Comparison of Three Incision Designs and Influence on Post-Operative Complications in Surgical Removal of Mandibular Third Molars.

Abstract

Background: Surgical removal of impacted mandibular third molars is a routine procedure in oral surgery, where flap design plays a key role in surgical access and postoperative recovery.

Objectives: This prospective study compared three mucoperiosteal flap designs: Ward’s incision, comma-shaped incision, and Koener’s envelope incision focusing on intraoperative visibility, ease of surgery, postoperative pain, swelling, trismus, wound healing, and complications.

Methods: Ninety patients diagnosed with impacted mandibular third molars were randomly divided into three groups of 30, each undergoing surgical extraction with a different flap design. All procedures were performed by experienced surgeons following standardized protocols. Clinical parameters were assessed on the 1st, 3rd, and 7th postoperative days, including pain (VAS score), facial swelling, trismus, wound healing, and complications such as dry socket, infection, dehiscence, paresthesia, and periodontal pocket depth distal to the second molar..

Results: All flaps allowed successful extractions. The comma-shaped incision showed better outcomes in terms of reduced pain, swelling, and faster recovery. Ward’s incision gave superior access but caused more tissue trauma. Koener’s incision balanced access and healing but was not significantly better than the comma-shaped flap. Complication rates were comparable across groups.

Conclusions: Flap design significantly influences early postoperative symptoms, particularly pain, swelling, and trismus. The comma-shaped incision emerged as the most favorable in terms of patient comfort and recovery. However, since all techniques were effective and complication rates were comparable, flap selection should be guided by clinical judgment, patient anatomy, and individual case requirements.