Evaluation of postoperative discomfort after impacted mandibular third molar surgery using three different types of flap.

Objective: The surgical extraction of an impacted third molar involves a wide range of consequences such as trismus, swelling, and pain, as well as more significant complications, temporary or permanent, that can manifest altered sensitivity of the tongue or lips. The purpose of this prospective study was to evaluate the effects of three different flaps on postoperative discomfort considering trismus, edema, and pain, after the extraction of impacted third molars. The data derived from the analysis of the surgical trials performed at the Oral Surgery Unit, Department of Surgical, Reconstructive and Diagnostic Sciences, IRCCS Policlinico, University of Milan, directed by Professor F. Santoro, MD.

Method And Materials: This study, developed over 2 years, involved 238 patients for a total of 238 extractions of impacted mandibular third molars. The 238 surgeries were performed on 114 men and 124 women: 54 avulsions were performed with the elevation of an envelope flap (Group 1), 48 avulsions through the elevation of a triangular flap (Group 2), and the remaining 136 avulsions were performed using a trapezoidal flap (Group 3).

Results: Trismus was significantly reduced (P < .05) in patients treated with envelope flap, as was the swelling perceived by the patient (P < .05). Pain was closely related to the elevation of a mucoperiosteal flap and osteotomy. Our study does not reveal statistically significant differences between the three types of flap used; however, the number of analgesic tablets taken was lower in cases of elevation of a less traumatic flap (envelope and triangular flaps).

Conclusion: The data collected in this study indicate the envelope flap as the most suitable for the reduction of the expression of postoperative complications such as swelling and trismus.