E138 Med Oral Patol Oral Cir Bucal. 2008 Feb1;13(2):E138-42. Flap repositioning in third molar surgery Flap repositioning versus conventional suturing in third molar surgery Jose M. Sanchis Bielsa 1 , Sergio Hernández Bazán 2 , Miguel Peñarrocha Diago 3 (1) Staff physician, Service of Stomatology, Valencia University General Hospital. Associate Professor of Oral Surgery. Valencia University Medical and Dental School (2) Degree in Dental Surgery. Associate Professor of Oral Medicine. Valencia University Medical and Dental School (3) Chairman of Oral Surgery. Valencia University Medical and Dental School. Valencia (Spain) Correspondence: Dr. Jose M. Sanchis-Bielsa Clínica Odontológica Gascó Oliag 1 46021 - Valencia. Spain E-mail: sanchisj@uv.es Received: 9/03/2007 Accepted: 1/12/2007 Sanchis-Bielsa JM, Hernández-Bazán S, Peñarrocha-Diago M. Flap repositioning versus conventional suturing in third molar surgery. Med Oral Patol Oral Cir Bucal. 2008 Feb1;13(2):E138-42. © Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946 URL: http://www.medicinaoral.com/medoralfree01/v13i2/medoralv13i2p138.pdf Summary Objectives: A comparative study is made of two types of flaps in semi-impacted third molar surgery and their relation to the postoperative period (pain, swelling and trismus). Material and methods: Twenty-five healthy patients were subjected to surgical extraction of both semi-impacted lower third molars, located in a similar clinical and radiographic position. In 25 cases the wound was sutured using a reflection flap (healing by first intention), while in the 25 contralateral cases the conventional technique was used (simple approximation of the wound margins). Pain, swelling and trismus were evaluated, during the first week of the postoperative period. Results: There was lesser pain, swelling and trismus after extraction of a semi-impacted third molar when healing took place by second intention (simple approximation of the margins), than in the case of healing by first intention (flap repositioning and margin-to-margin suturing). Conclusions: The postoperative course proved worse when using a reflection flap for healing by first intention than on suturing by simple approximation of the wound margins. Key words: Third molars, reflection flap, third molar surgery. Indexed in: -Index Medicus / MEDLINE / PubMed -EMBASE, Excerpta Medica -SCOPUS -Indice Médico Español -IBECS Introduction Impacted third molar surgery is characterized by posto- perative pain, swelling and trismus. These symptoms in turn depend on a number of factors such as the duration of the operation, the difficulty surgery, the magnitude of the ostectomy, the lack of oral hygiene, or the experience of the surgeon (1-3). Regarding the use of flaps, different designs have been used to minimize periodontal damage in the case of second molars (4-7). The postoperative course is worse the larger the raised mucoperiosteal flap (8,9), and there is some controversy over the use of would healing by first intention or partial closure (wound healing by second intention)(10-12). In 1936, Rehrmann (13) proposed a flap repositioning technique to secure healing by first intention after the extraction of lower third molars. With this approach com- plete wound sealing was achieved, and contamination from the oral cavity was avoided. However, in recent years, some authors (14) have suggested that primary closure of the wound prevents drainage of the latter - thereby worsening the postoperative pain and the swelling. Some authors (11,15) have recommended the possibility of leaving sur- gical drains in the region of the wound, after observing an improved postoperative course in these patients compared with individuals subjected to primary closure. Recently Waite and Cherala (16) have reported very good results after 1280 surgical extractions of mandibular third molars involving the raising of a small conservative flap that is passively repositioned without suturing. The present study compares the secondary postoperative Article Number: 10489927 © Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946 eMail: medicina@medicinaoral.com