jakes 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;93:7-12.

Szmyd L. Impacted teeth. Dent Clin North Am. 1971;15:299-318.

Nageshwar. Comma incision for impacted mandibular third molars. J Oral Maxillofac Surg. 2002;60:1506-9.

Alling CC, Helfrick JE, Alling RD. Impacted teeth. Philadalphia: PA Saunders. 1993.

Walters H. Reducing lingual nerve damage in third molar surgery: a clinical audit of 1350 cases. Br Dental J. 1995;178; 140-4.

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;46:363-72.

Kirtiloğlu T, Bulut E, Sümer M, Cengiz I. Comparison of 2 flap designs in the periodontal healing of second molars after fully impacted mandibular third molar extractions. J Oral Maxillofac Surg. 2007;65:2206-10.

Motamedi MH. A technique to manage gingival complications of third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Aug;90(2):140-3.

Kugelberg CF, Ahlström U, Ericson S, Hugoson A, Thilander H. The influence of anatomical, pathophysiological and other factors on periodontal healing after impacted lower third molar surgery-A multiple regression analysis. J Clin Periodontol. 1991;18:37-43.

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Published

2018-06-25

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Original Research Articles