None listed
Conditions
Brief summary
A sample of patients was obtained from the waiting list at the the School of Dentistry with symmetrically impacted lower wisdom teeth. The patients will receive removal of their wisdom tooth incorporating a different gum flap (incision) design randomly assigned to each side; a conventional flap or a pedicle flap design. Post-extraction complications, including pain, swelling, delayed healing, jaw muscle spasm, gum recession and associated tooth sensitivity will be evaluated immediately after the procedure and at a subsequent review appointment. To ascertain severity of sequelae, a comparison will be made of preoperative and postoperative values and conclusions drawn from the data. It is hypothesised that a pedicle flap will reduce the risk or severity of the above mentioned post-operative complications after lower third molar removal
Interventions
A mucoperiosteal flap often needs to be raised to remove impacted lower third molar teeth. The intervention involves the use of a pedicle flap design to raise the mucoperiosteum for lower third molar removal. The pedicle flap is used on one randomly assigned side of the patients lower jaw for this procedure, then the control flap is used on the other side around three weeks later, or vice versa. The order the flap designs are used in is also randomly assigned. The pedicle flap design involve
A mucoperiosteal flap often needs to be raised to remove impacted lower third molar teeth. The intervention involves the use of a pedicle flap design to raise the mucoperiosteum for lower third molar removal. The pedicle flap is used on one randomly assigned side of the patients lower jaw for this procedure, then the control flap is used on the other side around three weeks later, or vice versa. The order the flap designs are used in is also randomly assigned. The pedicle flap design involves an incision placed in the buccal gingival sulcus from the mesio-buccal line angle of the first molar to the most distal visible aspect of the third molar. Distal to the third molar the incision is extended approximately 1cm and curved towards the buccal sulcus to allow for rotation of the flap and primary closure over sound bone. Prior to closure the gingival papilla distal to the second molar is removed and the apex of the pedicle de-epithelialised. A lingual flap is raised in the subperiosteal plane and the lingual nerve protected using a Howarth retractor. A round surgical bur and copious irrigation was used to remove bone superior, distal and buccal to the crown of the third molar tooth. A fissure bur was used to section the tooth if required. The tooth is then elevated and delivered and the dental follicle removed. Sterile saline irrigation of the socket was carried out to remove debris. Interrupted and horizontal mattress sutures (3-0 polyglactin 910; Undyed Vicryl Rapide; Ethicon, Somerville, New Jersey, USA) are placed to stabilize the flap and close the extraction site to the desired degree. Each operation takes around 20 minutes. The participants are then followed up two and seven days after the procedure and again at six and nine months post-operatively.
Sponsors
Faculty of Dentistry, University of Otago
Study design
Allocation
Randomised controlled trial
Intervention model
Crossover
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
16 Years to 40 Years
Healthy volunteers
Yes
Inclusion criteria
The inclusion criteria for this study included: bilateral symmetrically impacted partially erupted mandibular third molars, with no associated pathology, no medical conditions or medications that may alter wound healing potential, must be American Society of Anesthesiologists physical status classification I or II, and aged between sixteen and forty years of age.
Exclusion criteria
Patients were excluded from the study if there was a history of abuse of midazolam, allergy to any medications used during or after the procedure for patient management, were on long term steroid or bisphosphonate medication, pregnancy, previous or present radiotherapy to the third molar tooth region of the lower jaw, or had a bone disorder such as Paget’s disease or fibrous dysplasia that could interfere with bone healing.
Outcome results
None listed