The influence of Positional Pooling with Swelling in Impaction Surgery

Objective: The objective was to evaluate results in a prospective study using two different flap designs in the removal of impacted teeth. Pooling of swelling may have influenced the outcome of this double-blinded study. Methods: Two different flap designs were used and compared in the search for an optimal flap, one with the least post-operative morbidity. The flaps used were the reverse-L flap (RLF) and the alternative miniature flap (AMF). In 36 patients the 38 and 48 impacted teeth were randomly determined and surgically removed. The visual analogue scale (VAS) assessment method was used. 33 Patients returned for follow-up examination at Day-3 and Day-8 and submitted their questionnaire with completed VAS from Day-1 to Day-7. This data was statistically analysed with the t-test, which rendered p>0.05. Results: The analysed results indicated that the majority experienced less pain on the side of the AMF (outcome not statistically significant [p>0.05]). In comparing these flaps in terms of swelling, much less swelling on the side of the AMF was experienced (statistically significant [p>0.05]). Five patients experienced more pain on the AMF side and three of these had more swelling. Two patients with more swelling on the AMF side had less pain. As no detailed sleeping pattern was included in the questionnaire, one might speculate that swelling in particular and possibly pain is more severe with pooling during sleep. Conclusions: Two different flaps were randomly selected and the results supported the AMF as the surgical flap procedure with less pain and swelling. However, evaluating the detailed results, a variation presented itself, which might be due to pooling of swelling (oedema and blood) at the lower side during sleep.