Envelope versus Triangular flap design: A Third Molar Surgery study in Nepal

Abstract Objectives This study was carried out in Nepal comparing the two most commonly used flap design employed in the removal of impacted 3rd molar in terms of postoperative outcomes- pain, swelling, trismus, alveolar osteitis and wound infection. Materials and method Forty-six patients (age ranged from 17 to 40 years) with bilateral, symmetrical impacted third molars (n = 45) were included in the study. One side impaction was removed using the envelope flap then after a month time other side impaction was removed using the triangular flap. Postoperative outcomes- pain, swelling, trismus, presence of alveolar osteitis and wound infection were compared. Mann-Whitney U test and independent sample T-test were used for data analysis. Result Facial swelling was low in cases of the envelope flap design and it was statistically significant on postoperative day 2nd (P < 0.05). Amount of mouth opening reduction was seen more in cases with the triangular flap with statistically significant (p < 0.05) on postoperative day 14th. The Visual Analog Scale (VAS) score of two flap designs were comparable. There was equal incidence of alveolar osteitis and no cases of wound infection in either flap design. Conclusion The envelope flap design has shown superior postoperative outcomes compared to the triangular flap design regarding the post-operative swelling and mouth-opening reduction. Clinical Relevance: Within the limitation of our study, we recommend the use of envelope flap design in third molar surgery cases.