Lingual-based mucoperiosteal flap Vs buccal-based mucoperios
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This recent meta-analysis states that lingual-based mucoperiosteal flap is associated with better outcomes- reduce postoperative morbidity after the surgical removal of impacted third molars.

This study in the Journal of Oral And Maxillofacial Surgery aimed to compare the lingual-based and buccal-based mucoperiosteal flaps with respect to postoperative responses and complications.

A systematic review with a meta-analysis was designed and the PubMed, Cochrane Library, EMBASE, and Web of Science databases and Google Scholar were searched for randomized clinical trials. The predictor variable was buccal-based or lingual-based flap in the surgery, and the outcome variables were pain, swelling, trismus, operative time and wound dehiscence. Other study variables were sex and retention depth of impacted teeth.

Seven publications met the inclusion criteria, contributing 370 subjects who had 590 teeth removed to sample.

--The lingual-based flap failed to significantly reduce postoperative discomfort. However, subgroup analysis revealed that subjects who underwent comma flap (a type of lingual-based flap) surgeries complained of milder pain than those who underwent buccal-based flap surgeries on day 1 and day 7 after surgery.

--Significant differences were also observed on days 1, 3, and 7 regarding postoperative swelling and trismus.

--In addition, the lingual-based flap was reported to cause a significantly lower rate of wound dehiscence.

In conclusion, the lingual-based flap was associated with better primary wound closure in third molar removal. The comma flap, as a subtype, was preferable for relieving postoperative pain, swelling and trismus over the buccal-based flap.

Source: https://doi.org/10.1016/j.joms.2021.02.023
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