| Background:The middle-lower impacted third molars cannot reach a normal position for the resistance of adjacent teeth,bones and soft tissues.Considering the variability of anatomical structures and location,the extraction of these impacted molars is a tricky process and conduces serious postoperative reaction and related complications,which brings unbearable pains to patients.Based on the facts,a series of clinical studies have been carried out by oral and maxillofacial surgeons to improve the present surgical techniques for the purpose of minimally invasive surgery,comfortable and personalized treatment.Flap designs are critically important for the minimally invasive extraction of mandibular impacted third molars.A perfect flap provides better surgical field and access to impacted teeth,not only reducing the operation time but also alleviating postoperative discomfort and affecting the wound healing.At present,those widely-used flap designs(including envelope and modified triangular flaps)were observed to have a frequent occourence of wound dehiscence in the distal buccal gingiva of the second molars when the stitches were removed,and therefore the residual food makes it difficult for patients to maintain oral hygiene,stimulating the local gingiva and even causing infection.To address the problem,the modified lingually-based flap was invented.All incisions of new flap design are located outside of the bone defects,which ensures a stable support during wound healing.Meanwhile,the base of lingually-based flap is located on the lingual side of the mandible and supplied by the branch of hypoglossal artery,which all provides a reliable theoretical basis for the advantage of the lingually-based flap.However,there is still a controversy over the influence of novel flap on postoperative response and complications.Compared to traditional flap designs,whether lingually-based flap can significantly reduce the incidence of postoperative dehiscence in practice and whether there is a significant difference in long-term periodontal healing remain questionable and call for more rigorous evidence-based medical research.My study will make a comprehensive comparison of different flap methods on postoperative response,complications,primary healing of sockets and periodontal recovery after mandibular impacted third molars extraction through a prospective randomized double-blind controlled trial so that the clinical effects of lingually-based flaps could be determined.Purpose:To compare the prognosis of lingually-based flaps and buccally-based flaps after surgeries of mandibular middle-lower impacted teeth.Methods:A total of 96 patients diagnosed with mandibular middle-lower impacted third molars were enrolled and then randomly allocated to lingually-based flap or buccally-based flap group to remove their teeth in the Department of Oral and Maxillofacial Surgery,Qilu Hospital,Shandong University from December 1st,2019 to August 31st,2020.The surgeries were performed parallelly between two groups and other surgical conditions were the same except for the flap designs.Postoperative pain,swelling and trismus,wound healing of sockets,complications including sensory hypoaesthesia,alveolar osteitis,abnormal hemorrhage and hematoma,periodontal health of adjacent molars after 3 months were recorded and evaluated.The relationship between wound healing and relevant factors such as participants’ age,operation time,the depth of impacted teeth was also analyzed.Statistical analysis was conducted using SPSS 21.0 software.Results:In 83 completed cases,the surgery of lingually-based flaps lasted longer than that of buccally-based flaps(p=0.004)and patients in the former group reported a higher pain level on the first day after the surgery(p=0.029).However,there was no significant difference in terms of swelling and trismus(p>0.05).In addition,early wound dehiscence occurred less frequently when lingually-based flaps were used(p=0.02)in the surgery and flap designs were demonstrated to be the most dominant factor contributing to primary healing of the wound[OR=0.219,95%CI(0.076-0.634),p=0.005].After 3 months,periodontal levels including pocket depth,attachment level and alveolar bone height of second molars were significantly improved compared to baseline in both groups,but no statistical difference was observed between them(p>0.05).The incidence of hematoma in the lingually-based flap group was insignificantly higher than that in the buccally-based flap group.No other adverse reactions occurred in both groupsConclusion:Lingually-based flaps showed better primary healing without inducing other complications after the mandibular middle-lower impacted teeth extraction.There was also no significant correlation between flap designs and the recovery of adjacent periodontal tissues. |
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