Incision Design and Primary Flap Closure to Reduce Incidence of Alveolar Osteitis, a Prospective, Randomized Single-Blind Split Mouth Study

One of the most common complications surgeons experience in mandibular third molar surgery is Alveolar Osteitis (AO). AO has had documented incidence reports as high as 45%.¹ Currently the pathogenesis of AO is not fully understood. There are multiple methods for prevention of AO as well as different etiologies that could possibly be attributed to AO.^2-5 We conducted a randomized single-blind split mouth study comparing our incision design with two traditional designs. 392 bilateral impacted third molars were removed from 196 patients over a 7 month period. One side was treated using a second molar mesial papilla-sparing marginal incision with distobuccal release (MPMI) while the contralateral side was surgically exposed using one of three methods: modified triangular flap (MTF), envelope flap (EF), or another MPMI flap.  The MPMI extraction sites were closed utilizing a double-layered primary closure, while the contralateral sites were re-approximated with 1-2 sutures.  Both Chi-Square and Fisher's exact test were used for analysis. Of the 196 patients, there was less incidence of AO when comparing the MPMI to the EF or MTF groups. Additionally, there was no evidence of AO when MPMI incision with double-layered primary closure was utilized.   The Chi-square and Fisher's exact test had significant P values < 0.05 with the MPMI groups. This study suggests the MPMI incision design with double-layered primary closure has more predictable outcomes resulting in a lower incidence of AO.

References:

1. Kolokythas A, Olech E, Miloro M: Alveolar osteitis: a comprehensive review of concepts and controversies. Int J Dent 2010:249073, 2010
2. Eshghpour M, Rezaei NM, Nejat A: Effect of menstrual cycle on frequency of alveolar osteitis in women undergoing surgical removal of mandibular third molar: a single-blind randomized clinical trial. J Oral Maxillofac Surg 71:1484–9, 2013
3. Hita-Iglesias P, et al: Effectiveness of chlorhexidine gel versus chlorhexidine rinse in reducing alveolar osteitis in mandibular third molar surgery. J Oral Maxillofac Surg 66:441–5, 2008
4. Congiusta MA, Veitz-Keenan A: Study confirms certain risk factors for development of alveolar osteitis. Evid-based Dent 14:86, 2013
5. Haraji A, Rakhshan V: Single-dose intra-alveolar chlorhexidine gel application, easier surgeries, and younger ages are associated with reduced dry socket risk. J Oral Maxillofac Surg 72:259–65, 2014
6. Eshghpour M, Nejat H: Dry socket following surgical removal of impacted third molar in an Iranian population: incidence and risk factors. Niger J Clin Pract 16:496–500, 2013

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