Abstract
Background To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. Material and Methods An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus. Results From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs. Conclusions Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs. Key words:Impacted third molar, triangular flap, envelope flap, surgical flap, pain perception, trismus.
Highlights
Since impacted third molars are not often erupted into the oral cavity, a surgical flap must be raised to remove them, employing ostectomy, tooth sectioning and sutures that may trigger postoperative tissue reactions (1)
Material and Methods The present systematic review was carried out according to the PRISMA statement (12) and AMSTAR-2 guidelines (13). - Focused question A predefined focused question was proposed according to the PICO format (14) as follows: To what extent does flap design during impacted third molar extraction affect postoperative patient morbidity in terms of pain perception and other clinical outcomes? Population: patients undergoing extraction of an impacted third molar
Lesser pain perception was recorded in the control group, with a weighted mean difference (WMD) of 0.42 (95%CI: 0.06-0.77) (p = 0.021)
Summary
Since impacted third molars are not often erupted into the oral cavity, a surgical flap must be raised to remove them, employing ostectomy, tooth sectioning and sutures that may trigger postoperative tissue reactions (1). Soft and hard tissue manipulation during third molar extraction may trigger transient effects such as postoperative discomfort, swelling and pain that can adversely affect patient wellbeing (2). Other clinical aspects such as osteitis or infection have been considered (4,5,79). The present study was carried out to systematically review the literature on the impact of different surgical flap designs upon postoperative pain perception and clinical outcomes after impacted molar extraction. To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. Conclusions: Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs
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