Incision Design/Flap Closure to Reduce Incidence of Alveolar Osteitis

Objectives: To demonstrate that a novel, mesial-papilla sparing incision and flap design along with meticulous primary closure may help reduce the incidence of alveolar osteitis (AO) in the removal of impacted mandibular third molars. Previous studies have indicated that the duration of AO is self-limited, but few take into account the potential effects of alternative surgical techniques in preventing the initiation of this painful condition.
Methods: In this split-mouth study, one mandibular third molar was treated using our "second molar mesial papilla-sparing marginal incision with distobuccal release" (MPMI) that was closed with a double-layered primary closure while the contralateral molar was accessed via 1 of 3 methods: modified triangular flap (MTF) (Group 1), envelope flap (EF) (Group 2), or another MPMI but with a single-layered primary closure (Group 3). All patients were evaluated at 5-7 days PO by an independent OMS.
Results: In Group 1, none of the 65 molars treated via MPMI experienced incidences of alveolar osteitis while 7 out of 65 molars treated via MTF showed signs of AO. In Group 2, none of the 63 molars treated via MPMI experienced signs of AO while 8 out of 63 molars showed symptoms. Finally, within Group 3 of patients treated only with MPMI, none of the 68 procedures closed with a double-layered closure experienced symptoms of AO while 2 out of 68 procedures closed with a single-layered closure were evaluated positive for AO.
Conclusions: Pairing MPMI with a double-layered primary closure may serve as a reliable surgical technique to reduce alveolar osteitis that results from impacted mandibular third molar surgery. The evidence from the present study suggests in favor of a minimally invasive flap design, such as the MPMI, accompanied by a double-layered primary closure in removing full bony and partial bony impacted mandibular third molars.