Minimal-invasive envelope flap Vs conventional envelope flap
The surgical removal of impacted third molars can lead to various postoperative consequences, which can be influenced by modifiable factors such as flap design. Minimal-invasive envelope flap (MIEF) in surgical removal of impacted mandibular third molars can lead to a significant reduction in postoperative consequences

The present study aimed to determine whether a minimal-invasive envelope flap (MIEF) can reduce surgical consequences and improve life quality compared to conventional envelope flap (CEF) after removing impacted mandibular third molars.

This single-blinded, cross-over randomized clinical trial was conducted on adult patients with bilateral, symmetrically impacted mandibular third molars. The flap design for surgical removal of the third molar was the primary predictor variable. The primary outcome (pain) and secondary outcome variables (swelling, mouth opening limitation (MOL)) were recorded daily and on the second and seventh days after the surgery, respectively. Wound dehiscence and patients' postoperative quality-of-life scores (PPOQL) were recorded on the 7th day. Sixty-eight impacted third molars of 34 subjects with a mean age of 22±12.9 years were followed.

- The postoperative pain level in the MIEF group at rest and chewing up to the 5th day was significantly lower than the CEF group.

- The difference did not reach a significant level at rest and chewing on the 6th and 7th days.

- On the seventh day, the subjects in the MIEF group showed a significantly lower level of swelling and MOL than the CEF group.

- Based on the PPOQL scale, patients in the MIEF group expressed a better recovery period than the CEF group.

Considering the reduction of pain, swelling, MOL, and wound dehiscence in MIEF cases, the application of MIEF in surgical removal of impacted mandibular third molars can lead to a significant reduction in postoperative consequences and also a noticeable improvement in PPOQL compared to CEF.

Journal of Oral and Maxillofacial Surgery
Source: https://doi.org/10.1016/j.joms.2021.07.010
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