COMPARISON OF COMMA INCISION VERSUS MODIFIED WARD’S INCISION IN MANDIBULAR THIRD MOLAR SURGERY- A CLINICAL STUDY

Authors

  • Vishal Lohana Oral & Maxillofacial Surgery Department, Liaquat University of Medical & Health Sciences, Jamshoro-Pakistan
  • Sundas Kunbher Oral & Maxillofacial Surgery Department, Liaquat University of Medical & Health Sciences, Jamshoro-Pakistan
  • Shumaila Younus Ziauddin University, Karachi-Pakistan
  • Suneel Kumar Punjabi Oral & Maxillofacial Surgery Department, Liaquat University of Medical & Health Sciences, Jamshoro-Pakistan
  • Omaiz Memon Oral & Maxillofacial Surgery Department, Liaquat University of Medical & Health Sciences, Jamshoro-Pakistan
  • Ghulam Ali Oral & Maxillofacial Surgery Department, Liaquat University of Medical & Health Sciences, Jamshoro-Pakistan

Keywords:

Comma incision; Modified Ward’s incision; Third molar

Abstract

Background: To evaluate the effectiveness of the two flap/incision techniques, viz. the comma incision versus modified ward’s incision in mandibular third molar surgery. Methods: This randomized research comprised of 126 participants, 63 in every group. Male and female patients between the ages of 20 and 45 who had mesio-angular impacted mandibular third molar till the age of 20 to 24 years were enrolled in the research. Patients with specific problems, that is pregnancy, trismus, pericoronitis, horizontally impacted wisdom teeth, and disto-angular impaction, and limited mouth opening in which there was difficulty in access to third molar region due to any reason were omitted from the study. The independent t-test were used to evaluate the mouth opening over groups, and the chi-square test were used to evaluate the pain and edema. Results: The participants average age was 31.16±9.29 years. On the first day, the comma shaped group reported significantly mild pain (47.6%) compared to the Modified Ward’s group (30.2%) (p=0.230). On the seventh day, the comma shaped group reported significantly greater mild pain (63.5%) and decreased severe pain (1.6%) compared to the Modified Ward’s group, which reported decrease mild pain (55.6%) and more severe pain (4.8%) (p=0.032). On the first, third and seventh days, mouth opening was also considerably higher in the comma-shaped group than in the Modified Ward's group. On the third and seventh days, swelling was much decreased in the comma-shaped group than in the Modified Ward's group. Conclusion: Our study delivers some proofs that the comma-shaped incision is more effective than the modified Widman's incision at promoting good mouth opening and decrease post-operative edema and discomfort after flap surgery.

References

Rezaei F, Imani MM, Khavid A, Nabavi A. Patterns of mandibular third molar impaction in an Iranian subpopulation. Pesqui Bras Odontopediatria Clín Integr 2020;20:e5411.

Staderini E, Patini R, Guglielmi F, Camodeca A, Gallenzi P. How to manage impacted third molars: Germectomy or delayed removal? A systematic literature reviews. Medicina (Kaunas) 2019;55(3):79–88.

Jung YH, Cho BH. Prevalence of missing and impacted third molars in adults aged 25 years and above. Imaging Sci Dent 2013;43(4):219–25.

Rauf S, Ali W, Tariq Q, Chaudhry R, Kazmi SS, Imtiaz M. Pattern of mandibular third molar impaction: a radiographic study. Pak Oral Dent 2019;39(3):238–42.

Blanco G, Lora D, Marzola C. The different types of flaps in the surgical relations of the third impacted molars–literature review. Dentistry 2016;7(425):2161.

Chiramel SJ, Chammanam S, Kalliath R, Gopinath A. Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study. Int Surg J 2018;5(7):2600–4.

Izquierdo Gómez K, González Navarro B, García Ortiz de Zárate F, Arranz Obispo C, Jane Salas E, LópezLópez J. The importance of flap design in third molar surgery: a systematic review. Biomed J Sci Tech Res 2018:11(5):8798–803.

Arjun B, Rubina G, Akanksha S, Richa A. Evaluation of risk factors predisposing to complications after mandibular third molar surgery. Int J Oral Health Dent 2017;3(2):97–104.

Nagargoje GL, Badal S, Mohiuddin SA, Balkunde AS, Jadhav SS, Bholane DR. Evaluation of electrocautery and stainless steel scalpel in oral mucoperiosteal incision for mandibular anterior fracture. Ann Maxillofac Surg 2019;9(2):230–4.

Ali A, Shah SJ, Shah AA, Aslam S. Comparison of comma incision with Ward's incision in third molar extraction in terms of postoperativecsequel–A clinical study. Natl J Maxillofac Surg 2019;10(2):200.

Kumar A, Memon A, Panjabi SK, Shams S. Flap design: Comparison of ward’s flap versus modified ward’s flap in surgical extraction of impacted mandibular third molar. Prof Med J 2019;26(8):1323–7.

Kumar BS, T S, M V, Raman U. To compare standard incision and comma shaped incision and its influence on post-operative complications in surgical removal of impacted third molars. J Clin Diagn Res 2013;7(7):1514–8.

Rajendran B. Comparison of buccal based triangular flap and lingual based triangular flap on postoperative course after impacted mandibular third molar surgery: a prospective randomized controlled study. J Oral Med Oral Surg 2023;29(1):7–13.

De Marco G, Lanza A, Cristache CM, Capcha EB, Espinoza KI, Rullo R, et al. The influence of flap design on patients’ experiencing pain, swelling, and trismus after mandibular third molar surgery: a scoping systematic review. J Appl Oral Sci 2021;29:e20200932.

Gold SI. Robert Neumann: a pioneer in periodontal flap surgery. J Periodontol 1982;53(7):456–9.

Izquierdo Gómez K, González Navarro B, García Ortiz de Zárate F, Arranz Obispo C, Jane Salas E, LópezLópez J. The importance of flap design in third molar surgery: a systematic review. Biomed J Sci Tech Res 2018:11(5):8798–803

Kirtiloğlu T, Bulut E, Sümer M, Cengiz I. Comparison of 2 flap designs in the periodontal healing of second molars after fully impacted mandibular third molar extractions. J Oral Maxillofac Surg 2007;65(11):2206–10.

Koyuncu BÖ, Cetingül E. Short-term clinical outcomes of two different flap techniques in impacted mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116(3):179–84.

Silva JL, Jardim EC, Dos Santos PL, Pereira FP, Garcia Junior IR, Poi WR. Comparative analysis of 2-flap designs for extraction of mandibular third molar. J Craniofac Surg 2011;22(3):1003–7.

Published

2024-06-02