Comparison of two incision designs for surgical removal of impacted mandibular third molar: A randomized comparative clinical study.

Objective: The objective of this study is to investigate the influence of flap design on visibility and accessibility during removal of impacted third molar and hematoma formation, wound gaping and healing of flap post-operatively.

Study Design: The randomized prospective comparative study included 30 patients with impacted mandibular third molars. Two flap designs namely envelope flap (Koener's incision) and 'triangular flap' (Ward's incision) were used. After 7 days, sutures were removed and status of wound, periodontal health, and progress of healing was assessed. Patients were followed through 15 days to judge the incidence of post-operative complications in both groups.

Results: No statistical differences were noted between the groups in terms of visibility, accessibility, excessive bleeding during surgery, healing of flap, sensitivity of adjacent teeth, and dry socket. A statistically significant difference was observed in post-operative hematoma, wound gaping, and distal pocket in adjacent tooth, which was significant in Ward's triangular incision group in comparison to Koeiner's envelope incision group.

Conclusion: The selection of the flap design is dependent on needs of the case and preference of the operating surgeon and does not seem to have a significant influence on the health of tissues. In order to avoid wide area of exposure of bone, the operating surgeon should clinically and radiographically assess the designing of incision and mucoperiosteal flap, the clinical relevance is still debatable.