Small Flap, Less Bone Removal And Suture In Extraction Of Impacted Mandibular Third Molar

Objective:Due to the particularity of anatomy of mandibular third molar, the extraction of impacted tooth is a quite complex operation with larger trauma, serious postoperative reaction and more complications. Now, flap operation and bone removal is the conventional method of extraction of impacted mandibular third molar. Many studies indicate that larger flap causes postoperative swelling, limited mouth opening, periodontitis in adjacent teeth and even bone resorption on the local alveolar. More bone removal and larger trauma cause more serious haemorrhagic activity, swelling response and postoperative pain. In recent years, the turbine is applied in the extraction of impacted tooth and the extraction of impacted tooth become less difficult, but it doesn't radically change the conventional method of flap and bone removal. The research adopts the turbine and the operation of osteotome. It will further decrease injury due to small flaps, less bone removal and suture during the operation.Methods:1 Clinical DataOne hundred patients of impacted mandibular third molar, who visited department of stomatology of Bethune International Peace Hospital of PLA, were selected (73 males and 27 females, with average age of 24.83±4.36, ranging from 18 to 37 years old) from Oct, 2008 to Dec, 2009. There were 74 cases of mesioangular impaction and 26 cases of horizontal impaction in 100 cases of impacted mandibular third molar. And the patients were randomly divided into two groups, according to their visiting sequence.2 Removal Method2.1 Control groupWe routinely performed flap operation by triangular flap, routine bone removal and bicuspidization and tight suture. We took stitches out of a wound 7 days later.2.2 Experimental groupThe patients in experimental group were treated with the removal method of small flaps, less bone removal and suture: The diseased teeth, of which the exposed area does not exceeds the half area of occlusal surface, were split lateral direction along the median of distoclusal gingival margin. The area after flap operation was slightly larger than the half area of occlusal surface. When the area of bone window was less than the half area of occlusal surface, we clung to exposed dental body and cleared bone around with carbide bur to enlarge the bone window to the extent in which a half area of occlusal surface was exposed. According to the condition, we prepared a groove (depth 2mm, width 3mm) for guide with carbide bur of high speed turbine, tightly pressed the bottom plane of the groove by osteotome and cleaved, then dug out diseased teeth piece by piece. rinsing tooth socket with 20ml Chlorhexidine Hydrochloride (0.12%, V/V) was accompanied and foreign bodycleared with suction. Tamp aseptic cotton ball directly after drying; if we found active bleeding, we should tightly suture and put a rubber drainage strip. We extracted drainage strip and demolished suture 3 days later.3 Postoperative Treatment and ObservationThe anodyne and antibiotics were given at the same dose after operation. The bleeding was observed 30min, 1d and 2d after operation. The pain degree was observed 1d, 2d, 3d and 7d after operation. The patients paid a return visit for the measurement and calculation of local swelling, the limitation of opening of mouth and dry socket 2d, 3d and 7d after operation.Results:1 The time of extractionThe time (8.44±5.23 min) of extraction in experimental group was shorter than that (12.98±3.07min) in control group (P<0.05).2 The bleeding on the wound Hemorrhage in the experimental group was more than that in the control group 30min after operation (P<0.05). There was no statistical significance in hemorrhage between two groups 1d and 2d after operation (P<0.05). It showed that there was no obvious effect of drainage and less suture on bleeding on the wound after operation.3 The degree of postoperative painThere was no statistical significance in postoperative pain between two groups 1d, 2d and 3d after operation, but there was a statistical significance 7d after operation and the degree of postoperative pain in control group was higher than that in experimental group. The data of 7d post operation showed that the pain of the patients in two groups was mild pain, but the number of the patients in control group was obviously larger than that in experimental group. The symptom of pain was covered due to the obvious inhibiting effect of ibuprofen on mild to moderate pain in period of medicine. The difference between two groups had statistical significance in the degree of pain 7d after operation; it was believed that postoperative pain was caused by large local injury and long reign of suture in the control group.4 Swelling degree in the cheek regionThe difference in swelling degree between two groups had statistical significance 2d and 3d after operation, and the degree of swelling in control group was obviously higher than that in experimental group. It was caused by the large area of flap and bone removal, large trauma and tight suture after operation prejudicing the unobstructed drainage in the control group. The difference in facial swelling degree in two groups had no statistical significance 7d after operation, and mouth opening was both normal.5 Limitation degree of maximal mouth opening after operationThe difference in maximal mouth opening between two groups had statistical significance 2d and 3d after operation. The limitation degree of opening in control group was higher than that in experimental group. It showed that larger trauma was caused by longer incision, larger flap and a larger area of bone removal. The difference in the limitation degree of opening of mouth in two groups had no statistical significance 7d after operation, and mouth opening was both normal.6 Dry socketThere was one patient with dry socket in each group.Conclusion:1 The method of small flaps, less bone removal and suture could reduce postoperative pain, swelling degree and limitation degree of mouth opening.2 During the extraction of impacted mandibular third molar, we could use alienability of alveolar bone and soft tissue to take out diseased teeth piece by piece without large flap and bone removal by a multiple of teeth separation, which made holistic bone resistance change to that of local tooth piece.3 Due to the less time of flap, bone removal and suture, the operation procedure become short. The method of small flap, less bone removal and suture in extraction operation is less discomfort for the patients.4 The method of small flap, less bone removal and suture in the extraction of impacted tooth has the characters of short operation time and less injuries and is a minimally invasive surgery.