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Comparison of three flap designs on postoperative complication after third molar surgery

  • Pingky Krisna Arindra ,
  • Adyaputra Indrapradana ,


Introduction: Third molar surgery can cause post-operative complications to the patient due to the presence of wound from the incision. The study aimed to compare modified triangular (triangular reverse) flap with triangular and envelope flap on postoperative complications by the measurements on post-surgical swelling, trismus, pain scale, wound dehiscence and the occurrence of alveolar osteitis.

Methods: Study design using a single-blind randomized clinical trial. Each treatment group consisted of 10 patients. An assessment was performed on day 1, 7 and 14 after surgery. The swelling was measured using different anatomical points, and trismus was measured using the distance of inter-incisal opening. The occurrence of dehiscence was measured from the width of the incision line. Alveolar osteitis and pain scale was observed.

Results: The results of one way ANOVA (p>0.05) shows there was no difference between treatment groups both for swelling and mouth opening, but there was a difference between treatment groups for dehiscence on days 7 and 14. The results of the Post Hoc test show that flap envelope differs from the other flap design, whereas triangular and triangular reverse flap showed no difference. Friedman test results (p>0.05) showed no difference in VAS score. There was no alveolar osteitis occurred in each treatment group during postoperative control. Kruskal Wallis test (p>0.05) showed that there was no difference of VAS score between treatment group during post-operative control.

Conclusion: The triangular reverse flap design may decrease the occurrence of postoperative complication after mandibular third molar surgery. 


  1. Rahpeyma A, Khajehahmadi S, Ilkhani S. Wound Dehiscence after Wisdom Tooth Removal in Mandibular Mesioangular Class IB Impactions: Triangular Transposition Flap versus Envelope Flap. Journal of Dental Research, Dental Clinics, Dental Prospects. 2015;9(3):175-180. doi:10.15171/joddd.2015.032.
  2. Aydintug, YS, Bayar GR, Gulses A, Misir AF, Ogretir O, Dogan N, Sencimen M, Acikel CH. Clinical study on the closure of extraction wounds of partially soft tissue-impacted mandibular third molars. Quintessence International. 2012;43:863–870.
  3. Borgonovo AE, Giussani A, Grossi GB, Maiorana CM. Evaluation of postoperative discomfort after impacted mandibular third molar surgery using three different types of flap. Quintessence International. 2012;22(1):1-12.
  4. Jeffrey A, Elo HH, Dong F, Tandon R, Singh HM. Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(3):124-133
  5. Kirk DG, Tong DC, Love RM., Influence of two different flap design on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery. Oral surg Oral med Oral pathol Oral radiol Endod. 2007;104:e1-e6
  6. Sandhu A, Sandhu S, Kaur T. Comparison of two different flap designs in the surgical removal of bilateral impacted mandibular third molars. Int. J. Oral Maxillofac. Surg. 2010;39(1):1091–1096
  7. Jackse N, Bankaoglu V, Wimmer G. Primary wound healing after third molar surgery: Evaluation of two different flap design. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(4):7-12.
  8. Klongnoi B, Kaewpradub, Boonsiriseth K, Wongsirichat N. Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery. Int. J. Oral Maxillofacial Surg. 2012;41(2):376-379.
  9. Agrawal J, Shenai PK, Chatra L, Kumar PY. Evaluation of normal range of mouth opening using three finger index : south India perspective study. Indian J Dent Res. 2015;26(4):361-365.
  10. Santosh BS, Shivamurthy DM, Shilpa IG, Thippeswamy SH, Singh JR, Mangalekar SB. Comparison of pain, swelling, and trismus in the surgical removal of impacted mandibular third molars by following two different flap techniques. Journal of Advanced Medical and Dental Sciences Research. 2016;4(1):139-142.
  11. Bodh R, Jain A. The flap design of third molar surgery : An Overview. International Journal of Medical and Health Reseach. 2015;1(3):32-35.
  12. Yolcu AH. Comparison of a new flap design with the routinely used triangular flap design in third molar surgery. Int. J. Oral Maxillofac. Surg. 2015;44(2):1390–1397.
  13. Mobilio N, Vecchiatini R, Vasquez M, Calura G, Catapano S. Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars: A randomized prospective study. Journal of Dental Research, Dental Clinics, Dental Prospects. 2017;11(3):156-160 doi:10.15171/joddd.2017.028.
  14. Refo’a Y, Ouatik N, Golchin F, Mahboodi N, Comparing primary and secondary wound healing discomfort after mandibular third molar surgery: a randomized, double-blind clinical trial. Gen Dent. 2011;59(4):310-313.

How to Cite

Arindra, P. K., & Indrapradana, A. (2018). Comparison of three flap designs on postoperative complication after third molar surgery. Intisari Sains Medis, 9(2).




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Pingky Krisna Arindra
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Adyaputra Indrapradana
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