What are the implications of flap design on post-operative complications when carrying out third molar surgery?

Data sources The review carried out electronic searches using several online databases through November 2018, namely PubMed, Virtual Health Library, Cochrane Library and Scopus. Terms searched for on these databases included third molar, flap and variations thereof. A grey literature search was also conducted.Study selection In total, 2,455 articles were identified,1,449 being duplicates. Additionally, 1,006 articles remained for assessment which, with clear exclusion criteria listed, was reduced to 20. From the 20 incorporated into the review, 18 articles were utilised for meta-analysis. Three of the researchers were involved in assessing the articles after research management software was used to remove the aforementioned duplicates. A Cohen's kappa index was calculated to confirm inter-rater consistency using 10% of the articles.Data extraction and synthesis Data extraction followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance.Results From their systematic review and meta-analyses, the authors found that flap design had no effect on common post-operative complications including pain, trismus, dehiscence, or osteitis. The triangular flap did, however, have greater post-operative ecchymosis but reduced periodontal probing depth on day seven when compared to the envelope flap in mandibular third molar surgeries.Conclusions Third molar surgery is carried out across all facets of dentistry, including general and specialised. Further studies must be carried out that look specifically at these variables utilising randomised controlled trials so a consensus can be achieved across the profession of which flap is of superior design.
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