Distal-triangular flap design for impacted mandibular third molars: a randomized controlled trial

doi:10.7518/hxkq.2021.05.016

Abstract

Abstract: Objective

This prospective study was performed to evaluate whether the distal-triangular flap was a practical alternative surgical approach for extracting mandibular third molars.

Methods

Sixty participants with impacted mandibular third molars were randomly divided into three groups: group A, distal-triangular flap; group B, Szmyd flap; and group C, envelope flap. The impacted third molars were extracted by the corresponding flapping method. During a three-month follow-up observation after the extraction, the postoperative pain, swelling, mouth opening, and periodontal status were recorded and analyzed by ANOVA and chi-square tests.

Results

The 60 participants had successful extraction and 3-month follow-up observation. No participant suffered from postoperative infections, lower lip disorder, or tongue sensory disorders. No statistical differences were found in the postoperative symptoms and signs of the three flap designs, such as postoperative pain, swelling, mouth opening, and periodontal status (P>0.05).

Conclusion

The distal-triangular flap was as safe and reliable as the Szmyd and envelope flaps but more advantageous because of its convenient operative field exposure and low requirement for the patient's mouth opening. Thus, the distal-triangular flap is one of the alternative flap options for extracting impacted mandibular third molars.

Key words: mandibular third molar extraction, distal-triangular flap, Szymd flap, envelope flap, postoperative complication

CLC Number:

R 782.11

Liu Jiyuan, Liu Chang, Pan Jian, Qu Tao, Hua Chengge.. Distal-triangular flap design for impacted mandibular third molars: a randomized controlled trial[J]. West China Journal of Stomatology, 2021, 39(5): 598-604.

Figures/Tables 5

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References 19

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项目	远中三角瓣组	近中三角瓣组	封套瓣组	P值
性别				0.817
女	12	11	10
男	8	9	10
年龄/岁	22.75±2.05	21.65±1.57	22.10±1.83	0.169
阻生位置				0.766
左侧	11	9	11
右侧	9	11	9
Pell & Gregory分类				0.583
Ⅰ类	5	8	6
Ⅱ类	15	12	14

项目	远中三角瓣组	近中三角瓣组	封套瓣组	P值
手术时间/min	8.40±5.91	8.95±4.11	7.95±5.04	0.823
术后疼痛/mm				时间P=0.000，时间×组间P=0.592，组间P=0.587
术后1 d	27.65±16.63	28.15±21.62	30.40±19.12
术后2 d	23.50±18.00	30.80±20.71	25.45±19.48
术后3 d	18.80±15.93	24.35±18.35	21.55±17.14
术后7 d	2.90±4.61	7.50±10.57	4.95±6.60
术后肿胀/mm				时间P=0.000，时间×组间P=0.473，组间P=0.787
术后1 d	3.8±7.0	3.5±4.4	5.1±6.2
术后2 d	6.3±7.2	4.1±3.8	5.0±9.0
术后3 d	3.7±5.4	2.7±2.8	2.5±5.5
术后7 d	0.7±3.3	0.3±4.1	0.9±3.8
张口度/mm				时间P=0.000，时间×组间P=0.367，组间P=0.661
术前	49.65±6.47	51.35±7.49	48.25±7.24
术后1 d	43.95±10.49	46.10±12.81	44.65±5.80
术后2 d	44.30±10.90	46.65±11.94	45.35±5.84
术后3 d	46.25±9.36	47.70±11.30	47.20±6.11
术后7 d	49.55±6.93	49.80±9.28	48.40±6.58
术后1月	51.50±5.03	52.25±7.00	49.60±5.99
术后2月	52.25±4.84	52.50±7.54	49.10±5.78
术后3月	52.45±4.72	52.40±7.88	49.80±6.07

项目	远中三角瓣组	近中三角瓣组	封套瓣组	P值
第二磨牙PPD/mm
近颊				时间P=0.955，时间×组间P=0.904，组间P=0.995
术前	2.33±0.47	2.23±0.57	2.20±0.70
术后1月	2.28±0.68	2.25±0.41	2.30±0.64
术后2月	2.20±0.50	2.28±0.57	2.25±0.51
术后3月	2.25±0.53	2.25±0.50	2.25±0.62
颊侧中点				时间P=0.200，时间×组间P=0.313，组间P=0.310
术前	1.98±0.55	2.03±0.53	1.93±0.49
术后1月	2.03±0.53	2.08±0.37	1.85±0.61
术后2月	2.15±0.33	2.13±0.46	1.93±0.49
术后3月	2.28±0.44	2.00±0.43	2.00±0.56
远颊				时间P=0.000，时间×组间P=0.113，组间P=0.215
术前	3.03±0.99	3.50±1.54	4.23±2.28
术后1月	2.45±0.67	3.03±1.29	2.98±1.36
术后2月	2.38±0.65	2.63±1.02	2.43±0.54
术后3月	2.38±0.48	2.25±1.00	2.25±0.44
近舌				时间P=0.033，时间×组间P=0.448，组间P=0.798
术前	2.30±0.50	2.35±0.83	2.15±0.86
术后1月	2.60±0.58	2.48±0.55	2.68±0.49
术后2月	2.53±0.55	2.38±0.48	2.50±0.36
术后3月	2.50±0.79	2.38±0.58	2.55±0.39
舌侧中点				时间P=0.101，时间×组间P=0.062，组间P=0.168
术前	2.00±0.46	1.88±0.58	2.18±0.57
术后1月	2.30±0.55	1.93±0.49	1.90±0.42
术后2月	2.30±0.47	2.13±0.43	2.05±0.43
术后3月	2.20±0.57	2.03±0.44	2.35±0.49
远舌				时间P=0.000，时间×组间P=0.723，组间P=0.759
术前	2.83±1.17	2.78±1.56	2.85±1.13
术后1月	2.20±0.55	2.05±0.54	2.08±0.67
术后2月	2.33±0.67	2.10±0.75	2.13±0.32
术后3月	2.25±0.62	2.10±0.80	2.38±0.43
第二磨牙远中裂隙/n				P=0.918 P=0.490 P=0.362
术后1月	14	15	15
术后2月	5	5	8
术后3月	0	1	0