title: Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery.
abstract: OBJECTIVE
  To measure the influence of flap design on alveolar osteitis (AO) and postoperative complications following mandibular third molar surgery.
  
  
  METHODS
  This study was designed as a randomized single-blind, split-mouth clinical trial. The predictor variable was flap type. Envelope flap, modified triangular flap (MTF), and two related experimental flaps (second molar mesial papilla-sparing marginal incision with distobuccal release with double-pass single-layered primary closure [MPMI-2 X] and single-pass single-layered primary closure [MPMI-1 X]) were used. The primary outcome variable was AO. The secondary outcome variables were wound dehiscence and infection. Bivariate and logistic analyses were computed. P value < .05 was considered to be statistically significant.
  
  
  RESULTS
  One hundred ninety-six patients with symmetric bilateral partial bony or full bony impacted mandibular third molars participated. No sites (0 of 196) treated with MPMI-2 X developed AO, and only two sites (2 of 196) treated with MPMI-2 X developed postoperative infection. Both MPMI-1 X and MPMI-2 X were associated with decreased odds of complications compared with MTF and envelope flap. MPMI-2 X sites were significantly less likely than MTF sites to experience complications for both sides.
  
  
  CONCLUSIONS
  MPMI-2 X is a reliable technique to reduce complications, such as AO, wound dehiscence, and infection in mandibular third molar surgery.
authors.affiliation: Associate Professor, Division of Oral and Maxillofacial Surgery, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA; Assistant Professor, Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, California, USA. Electronic address: jelo@WesternU.edu.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Elo
authors.affiliation: Dental Student, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA.
authors.forename: Ho-Hyun Brian
authors.initials: HH
authors.lastname: Sun
authors.affiliation: Associate Professor, Biostatistician, Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, California, USA.
authors.forename: Fanglong
authors.initials: F
authors.lastname: Dong
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Tandon
authors.affiliation: Assistant Professor, Western University of Health Sciences College of Dental Medicine, Pomona, California, USA.
authors.forename: Hardev M
authors.initials: HM
authors.lastname: Singh
mesh_terms: D003762:Dental Instruments; D004368:Dry Socket / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005491:Focal Infection, Dental / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008964:Molar, Third / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000517:prevention & control*; D014095:Tooth, Impacted / Q000601:surgery*; D055815:Young Adult