The effectiveness of limited flap design in surgical removal of fully impacted lower third molars: a comparative clinical study

Introduction
Surgical removal of impacted lower wisdom teeth is one of the most commonly performed procedures in oral and maxillofacial surgery.

Objectives
This study aimed to compare the operative and post-operative outcomes of 2 flap designs (limited vs. extended 2-sided flap) in surgical extractions of lower third molars (M3) regarding fully impacted teeth.

Material and methods
A prospective, randomized, controlled split-mouth trial was designed, and included 27 patients with bilateral (symmetrically positioned) impacted M3. Limited 2-sided flap was performed on one side (group 1) and extended 2-sided flap on the other side (group 2). The effect of flap design on intra-operative (visibility, accessibility, and duration of surgery) and post-operative sequelae (pain, trismus, swelling, alveolar osteitis, and wound dehiscence) were analyzed at different post-operative days. Any associated complications or side effects were also recorded.

Results
Regarding pain, no significant differences were observed between the two groups (p > 0.05). Trismus and facial swelling were significantly greater in the extended flap group in the early post-operative period (p < 0.05). Pain, trismus, and swelling were significantly correlated with operation time in both the groups (p < 0.01). Wound dehiscence occurred only in 3 cases in group 2.

Conclusions
Surgical and post-surgical outcomes obtained from the group 1 flap design are superior to the other group. The study findings indicated that trismus and swelling (not the pain) were significantly affected by the flap design.