Assessment of Post-Surgical Outcomes of Triangular, Envelope, and Modified Triangular Flap Designs in the Extraction of Impacted Mandibular Wisdom Teeth

Abstract

Background: The surgical extraction of impacted mandibular third molars remain a standard procedure in oral and maxillofacial surgery. The choice of flap design significantly influences the postoperative outcomes, including pain, swelling, and mouth opening (trismus). The triangular flap, modified triangular flap, and envelope flap each present distinct advantages and limitations, necessitating comparative evaluation to identify the most effective technique. Methods: A randomized controlled comparative study involved 45 healthy participants aged 20-30 who underwent surgical removal of impacted mandibular third molars. Participants were randomly assigned to three groups (n=15 each): Envelope Flap, Triangular Flap, and Modified Triangular Flap. Preoperative and postoperative assessments were conducted, measuring pain and swelling via visual analog scales (VAS) and trismus by interincisal mouth opening in millimeters. Data were collected on postoperative days 1, 3, 7, and 10. Statistical analyses included Fisher's exact test for qualitative variables (pain and swelling) and unpaired t-tests for quantitative variables (mouth opening). Results: Significant clinical differences were observed among flap designs. On Day 1, severe pain was notably higher in the Envelope Flap group (60%) compared to Triangular (27%) and Modified Triangular Flaps (40%) (p<0.05). Similarly, severe swelling was most prevalent in the Envelope Flap group (47%), significantly more than the Triangular (13%) and Modified Triangular (40%) groups (p<0.05). The Triangular Flap demonstrated the quickest recovery for both pain and swelling by Day 7. Mouth opening recovery was significantly better in the Triangular Flap group, with 27% achieving near-normal mouth opening by Day 10 compared to none in the other groups (p<0.05). Conclusion: Among the three flap designs studied, the Triangular Flap exhibited superior postoperative outcomes, validated by robust statistical significance (p < 0.05), resulting in reduced pain and swelling and quicker functional recovery of mouth opening. The Modified Triangular Flap provided intermediate results, suggesting its potential as an effective alternative.