Comparison of different flap designs in soft tissues periodontal healing after lower third molars extraction: a descriptive review

Abstract

The purpose of this descriptive review was to assess post-operative periodontal outcomes of adjacent molar sites after the extraction of lower third molars, comparing different surgical techniques. The electronic search strategy was conducted on different databases (PubMed, Scopus, and Web of Science) fitting the following selection criteria: clinical human studies (RCTs, retrospective and prospective); studies comparing different flap designs (e.g., envelope, triangular, and trapezoidal flaps) for surgical extraction of lower 3rd molars; studies assessing clinical outcomes of periodontal healing at adjacent molar sites. Studies included had to present a minimum follow-up of 1 month and at least variations of probing pocket depth (PPD) at 2nd molar site between baseline and follow-up. The search strategy considered a total of 148 records: based on the predetermined eligibility criteria, 24 articles were read, and 9 were finally identified. Regarding the primary outcome considered (PPD at 2nd molar site), no significant differences in its reduction between baseline and follow-up were found comparing different flaps designs. However, the greatest clinical attachment loss (CAL) was generally reported using a trapezoidal flap. Considering the heterogeneity of studies included, after 1 to 6 months of follow-up, no substantial evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.