Int J Stomatol

Inter J Stomatol ›› 2019, Vol. 46 ›› Issue (2): 142-148.doi: 10.7518/gjkq.2019011

• Systematic Reviews • Previous Articles     Next Articles

Flap design associated pain after the extraction of mandibular third molars: a systematic review and Meta-analysis

Weilin Pan,Yubin Cao,Chang Liu,Jiyuan Liu,Chunjie Li,Jian Pan,Chengge Hua()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-09-17 Revised:2018-12-03 Online:2019-03-01 Published:2019-03-15
  • Contact: Chengge Hua E-mail:huacg@163.com
  • Supported by:
    This study was supported by Key Research Project of Sichuan Province(2018SZ0181)

RichHTML

78

PDF (PC)

1103

Abstract:

Objective This review aimed to assess the effects of flap design on pain after the extraction of mandibular third molars. Methods Nine databases were searched electronically on 29 June 2018. A manual search of reference lists of included studies was conducted. Two reviewers performed quality assessment independently with tools suggested by Cochrane’s handbook, and then, they extracted data. Meta-analysis was performed using Review Manager 5.3. Results Seventeen studies with 1 033 participants and 1 421 teeth were included. Among these studies, one was at high risk of bias, whereas the risk in the other 16 was unclear. The postoperative pain of envelope flap was milder than that of standard triangular flap, and the difference was statistically significant. No significant difference was found in postoperative pain between envelope flap and Szmyd flap. Conclusion Envelope flap and Szmyd flap can be more effective in reducing the postoperative pain of patients than standard triangular flap.

Key words: third molar, tooth extraction, Meta-analysis, pain, surgical flaps

CLC Number: 

  • R782.1

TrendMD: 

Tab 1

Characteristics of included studies"

研究 方法 纳入人数（牙数） 评估人数（牙数） 干预措施 结局指标VAS
研究类型 地区
Abandansari和Foroughi[6] 口内自身对照RCT 伊朗 20（40） 20（40） 标准封套瓣;标准三角瓣 第2天VAS,没有标准差*
Baqain等[11] 口内自身对照RCT 约旦 20（40） 19（38） 标准封套瓣;Szmyd瓣 第2天VAS
Erdogan等[12] 口内自身对照RCT 土耳其 20（40） 20（40） 标准封套瓣;标准三角瓣 第3天VAS
Goldsmith等[9] 口内自身对照RCT 新西兰 57（114） 42（84） 蒂状瓣;标准封套瓣 第1~4天平均VAS*
何锦泉等[13] 平行对照RCT 中国 400（400） 372（372） 线形瓣;Szmyd瓣 第3天VAS
Kim等[14] 口内自身对照RCT 韩国 30（60） 27（54） Kruger封套瓣;无翻瓣设计 第2天VAS
Kirk等[15] 口内自身对照RCT 新西兰 35（70） 32（64） 标准封套瓣;Szmyd瓣 第2天VAS
Korkmaz等[16] 口内自身对照RCT 土耳其 28（56） 28（56） 标准封套瓣;标准三角瓣 第2天VAS
Koyuncu等[17] 平行对照RCT 土耳其 80（80） 80（80） 标准封套瓣;Szmyd瓣 第2天VAS
Koyuncu等[18] 口内自身对照RCT 土耳其 40（80） 36（72） 刺刀形瓣;Szmyd瓣 第2天VAS
Mobilio等[10] 平行对照RCT 意大利 25（25） 25（25） 标准封套瓣;标准三角瓣 最大VAS*
Nageshwar[7] 平行对照RCT 印度 100（100） 100（100） 逗号形瓣;标准封套瓣 第3天VAS,没有标准差*
乔峰和朱东望[19] 口内自身对照RCT 中国 60（120） 52（104） 标准封套瓣;Szmyd瓣 第2天VAS
Roode和Bütow[8] 口内自身对照RCT 南非 36（72） 33（66） 线形瓣;Szmyd瓣 第2天VAS,没有标准差*
Sandhu等[5] 口内自身对照RCT 印度 20（40） 20（40） 刺刀形瓣;标准封套瓣 VAS的等级资料*
Tareen等[20] 平行对照RCT 巴基斯坦 40（40） 40（40） Kruger封套瓣;标准三角瓣 第2天VAS
Yolcu和Acar[21] 口内自身对照RCT 土耳其 22（44） 22（44） 舌向瓣;Szmyd瓣 第2天VAS

Tab 2

Risk of bias summary"

研究 随机方法 分配隐藏 实施盲法 测量盲法 数据完整 报道偏倚 其他偏倚 整体评价
Abandansari和Foroughi[6] 1 1 1 2 2 2 2 1
Baqain等[11] 2 1 1 1 2 2 2 1
Erdogan等[12] 1 1 2 1 2 2 2 1
Goldsmith等[9] 1 1 1 1 0 2 2 0
何锦泉等[13] 1 1 1 1 2 2 2 1
Kim等[14] 2 1 1 2 2 2 2 1
Kirk等[15] 1 1 1 1 2 2 2 1
Korkmaz等[16] 2 1 1 2 2 2 2 1
Koyuncu等[17] 1 1 1 2 2 2 2 1
Koyuncu等[18] 1 1 1 1 2 2 2 1
Mobilio等[10] 1 1 1 1 2 2 2 1
Nageshwar[7] 1 1 1 1 2 2 2 1
乔峰和朱东望[19] 2 1 2 2 1 2 2 1
Roode和Bütow[8] 2 1 1 1 2 2 2 1
Sandhu等[5] 1 1 2 2 2 2 2 1
Tareen等[20] 1 1 1 1 2 2 2 1
Yolcu和Acar[21] 1 1 1 2 2 2 2 1

Fig 1

Envelope flap verus other flaps"

Fig 2

Szmyd flap verus non-envelope flap"

Fig 3

Flap designs"

[1] Rafetto LK, Synan W . Surgical management of third molars[J]. Atlas Oral Maxillofac Surg Clin North Am, 2012,20(2):197-223.
doi: 10.1016/j.cxom.2012.07.002 pmid: 23021396
[2] Karaca I, Simşek S, Uğar D , et al. Review of flap design influence on the health of the periodontium after mandibular third molar surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007,104(1):18-23.
doi: 10.1016/j.tripleo.2006.11.049 pmid: 17448707
[3] Coulthard P, Bailey E, Esposito M , et al. Surgical techniques for the removal of mandibular wisdom teeth[J]. Cochrane Database Syst Rev, 2014( 7): CD004345.
doi: 10.1002/14651858.CD004345.pub2 pmid: 25069437
[4] Higgins JPT, Green S. Cochrane handbook for sys-tematic reviews of interventions[EB/OL]. , 2011-03-01.
[5] Sandhu A, Sandhu S, Kaur T . Comparison of two different flap designs in the surgical removal of bila-teral impacted mandibular third molars[J]. Int J Oral Maxillofac Surg, 2010,39(11):1091-1096.
doi: 10.1016/j.ijom.2010.07.003 pmid: 20727713
[6] Abandansari AS, Foroughi R . The effect of releasing incision on the postoperative complications of man-dibular third molar surgery[J]. Int J Adv Biotechnol Res, 2016,7(S3):1144-1151.
[7] Nageshwar . Comma incision for impacted mandibu-lar third molars[J]. J Oral Maxillofac Surg, 2002,60(12):1506-1509.
doi: 10.1053/joms.2002.36152 pmid: 12465020
[8] Roode GJ, Bütow K . An alternative surgical flap design for impacted third molars: a comparison of two different surgical techniques[J]. SADJ, 2010, 65(6): 246, 248-251.
pmid: 20879647
[9] Goldsmith SM, De Silva RK, Tong DC , et al. Influe-nce of a pedicle flap design on acute postoperative sequelae after lower third molar removal[J]. Int J Oral Maxillofac Surg, 2012,41(3):371-375.
doi: 10.1016/j.ijom.2011.08.006 pmid: 22033341
[10] Mobilio N, Vecchiatini R, Vasquez M , et al. Effect of flap design and duration of surgery on acute post-operative symptoms and signs after extraction of lower third molars: a randomized prospective study[J]. J Dent Res Dent Clin Dent Prospects, 2017,11(3):156-160.
doi: 10.15171/joddd.2017.028 pmid: 5666214
[11] Baqain ZH, Al-Shafii A, Hamdan AA , et al. Flap design and mandibular third molar surgery: a split mouth randomized clinical study[J]. Int J Oral Maxi-llofac Surg, 2012,41(8):1020-1024.
doi: 10.1016/j.ijom.2012.02.011 pmid: 22424708
[12] Erdogan O, Tatlı U, Ustün Y , et al. Influence of two different flap designs on the sequelae of mandibular third molar surgery[J]. Oral Maxillofac Surg, 2011,15(3):147-152.
doi: 10.1007/s10006-011-0268-7 pmid: 21484217
[13] 何锦泉, 欧阳可雄, 张清彬 , 等. 2种切开翻瓣法拔除下颌智牙的临床效果分析[J]. 上海口腔医学, 2015,24(2):224-227.
He JQ, Ouyang KX, Zhang QB , et al. Comparison of two different flap designs in removal of impacted wisdom tooth[J]. Shanghai J Stomatol, 2015,24(2):224-227.
[14] Kim HR, Choi BH, Engelke W , et al. A comparative study on the extractions of partially impacted mandi-bular third molars with or without a buccal flap: a prospective study[J]. J Oral Maxillofac Surg, 2011,69(4):966-970.
doi: 10.1016/j.joms.2010.02.025 pmid: 20678841
[15] Kirk DG, Liston PN, Tong DC , et al. Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007,104(1):e1-e6.
doi: 10.1016/S1079-2104(07)00420-9
[16] Korkmaz YT, Mollaoglu N, Ozmeriç N . Does late-rally rotated flap design influence the short-term periodontal status of second molars and postopera-tive discomfort after partially impacted third molar surgery[J]. J Oral Maxillofac Surg, 2015,73(6):1031-1041.
doi: 10.1016/j.joms.2015.01.005 pmid: 25872465
[17] Koyuncu Bö, Cetingül E . Short-term clinical out-comes of two different flap techniques in impacted mandibular third molar surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013,116(3):e179-e184.
doi: 10.1016/j.oooo.2011.12.023 pmid: 22921446
[18] Koyuncu Bö, ZeytİnoĞlu M, ÇetİngÜl E . Compa-rison of 2 different flap techniques in the surgical removal of bilateral impacted mandibular third molars[J]. Turk J Med Sci, 2013,43(6):891-898.
doi: 10.1016/j.ijom.2010.07.003 pmid: 20727713
[19] 乔峰, 朱东望 . 封套瓣与三角瓣对下颌第三磨牙拔除术后并发症的影响[J]. 天津医药, 2015,43(1):78-81.
doi: 10.3969/j.issn.0253-9896.2015.01.02
Qiao F, Zhu DW . The influence of the envelope flap and triangular flap designs on postoperative com-plications after mandibular third molar removal[J]. Tianjin Med J, 2015,43(1):78-81.
doi: 10.3969/j.issn.0253-9896.2015.01.02
[20] Tareen MK, Hamad J, Saleem SM , et al. To compare the triangular flap to envelop flap for the removal of impacted mandibular last molar[J]. Pakistan J Med Health Sci, 2015,9(1):434-436.
[21] Yolcu Ü, Acar AH . Comparison of a new flap design with the routinely used triangular flap design in third molar surgery[J]. Int J Oral Maxillofac Surg, 2015,44(11):1390-1397.
doi: 10.1016/j.ijom.2015.07.007 pmid: 26254819
[22] Briguglio F, Zenobio EG, Isola G , et al. Complica-tions in surgical removal of impacted mandibular third molars in relation to flap design: clinical and statistical evaluations[J]. Quintessence Int, 2011,42(6):445-453.
doi: 10.1097/PRS.0b013e318213a0a2 pmid: 21519580
[23] Laskin DM . Indications and contraindications for removal of impacted third molars[J]. Dent Clin North Am, 1969,13(4):919-928.
doi: 10.1016/0003-9969(69)90262-3 pmid: 5258215
[24] Saravana KB, Sarumathi T, Veerabahu M , et al. To compare standard incision and comma shaped inci-sion and its influence on post-operative complications in surgical removal of impacted third molars[J]. J Clin Diagn Res, 2013,7(7):1514-1518.
doi: 10.7860/JCDR/2013/6200.3135 pmid: 23998110
[25] Szmyd L . Impacted teeth[J]. Dent Clin North Am, 1971,15(2):299-318.
[26] Rai A, Rai M . Lingual based four cornered flap for third molar surgery[J]. J Maxillofac Oral Surg, 2017,16(2):258-259.
doi: 10.1007/s12663-016-0909-3
[27] 华成舸 . 微创拔牙的刚体力学分析[J]. 华西口腔医学杂志, 2017,35(2):119-123.
doi: 10.7518/hxkq.2017.02.002
Hua CG . Geostatics in minimally invasive surgical exodontias[J]. West Chin J Stomatol, 2017,35(2):119-123.
doi: 10.7518/hxkq.2017.02.002
[1] Han Chong,He Dongning,Yu Feiyan,Wu Dongchao. Research progress on the mechanism and treatment of pain after oral implants [J]. Int J Stomatol, 2024, 51(1): 99-106.
[2] Chai An,Lei Rongchang,Jiang Zhisheng,Qu Binbin,Guo Jincai,Li He,Shao Qi. Review of classification methods for evaluating the difficulty of mandibular third molar extraction [J]. Int J Stomatol, 2023, 50(6): 718-722.
[3] Liao Honglin,Fang Zhonghan,Zhang Yanyan,Liu Fei,Shen Jiefei.. Diagnosis and treatment of post-traumatic trigeminal neuropathic pain after dental implantation [J]. Int J Stomatol, 2023, 50(6): 729-738.
[4] Gong Jiaming,Zhao Ruimin,Pan Hongwei,Lang Xin,Yu Zhanhai,Li Jianxue. Meta-analysis of dynamic navigation versus static navigation in the accuracy of implant surgery [J]. Int J Stomatol, 2023, 50(5): 538-551.
[5] Wang Renyi,Zhao Chengzhi,Pan Jian.. Research progress on the effects of prophylactic antibiotics on postoperative complications during the perioperative period of tooth extraction [J]. Int J Stomatol, 2023, 50(5): 558-565.
[6] Liu Yuntong,Liu Chang,Gao Lichao,Luo Yuxue,Cao Yubin,Hua Chengge.. Research progress on the postoperative inferior alveolar neurosensory disturbance [J]. Int J Stomatol, 2023, 50(4): 479-484.
[7] revascularization Meta-analysis of the efficacy comparison between endodontic,Zhuanzhuan apexification Li. OSID） [J]. Int J Stomatol, 2023, 50(2): 177-185.
[8] Pei Ling,Zeng Ni,Yang Chao,Wang Yan,He Miao,Luo Qiang,Shi Bing. Analgesic effects of local anesthesia after cleft lip and palate repair [J]. Int J Stomatol, 2022, 49(6): 657-662.
[9] Ren Hai-xia,Liu Yingfeng,Liang Huimin,Li Jiayong,Wen Chunqin,Wang Chunmei. Intervention effect of virtual reality technology on dental fear in the treatment of deep caries in children [J]. Int J Stomatol, 2022, 49(5): 529-536.
[10] Gong Jiaming,Zhao Ruimin,Li Wanxin,Su Linhan,Yu Zhanhai,Li Jianxue. The socket-shield technique for immediate implant placement： a meta-analysis of randomized controlled trials [J]. Int J Stomatol, 2022, 49(5): 537-547.
[11] Zhang Shan,Ge Xiaolei,Li Jie,Xie Xinyu,Chang Weiwei,Ma Wensheng.. Meta-analysis of the long-term effect of maxillary protraction on jaw growth and development [J]. Int J Stomatol, 2022, 49(5): 548-555.
[12] Pang Yu,Liu Xian,Wang Liao. Application of digital template in the extraction of embedded supernumerary tooth [J]. Int J Stomatol, 2022, 49(4): 448-452.
[13] Ma Yu,Zuo Yu,Zhang Xin. Photodynamic therapy as an adjunct to periodontitis: a meta-analysis [J]. Int J Stomatol, 2022, 49(3): 305-316.
[14] Liu Chengcheng, Ding Yi. Clinical diagnosis, treatment, and management strategies of common oral infectious disease during pregnancy [J]. Int J Stomatol, 2021, 48(6): 621-628.
[15] Zhou Wanhang,Li Yanfei,Xu Ricong,Wan Qijun. Effects of non-surgical periodontal treatment on risk factors of chronic kidney disease and systematic inflammatory levels in patients with chronic kidney disease and periodontal disease: a Meta-analysis [J]. Int J Stomatol, 2021, 48(5): 528-535.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[8] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[9] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[10] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .