Novel Incision Design and Primary Flap Closure Reduces the Incidence of Alveolar Osteitis and Infection in Impacted Mandibular Third Molar Surgery

• Published in: Oral surgery, oral medicine, oral pathology and oral radiology Vol. 122; no. 2; pp. 124 - 133
• Main Authors: Elo, Jeffrey A., DDS, MS, Sun, Ho-Hyun (Brian), MS, Dong, Fanglong, PhD, Tandon, Rahul, DMD, Singh, Hardev M., DMD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Dental Instruments; Dentistry; Dry Socket - epidemiology; Dry Socket - prevention & control; Female; Focal Infection, Dental - epidemiology; Focal Infection, Dental - prevention & control; Humans; Male; Molar, Third - surgery; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Surgery; Surgical Flaps; Surgical Wound Dehiscence - epidemiology; Surgical Wound Dehiscence - prevention & control; Tooth, Impacted - surgery; Young Adult
• ISSN: 2212-4403; 2212-4411
• DOI: 10.1016/j.oooo.2016.01.024

Abstract Purpose To measure the influence of flap design on alveolar osteitis (AO) and postoperative complications following mandibular third molar surgery. Patients and methods This study was designed as a randomized single-blind, split-mouth clinical trial. The predictor variable was flap type. Envelope flap (EF), modified triangular flap (MTF), and two related experimental flaps [second molar mesial papilla-sparing marginal incision with distobuccal release with double-pass single-layered primary closure (MPMI-2X) and single-pass single-layered primary closure (MPMI-1X)] were used. The primary outcome variable was AO. The secondary outcome variables were wound dehiscence and infection. Bivariate and logistic analyses were computed. P-value <0.05 was considered to be statistically significant. Results One hundred ninety-six patients with symmetric bilateral partial bony or full bony impacted mandibular third molars participated. No sites (0/196) treated with MPMI-2X developed AO, and only two sites (2/196) treated with MPMI-2X developed post-operative infection. Both MPMI-1X and MPMI-2X were associated with decreased odds of complications compared to MTF and EF. MPMI-2X sites were significantly less likely than MTF sites to experience complications for both sides. Conclusions MPMI-2X is a reliable technique to reduce complications such as AO, wound dehiscence, and infection in mandibular third molar surgery.