Modified envelope flap, a novel incision design, can relieve complications after extraction of fully horizontal impacted mandibular third molar.

Background/purpose: Patients always suffer from dental extraction complications of fully horizontal impacted mandibular third molar, such as pain, swelling and limited mouth opening. A novel incision, modified envelope flap (MEF), was designed to alleviate the complications through minimizing the tissue injury during this surgery procedure.

Materials And Methods: With indications of removing bilateral fully horizontal impacted mandibular the third molars, 40 patients were recruited and received dental extraction under incision with modified envelope flap (MEF) in one lateral and modified triangular flap (MTF) in the other lateral respectively. MEF incision was made along the buccal gingival sulcus from mesial to distal of the mandibular second molar with an extension to retromolar trigone at 45°inclination. As a control, traditional incision MTF was made starting with a vertical incision at the mesial buccal gingiva of the mandibular second molar with extension as MEF. Fully horizontal impacted mandibular third molar were extracted successfully. Surgery time and postoperative pain, swelling and mouth opening were recorded at day 1, 3, 7.

Results: There was no significant difference of the surgery time, pain, swelling (day 1) and mouth opening (day1) between MEF and MTF group ( > 0.05). However, the scores of swelling (day 3, 7) and mouth opening (day3, 7) of MEF group were much lower than that of MTF group ( < 0.05), indicating attenuated complications and quicker recovery.

Conclusion: With small injury, MEF hasn't prolong the surgery time but relieves complications after extraction of fully horizontal impacted mandibular third molar and might be a promising method compared with MTF.