Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis

Evaluation of a New Simplified Approach for Upper Superficial Impacted Third Molar Extraction-A Retrospective Split-Mouth Study

BACKGROUND

A new access technique was developed to reduce postoperative adverse events after the extraction of impacted maxillary wisdom teeth. Hence, this study aimed to assess the occurrence of adverse events after the extraction of maxillary impacted wisdom teeth using a traditional access (TA) or a new technique (NT).

METHODS

Two different surgical incision designs were used for bilateral wisdom tooth extractions in 30 patients. The traditional incision was performed distal to the second molar in the center of the tuberosity, followed by a buccal releasing incision. After the tooth extraction, the wound was secured by sutures. The new technique consists of an oblique incision from the distal palatal aspect of the tuberosity towards the buccal aspect of the second molar. After the tooth extraction, cyanoacrylate glue was used on the wound.

RESULTS

Lower pain was reported by patients at the site treated with the new technique (p < 0.01). Edema, postsurgical bleeding, and hematoma were similar in both groups. The surgical time was shorter for the new technique (p < 0.01).

CONCLUSIONS

The new technique applied for the extraction of impacted maxillary wisdom teeth reduced postsurgical pain and the duration of surgery.

Assessment of Changes in the Outcome of Autogenous Tooth Grafts Over Time: A Clinical Study Evaluating Periodontal Healing in Bone Defects After Lower Third Molar Removal

BACKGROUND

The removal of impacted lower third molars (ILTMs) is associated with bone defects in the distal area of second molars. Different methods have been described to minimize these defects.

PURPOSE

The primary objective was to assess changes in probing depth (PD) over time (up to 36 months) between test (grafted) and control (ungrafted) groups; the graft was obtained from the extracted ILTM.

STUDY DESIGN, SETTING, SAMPLE

This split-mouth randomized clinical trial was conducted at the Postgraduate Course in Oral Surgery of the Faculty of Dentistry of the Complutense University of Madrid. Adult patients requiring bilateral ILTM extraction with adjacent second molars were recruited, excluding pregnant/lactating women, patients in treatment with nonsteroidal anti-inflammatory drugs and patients with periodontal diseases.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

The predictor variable was the graft technique. The bone defect after ILTM removal was treated with autogenous tooth graft (ATG) in the test group, leaving the control group ungrafted.

MAIN OUTCOME VARIABLE

PD on the distobuccal, distomedial, and distolingual surfaces was recorded in both groups and averaged at baseline (T0), 3 (T1), 6 (T2), and 36 months (T3) postoperatively.

COVARIATES

Sex, age, surgical time, ILTM situation and position between groups were assessed.

ANALYSES

ANOVA repeated measures for comparisons between groups and the Friedman test for comparisons within the groups over time were applied. Statistical significance was established with a confidence interval of 95% (P < .05).

RESULTS

The sample comprised 22 patients (6 males, 16 females) with a mean age of 21.68 ± 2.19 years; 44 ILTM extractions were performed. Statistically significant differences in PD average were found between groups (P < .001, 95% confidence interval) at 3 (1.63 ± 0.29), 6 (1.76 ± 0.3), and 36 months (1.74 ± 0.36). Reductions from T0 to T3 of 2.74 ± 0.28 (P < .001) and 0.54 ± 0.3 (P = .43) were observed in test and control groups, respectively.

CONCLUSION AND RELEVANCE

ATG placed on the distal surface of lower second molars and almost completely filling the extraction socket improved PD 3, 6 and 36 months after ILTM. Furthermore, no significant changes in PD were observed over time; no major complications occurred. ATG appears to be a viable alternative graft material for this procedure.

Development and validation of a rule-based algorithm to identify periodontal diagnosis using structured electronic health record data

AIM

To develop and validate an automated electronic health record (EHR)-based algorithm to suggest a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal Diseases and Conditions.

MATERIALS AND METHODS

Using material published from the 2017 World Workshop, a tool was iteratively developed to suggest a periodontal diagnosis based on clinical data within the EHR. Pertinent clinical data included clinical attachment level (CAL), gingival margin to cemento-enamel junction distance, probing depth, furcation involvement (if present) and mobility. Chart reviews were conducted to confirm the algorithm's ability to accurately extract clinical data from the EHR, and then to test its ability to suggest an accurate diagnosis. Subsequently, refinements were made to address limitations of the data and specific clinical situations. Each refinement was evaluated through chart reviews by expert periodontists at the study sites.

RESULTS

Three-hundred and twenty-three charts were manually reviewed, and a periodontal diagnosis (healthy, gingivitis or periodontitis including stage and grade) was made by expert periodontists for each case. After developing the initial version of the algorithm using the unmodified 2017 World Workshop criteria, accuracy was 71.8% for stage alone and 64.7% for stage and grade. Subsequently, 16 modifications to the algorithm were proposed and 14 were accepted. This refined version of the algorithm had 79.6% accuracy for stage alone and 68.8% for stage and grade together.

CONCLUSIONS

Our findings suggest that a rule-based algorithm for suggesting a periodontal diagnosis using EHR data can be implemented with moderate accuracy in support of chairside clinical diagnostic decision making, especially for inexperienced clinicians. Grey-zone cases still exist, where clinical judgement will be required. Future applications of similar algorithms with improved performance will depend upon the quality (completeness/accuracy) of EHR data.

Six-Month Soft Tissues Healing after Lower Third Molar Extraction: Comparison of Two Different Access Flaps

BACKGROUND

As specific flap designs performed for lower third molar extractions usually influence periodontal healing of the adjacent first and second molars, this study aimed to evaluate the periodontal conditions of these sites after 6 months post-surgery.

METHODS

Forty patients, aged 14-30 years, were included. Surgical extraction of the lower third molar was performed through a flap with papilla detachment (a modified envelope technique with detachment of gingival papilla between the first and second molars) or a trapezoidal flap (characterized by mesial- and distal-releasing incisions). Periodontal parameters at the first and second molar sites were assessed for visible plaque index, bleeding on probing, recession, probing pocket depth, and clinical attachment loss before surgery (T0), one month (T1), and six months after extraction (T2).

RESULTS

No statistical differences were found for the plaque and bleeding indexes between the two flaps at each observation time and considering both time intervals. For recession, no statistical differences were found between the two flaps considering the final time interval. For probing pocket depth at the second molar site, both techniques registered a significant increase between T0 and T1, followed by a decrease up to T2. For clinical attachment loss, mean values assessed for the first and second molar sites demonstrated evidently increased values between T0 and T1, followed by moderate decreases up to T2.

CONCLUSIONS

Considering short (T1) and mid-term (T2) follow-ups, a specific flap design does not seem to particularly influence periodontal healing six months after surgery.

Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study

The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.

Marginal and Para-Marginal Technique in Late Germectomy of Lower Third Molars

INTRODUCTION

Third molar surgery can cause post-operative complications to the patient due to the presence of a wound from the incision. This study aimed to compare marginal flap with para-marginal flap on postoperative complications by the measurements on pre and post-surgical plaque index (PI), bleeding on probing (BoP), maximum opening of the mouth (MOM), pain perception (PP) and post-surgical tumefaction (PT).

METHODS

In this double-blind randomized clinical trial, 40 patients were recruited and randomly allocated in two groups. In Group 1, third molar extraction was carried out after a marginal flap design was performed, while in Group 2 a para-marginal flap was performed. Plaque index, bleeding on probing, maximum mouth opening, and distal probing were assessed right before and one week after surgery, while post-operative pain perception and post-operative swelling were accounted one week following surgery.

RESULTS

Statistically significant differences were reported between treatment groups, as the para-marginal flap led to better outcomes for all the measured indexes.

CONCLUSIONS

The para-marginal flap design may decrease the occurrence of post-operative complications and discomforts after mandibular third molar surgery, compared to marginal flap design.

Effects of Flap Design on the Periodontal Health of Second Lower Molars after Impacted Third Molar Extraction

The purpose of this study was to compare the envelope flap and triangular flap for impacted lower third molar (M3) extraction and their effects on the periodontal health of adjacent second molars (M2). A population of 60 patients undergoing M3 extraction with the envelope flap (Group A) or triangular flap (Group B) was analyzed, comparing probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) recorded at six sites (disto-lingual, mid-lingual, mesio-lingual, disto-vestibular, mid-vestibular, and mesio-vestibular) before (T⁰) and 6 months after extraction (T¹). There was a statistically significant mean difference in PPD and CAL at two sites, disto-vestibular (dv) and disto-lingual (dl), between values recorded before and 6 months after surgery for either Group A or Group B. Furthermore, for the same periodontal records, at 6 months after surgery, a statistically significant difference was recorded between younger and older patients, implying that the healing process was more beneficial for younger patients. No significant differences were found between the two groups (A and B) in PPDdl, PPDdv, CALdl, and CALdv, confirming that the mucoperiosteal flap design does not influence the periodontal healing process of second molars.

Factors affecting periodontal healing of the adjacent second molar after lower third molar surgery: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aim to evaluate the effect modifiers which may influence the periodontal healing of the adjacent second molar after lower third molar surgery.

MATERIALS AND METHODS

Prospective studies including patients with third molars requiring removal, with at least 6 months follow-up were considered. Outcomes were periodontal probing depth (PPD) reduction, final PPD, clinical attachment level (CAL) change, final CAL, alveolar bone defect (ABD) reduction, and final ABD depth. Meta-regression was performed to identify factors.

RESULTS

Fourteen studies were included in the quantitative synthesis. At 6 months, the PPD reduction was 1.06 mm (95% CI, 0.72 to 1.39 mm) and the remaining PPD was 3.81 mm (95% CI, 3.00 to 4.62 mm). Baseline PPD was strongly correlated with the remaining PPD at 6 months (p < 0.001, adjusted R² = 70.05%).

CONCLUSIONS

Lower third molar surgery results in a modest reduction in PPD, CAL, and ABD; however, periodontal defects still remain at 6 months and beyond. Baseline PPD is strongly correlated with final PPD. While age is not shown to have effect on most of the periodontal parameters, a larger baseline PPD is more likely to manifest with increasing age and third molar surgery should be done before severe periodontitis occurs to avoid persistent periodontal defects.

CLINICAL RELEVANCE

This study shows that lower third molar surgery results in modest improvement in periodontal parameters on adjacent second molars and identified factors such as baseline PPD which may affect the healing, which may guide the pre-, peri-, and post-operative management of lower third molar surgery.

Periodontal Healing after Lower Third Molars Extraction: A Clinical Evaluation of Different Flap Designs

Periodontal healing after third molars extraction seems to be influenced by the choice of different flap techniques. The purpose of the present study was to assess the clinical condition of adjacent first and second molar sites, after the extraction of lower third molars, performed through different flap designs. Eighty patients, aged between 14 and 30 years, were analyzed for periodontal parameters of VPI, PPD, and CAL, pre-operatively (T0), after 15 days (T1), after 1 month (T2), and after 2 months (T3) from extraction. Techniques performed were trapezoidal flap (TRAP), marginal flap (MARG), flap with papilla detachment (DETP), and flap with papilla decapitation (DEC). No significant differences were found between the four flaps at each observation time and considering the interval between T0 and T3, for VPI, PPD at first molar site, PPD at second molar site, and CAL at second molar site. Significant variations for CAL were registered, for each flap, between T0 and T3, in all cases for buccal site, in three cases for buccal-distal site. After 2 months of follow-up, no strong evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.

Antibiotics Efficiency in the Infection Complications Prevention after Third Molar Extraction: A Systematic Review

(1) Background: Antibiotics are used in every medical field including dentistry, where they are used for the prevention of postoperative complications in routine clinical practice during the third molar extraction. (2) Methods: This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The present systematic review aimed to evaluate and systematize the use of antibacterial drugs in order to prevent postoperative complications in outpatient oral surgery for wisdom teeth extraction. We conducted a systematic review using electronic databases such as Medline PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Considering inclusion and exclusion criteria, we included randomized clinical trials published up to 2021 investigating the antibiotic prescription for third molar extraction. (3) Results: We selected 10 studies after the application of inclusion and exclusion criteria. The results showed that the most widely used antibiotic was amoxicillin both with and without clavulanic acid, in different dosages and duration. There were no statistically significant differences between treatment groups for development of postoperative complications. (4) Conclusions: Based on the analysis of the included studies, penicillin is currently the most widely prescribed group of antibiotics. The widespread use of this antibiotic group can lead to antimicrobial resistance (AMR). Due to increasing prevalence of bacteria resistance to penicillins, clinicians should carefully prescribe these antibiotics and be aware that the widespread use of amoxicillin may do more harm than good for the population.

Clinical Evaluation of Intraoral Suture Patterns Using Poliglecaprone 25 in Greyhound Dogs

To evaluate healing and complications of extraction sites closed with a simple interrupted pattern (SI) and a simple continuous (SC) suture pattern in a prospective randomized clinical trial. Greyhounds were selected from a rescue with a standardized environment and naturally occurring disease. Surgical extractions were performed (35 sites) and all mucogingival flaps were closed with 4-0 poliglecaprone 25 using either SI or SC randomly assigned by surgical site. Oral healing/dehiscence, suture inflammation, suture loss, accumulation of debris, presence/nature of discharge, necrotic tissue and adjacent contact ulceration were evaluated. Fisher's exact test was used to compare categorical data and two-tail T tests used to compare continuous data. Results showed SC was faster to apply. No new dehiscence events were detected after Recheck 1. There was no significant difference for dehiscence scores between SI and SC. A trend was seen towards more major dehiscence in the SI group. This study concluded SC is an alternative to SI for closure of occlusal surfaces in the mouth. Mandibular canine tooth extraction sites were more likely to have a high dehiscence score than all other sites combined regardless of surgical technique.

Lingual bone thickness in the apical region of the horizontal mandibular third molar: A cross-sectional study in young Japanese

Background

Perforation of the lingual plate in the apical region of mandibular third molars will increase the risk of aberration and migration of the root tip and the risk of lingual nerve injury. The aim of this study was to analyze anatomical information, including relationships between the apical region of horizontally impacted mandibular third molars and lingual plates, in young Japanese.

Methods

Japanese patients, with horizontally impacted third molars, who underwent CT examination as a preoperative assessment for mandibular third molar extraction were included, and anatomical characteristics in the apical region of the right mandibular third molar were analyzed, in this study.

Results

A total of 121 patients were included based on the inclusion and exclusion criteria of this study. The mean and standard deviation of the bone thickness on the lingual side of the mandibular third molar in the apical region was 1.5 ± 1.6 mm, and the absence of lingual cortical bone in the apical region, namely, “perforation”, was observed in 44 patients. The statistical analysis revealed the predictors of cases with perforation as follows: gender, age, and the available space evaluated by Pell and Gregory classification.

Conclusions

This study clarified that “perforation” was sometimes observed in young Japanese, and that the predictors of those cases were as follows: gender, age, and the available space evaluated by Pell and Gregory classification.

Does kinesio taping reduce pain, swelling, and trismus after mandibular third molar surgery? A systematic review and meta-analysis

The aim of this study is to provide an evidence-based conclusion regarding the effectiveness of kinesio taping (KT) in reducing postsurgical discomforts after mandibular third molar surgery and critically appraise the available literature. Eligible clinical trials evaluating patients older than 18 years who were treated with any type of KT compared to no taping in which pain, swelling, or trismus scores were reported were included. An electronic literature search was carried out in the following databases to identify relevant papers up to May 30, 2021: Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The effect sizes were calculated using mean difference (MD) and standardized mean difference (SMD). The heterogeneity analysis was conducted using (I²) statistic at alpha = 0.10 (PROSPERO; CRD42021252670). Nine randomized clinical trials with 444 participants were included in the qualitative analysis and eight in the quantitative analysis. The results of the meta-analysis revealed a statistically significant reduction in pain and swelling scores before the 7th postoperative day. On the 7th postoperative day, no significant difference was observed between KT and control groups in terms of pain and swelling. Additionally, KT led to an increase in patients' maximum mouth opening of more than 3 mm in postoperative intervals. KT is effective in reducing postoperative pain within the first 48 h after surgery and improving mouth opening during all postoperative intervals with moderate to high certainty of evidence.

A systematic review and meta-analysis on the effectiveness of xenograft to prevent periodontal defects after mandibular third molar extraction

Background

To evaluate the use of guided bone regeneration with xenograft to prevent periodontal defect in the distal aspect of the second molar after the surgical removal of the mandibular third molar.

Material and Methods

Three electronic databases (Pubmed, Cochrane Library and Scopus) were searched in April 2020. Randomized clinical trials in non-smokers and healthy patients, with at least six months follow-up, comparing periodontal probing depth, clinical attachment level, alveolar bone level and adverse events were selected by two independent investigators. The risk of bias assessment of the selected studies was evaluated by means of the Cochrane Collaboration’s Tool. Finally, a meta-analysis of the outcomes of interest was performed.

Results

Despite 795 articles were found in the initial search, only three randomized controlled clinical trials were included. Pooled results favoured the use of the xenograft plus collagen membrane over the spontaneous healing in terms of periodontal probing depth gain (MD=2.36; 95% CI 0.69 to 4.03; P=0.005) and clinical attachment level gain (MD=2.52; 95% CI 0.96 to 4.09; P=0.002). No other statistically significant differences were found.

Conclusions

Within the limitations of the present review, the xenograft plus collagen membrane exhibited better periodontal results than spontaneous healing without increasing postoperative complications. However, future well-designed studies with larger samples are required to confirm our results.

Key words:Third molar, tooth extraction, bone regeneration, xenograft.

The influence of flap design on patients' experiencing pain, swelling, and trismus after mandibular third molar surgery: a scoping systematic review

Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane’s Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient’s perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon’s experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.

A Pilot Retrospective Study on the Effect of Bone Grafting after Wisdom Teeth Extraction

This study aimed to retrospectively investigate the effect of bone graft after extraction of wisdom teeth impacting with the distal aspect of the second molar, on soft tissue wound healing, bone loss, and periodontal parameters. Sixteen patients treated an for impacted mandibular wisdom tooth at least one year ago were re-called (18 teeth). Dental panoramic tomography and periodontal parameters were assessed. A graft material was used to fill the post-extractive sockets in the test group (GUIDOR easy-graft CRYSTAL), whereas in the control group, the socket was filled using a collagen sponge and blood clot (Hemocollagene, Septodont, Matarò, Spain). The radiographic bone loss was measured at the distal aspect of the second molar. The Wilcoxon singed-rank test for paired data was performed to evaluate statistical differences. In the test group, only two cases out of nine showed bone loss, with an average of 0.55 ± 1.30 mm. Conversely, in the control group, five teeth out of nine showed bone resorption with an average of 1.22 ± 1.30 mm. However, the differences were not statistically significant. Periodontal parameters at the second molar demonstrated similar behavior between the test and control groups. Soft tissue healing complications were lower in the grafted compared to the comparator sites without reaching statistical significance. Within the limitations of the present study, no difference was found between the two groups.

Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar

The extraction of impacted lower third molars (ILTM) is one of the most common procedures in oral-maxillofacial surgery. Being adjacent to lower second molars, most impacted lower third molars often lead to distal periodontal defects of adjacent second molars. Several symptoms may occur after extraction, such as periodontal pocket formation, loss of attachment, alveolar bone loss and even looseness of second molar resulting in extraction. The distal periodontal defects of second molars are affected by many factors, including periodontal conditions, age, impacted type of third molars, and intraoperative operations. At present, several studies have suggested that dentists can reduce the risk of periodontal defects of the second molar after ILTM extraction through preoperative evaluation, reasonable selection of flap design, extraction instruments and suture type, and necessary postoperative interventions. This review summarizes the research progress on the influence factors, interventions methods and some limitations of distal periodontal defects of adjacent second molar after extraction of impacted mandibular third molars, with the aim of opening up future directions for studying effects of ILTM extraction on periodontal tissue of the adjacent second molar.

Does the Lingual-Based Mucoperiosteal Flap Reduce Postoperative Morbidity Compared With the Buccal-Based Mucoperiosteal Flap After the Surgical Removal of Impacted Third Molars? A Meta-analysis Review

PURPOSE

The lingual-based mucoperiosteal flap, a novel flap, was unclear about the effects on the prognosis of surgery for impacted mandibular third molars. This study aimed to compare the lingual- and buccal-based mucoperiosteal flaps with respect to postoperative responses and complications.

MATERIALS AND METHODS

A systematic review with a meta-analysis was designed and the PubMed, Cochrane Library, EMBASE, and Web of Science databases and Google Scholar from January 1, 2000 to April 30, 2020 were searched for randomized clinical trials. The predictor variable was buccal- or lingual-based flap in the surgery, and the outcome variables were pain, swelling, trismus, operative time, and wound dehiscence. Other study variables were sex and retention depth of impacted teeth. RevMan 5.3 software was used for data analysis. Mean differences or standardized mean differences and risk ratios were computed to assess associations between 2 variables, where statistical significance was set at P < .05.

RESULTS

Seven publications met the inclusion criteria, contributing 370 subjects who had 590 teeth removed to sample. The lingual-based flap failed to significantly reduce postoperative discomfort. However, subgroup analysis revealed that subjects who underwent comma flap (a type of lingual-based flap) surgeries complained of milder pain than those who underwent buccal-based flap surgeries on day 1 (mean difference = -1.18, 95% confidence interval [CI] [-1.53, -0.83], P < .001) and day 7 (mean difference = -1.80, 95% CI [-2.13, -1.48], P < .001) after surgery. Significant differences were also observed on days 1, 3, and 7 regarding postoperative swelling and trismus (P < .01). In addition, the lingual-based flap was reported to cause a significantly lower rate of wound dehiscence (relative risk = 0.46, 95% CI [0.30, 0.69], P = .0002).

CONCLUSIONS

The lingual-based flap was associated with better primary wound closure in third molar removal. The comma flap, as a subtype, was preferable for relieving postoperative pain, swelling, and trismus over the buccal-based flap.

Flapless Surgical Approach to Extract Impacted Inferior Third Molars: A Retrospective Clinical Study

This study aimed to compare a flapless surgical approach (FSA) with a traditional envelope flap (traditional approach (TA)). Every patient was treated with two approaches: TA and FSA. The primary outcome variables were both the discomfort during the post-operative convalescence and the correct final recovery of the impacted area. The secondary outcome variable was the average duration of the surgery. Post-operative pain and oedema were recorded. The measurements of soft tissue interface toward the distobuccal edge of the second molar were taken by periodontal probe before surgery (baseline) and 8 weeks after surgery. Statistical software was used to evaluate the data; a p-value < 0.05 was considered statistically significant. Twenty-four teeth of 12 patients (six Caucasian males and six Caucasian females, aged 23 ± 4 (17-30) years) with both lower impacted third molars (Ms3) were analysed. Considering an alpha error 0.05 that sample size allows power from 0.80 to 0.90, depending on the variable evaluated. Concerning attached gingiva, oedema and pain, the linear mixed model resulted in a statistically significant difference between the TA and FSA (p = 0.003; p < 0.01; and p = 0.018, respectively). Conversely, the model did not show a difference (p = 0.322) if pocket probing depth was considered. The FSA procedure was faster (p < 0.05) than the TA procedure (17 min and 8 s (±6 s) vs. 28 min and 6 s (±4 s), respectively). The results suggest that the FSA could be a suitable option for improving the surgical removal of lower Ms3. However, additional randomized controlled trial studies are necessary to confirm the reliability of our procedure and to verify its suitability in more complex Ms3 classifications.

Effectiveness of Bone Graft for an Alveolar Defect on Adjacent Second Molar After Impacted Mandibular Third Molar Extraction

PURPOSE

This retrospective study examined distal bone healing on the adjacent second molar between the demineralized bone matrix incorporated with recombinant human bone morphogenetic protein-2 (DBM/rhBMP-2) and a collagen sponge in the mandibular third molar extraction socket.

MATERIALS AND METHODS

From 2018 to 2020, 26 extraction patients (male, average 21.5 years), who received a graft (each of 13 using DBM/rhBMP-2 and collagen plug, respectively) on the extraction socket without primary closure, were enrolled in this study. The bony defect was measured by computed tomography before and 6 months after the extraction. The difference in the bone healing was analyzed between the DBM/rhBMP-2 and collagen plug groups using a Mann-Whitney U test.

RESULTS

No complications, such as infection and food packing, were encountered. The DBM/rhBMP-2 and collagen plug groups showed a similar distribution of preoperative bony defect (median 5.8 and 5.0 mm, respectively). After 6 months, more bone healing was observed in the DBM/rhBMP-2 group than in the collagen plug group (median 3.85 and 2.37 mm, respectively, P = .029) CONCLUSIONS: A DBM/rhBMP-2 graft after a third molar extraction does significantly alter the bony defect on the distal aspect of the second molar compared with a collagen plug.

Five-Years Periodontal Outcomes of Early Removal of Unerupted Third Molars Referred for Orthodontic Purposes

PURPOSE

The removal of third molars (M3) is one of the most common oral-maxillofacial surgical procedures affecting periodontal tissues of neighboring second molars (M2). The aim of this study was to evaluate the periodontal status of lower M2 following the removal of unerupted lower M3 up to 5 years after removal.

PATIENTS AND METHODS

Primary predictor variable in this prospective cohort-study was time [baseline (BL; preoperatively), 6 and 60 months postoperatively]. The primary outcome variable was probing pocket depth (PPD). Clinical attachment level (CAL) was defined as a secondary outcome variable. Plaque index (PlI) and gingival index (GI) were assessed descriptively. All variables were compared using nonparametric tests. M3 were classified as either completely bony or partially bony unerupted. Risk factors (removed M3, type of impaction, mean BL PPD≥4 mm, gender, age) were analyzed (repeated measures ANCOVA). The significance level was set at 0.05.

RESULTS

From originally 91 subjects enrolled in this study, 39 subjects (22 females; mean age: 21.6 ± 2.5 years) contributing 39 M3 completed the study after 5 years. Average BL PPD significantly decreased at 6 (-0.50 ± 0.61 mm, P = .001), 60 months (-0.81 ± 0.56, P < .0001), as well as between 6 and 60 months (-0.31 ± 0.51 mm, P = .030). Corresponding CAL values decreased accordingly (BL-6 months: -0.37 ± 0.59 mm, P = .004; BL-60 months: -0.67 ± 0.55 mm, P < .0001; 6 to 60 months: -0.34 ± 0.48 mm, P = .004). The was confirmed as risk factor for PPD (P = .026) and CAL (P = .042) changes.

CONCLUSIONS

Average PPD and CAL of mandibular M2 in young subjects improved 5 years after early removal of unerupted M3 in favor of an initial partially bony unerupted type of impaction.

Influence factors of dental anxiety in patients with impacted third molar extractions and its correlation with postoperative pain: a prospective study

Background

To explore the prevalence of dental anxiety (DA) in patients with third molar extractions and its influence factors and the correlation between DA levels and postoperative pain.

Material and Methods

A prospective and descriptive clinical study was performed. All patients who underwent the impacted third molar extraction from October 2017 to February 2019 were enrolled. DA levels were assessed by virtue of the modified dental anxiety scale (MDAS) and pain was assessed with a visual analog scale (VAS).

Results

A total of 150 patients were investigated and 136 valid questionnaires were retrieved, with an effective rate of 90.7%. The independent sample t-test and ANOVA results showed that the anxiety level of patients with the third molar extractions was statistically different in gender, teeth extraction experience and self-assessment oral health status. Multiple linear regression analysis with DA as a dependent variable showed that gender and teeth extraction experience were independent factors influencing DA in patients with third molar extractions. Pearson's test showed that there was a significant correlation between DA level in patients and the postoperative pain on the first day (r=0.542, p=0.000).

Conclusions

For patients (females, poor oral hygiene and no teeth extraction experience), surgeon should pay more attention to DA of such patients and take measures to reduce the anxiety when removing the third molars. Furthermore, surgeon can recommend oral administration ibuprofen sustained release capsules after surgery.

Key words:Dental anxiety, modified dental anxiety scale, visual analogue scale, postoperative pain.

Treatment of Osseous Defects after Mandibular Third Molar Removal with a Resorbable Alloplastic Grafting Material: A Case Series with 1- to 2-Year Follow-Up

Mandibular third molar (M3) surgical extraction may cause periodontal complications on the distal aspect of the root of the adjacent mandibular second molar (M2). Patients older than 26 years with periodontal pathology on the distal surface of the M2 and a horizontal/mesioangular impacted M3 may benefit from bone regenerative therapy at the time of surgery. In this prospective case series, an alloplastic fully resorbable bone grafting material, consisting of beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), was used for the treatment of the osseous defects after the removal of horizontal or mesioangular M3s in 4 patients older than 26 years. On presentation, the main radiological finding in all patients, indicating periodontal pathology, was the absence of bone between the crown of the M3 and the distal surface of the root of the M2. To evaluate the treatment outcome, bone gain (BG) was assessed by recording the amount of bone defect (BD) at the time of surgical removal (T0) and at the time of final follow-up (T1) 1 or 2 years post-operatively. The healing in all cases was uneventful, with no complications associated with the use of the alloplastic grafting material. Clinical and radiological examination at T1 revealed that all extraction sites were adequately restored, with significant BG of 6.07 ± 0.28 mm. No residual pathological pockets on the distal surface of the M2 were detected. Pocket depth (PD) at T1 was 2 ± 0.71 mm. Within the limitations of this case series, the results suggest that β-TCP/CS can support new bone formation at M3 post-extraction sites where bone regeneration methods are indicated, thus reducing the risk of having persistent or developing new periodontal problems at the adjacent M2.

Modified envelope flap, a novel incision design, can relieve complications after extraction of fully horizontal impacted mandibular third molar

Background/purpose

Patients always suffer from dental extraction complications of fully horizontal impacted mandibular third molar, such as pain, swelling and limited mouth opening. A novel incision, modified envelope flap (MEF), was designed to alleviate the complications through minimizing the tissue injury during this surgery procedure.

Materials and methods

With indications of removing bilateral fully horizontal impacted mandibular the third molars, 40 patients were recruited and received dental extraction under incision with modified envelope flap (MEF) in one lateral and modified triangular flap (MTF) in the other lateral respectively. MEF incision was made along the buccal gingival sulcus from mesial to distal of the mandibular second molar with an extension to retromolar trigone at 45°inclination. As a control, traditional incision MTF was made starting with a vertical incision at the mesial buccal gingiva of the mandibular second molar with extension as MEF. Fully horizontal impacted mandibular third molar were extracted successfully. Surgery time and postoperative pain, swelling and mouth opening were recorded at day 1, 3, 7.

Results

There was no significant difference of the surgery time, pain, swelling (day 1) and mouth opening (day1) between MEF and MTF group (p > 0.05). However, the scores of swelling (day 3, 7) and mouth opening (day3, 7) of MEF group were much lower than that of MTF group (p < 0.05), indicating attenuated complications and quicker recovery.

Conclusion

With small injury, MEF hasn't prolong the surgery time but relieves complications after extraction of fully horizontal impacted mandibular third molar and might be a promising method compared with MTF.

Surgical techniques for the removal of mandibular wisdom teeth

BACKGROUND

Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that may occasionally threaten life. Surgery is commonly associated with short-term postoperative pain, swelling and trismus. Less frequently, infection, dry socket (alveolar osteitis) and trigeminal nerve injuries may occur. This review focuses on the optimal methods in order to improve patient experience and minimise postoperative morbidity.

OBJECTIVES

To compare the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 8 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2019, Issue 6), MEDLINE Ovid (1946 to 8 July 2019), and Embase Ovid (1980 to 8 July 2019). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication.

SELECTION CRITERIA

Randomised controlled trials comparing different surgical techniques for the removal of mandibular wisdom teeth.

DATA COLLECTION AND ANALYSIS

Three review authors were involved in assessing the relevance of identified studies, evaluated the risk of bias in included studies and extracted data. We used risk ratios (RRs) for dichotomous data in parallel-group trials (or Peto odds ratios if the event rate was low), odds ratios (ORs) for dichotomous data in cross-over or split-mouth studies, and mean differences (MDs) for continuous data. We took into account the pairing of the split-mouth studies in our analyses, and combined parallel-group and split-mouth studies using the generic inverse-variance method. We used the fixed-effect model for three studies or fewer, and random-effects model for more than three studies.

MAIN RESULTS

We included 62 trials with 4643 participants. Several of the trials excluded individuals who were not in excellent health. We assessed 33 of the studies (53%) as being at high risk of bias and 29 as unclear. We report results for our primary outcomes below. Comparisons of different suturing techniques and of drain versus no drain did not report any of our primary outcomes. No studies provided useable data for any of our primary outcomes in relation to coronectomy. There is insufficient evidence to determine whether envelope or triangular flap designs led to more alveolar osteitis (OR 0.33, 95% confidence interval (CI) 0.09 to 1.23; 5 studies; low-certainty evidence), wound infection (OR 0.29, 95% CI 0.04 to 2.06; 2 studies; low-certainty evidence), or permanent altered tongue sensation (Peto OR 4.48, 95% CI 0.07 to 286.49; 1 study; very low-certainty evidence). In terms of other adverse effects, two studies reported wound dehiscence at up to 30 days after surgery, but found no difference in risk between interventions. There is insufficient evidence to determine whether the use of a lingual retractor affected the risk of permanent altered sensation compared to not using one (Peto OR 0.14, 95% CI 0.00 to 6.82; 1 study; very low-certainty evidence). None of our other primary outcomes were reported by studies included in this comparison. There is insufficient evidence to determine whether lingual split with chisel is better than a surgical hand-piece for bone removal in terms of wound infection (OR 1.00, 95% CI 0.31 to 3.21; 1 study; very low-certainty evidence). Alveolar osteitis, permanent altered sensation, and other adverse effects were not reported. There is insufficient evidence to determine whether there is any difference in alveolar osteitis according to irrigation method (mechanical versus manual: RR 0.33, 95% CI 0.01 to 8.09; 1 study) or irrigation volume (high versus low; RR 0.52, 95% CI 0.27 to 1.02; 1 study), or whether there is any difference in postoperative infection according to irrigation method (mechanical versus manual: RR 0.50, 95% CI 0.05 to 5.43; 1 study) or irrigation volume (low versus high; RR 0.17, 95% CI 0.02 to 1.37; 1 study) (all very low-certainty evidence). These studies did not report permanent altered sensation and adverse effects. There is insufficient evidence to determine whether primary or secondary wound closure led to more alveolar osteitis (RR 0.99, 95% CI 0.41 to 2.40; 3 studies; low-certainty evidence), wound infection (RR 4.77, 95% CI 0.24 to 96.34; 1 study; very low-certainty evidence), or adverse effects (bleeding) (RR 0.41, 95% CI 0.11 to 1.47; 1 study; very low-certainty evidence). These studies did not report permanent sensation changes. Placing platelet rich plasma (PRP) or platelet rich fibrin (PRF) in sockets may reduce the incidence of alveolar osteitis (OR 0.39, 95% CI 0.22 to 0.67; 2 studies), but the evidence is of low certainty. Our other primary outcomes were not reported.

AUTHORS' CONCLUSIONS

In this 2020 update, we added 27 new studies to the original 35 in the 2014 review. Unfortunately, even with the addition of these studies, we have been unable to draw many meaningful conclusions. The small number of trials evaluating each comparison and reporting our primary outcomes, along with methodological biases in the included trials, means that the body of evidence for each of the nine comparisons evaluated is of low or very low certainty. Participant populations in the trials may not be representative of the general population, or even the population undergoing third molar surgery. Many trials excluded individuals who were not in good health, and several excluded those with active infection or who had deep impactions of their third molars. Consequently, we are unable to make firm recommendations to surgeons to inform their techniques for removal of mandibular third molars. The evidence is uncertain, though we note that there is some limited evidence that placing PRP or PRF in sockets may reduce the incidence of dry socket. The evidence provided in this review may be used as a guide for surgeons when selecting and refining their surgical techniques. Ongoing studies may allow us to provide more definitive conclusions in the future.

The effect of triangular and reversed triangular flap designs to post third molar odontectomy complications (a pilot study)

Background

Odontectomy is one of the most common surgical procedures in oral and maxillofacial surgery. Flap design influences the post operative complications. Triangular flap is the most widely used flap design but it has many shortages such as dehiscence, alveolar osteitis, reactionary bleeding, and periodontal disruption distal of second molar. The aim of this study is to introduce an alternative flap design in the surgical removal of impacted mandibular third molars – reversed triangular flap – and to compare this flap design with the triangular flap in case of dehiscence, reactionary bleeding, and clinical attachment loss.

Material and Methods

This prospective, split-mouth study involved 15 patients with bilateral partially impacted mandibular third molars with similar impaction classification. One impacted tooth was removed using a triangular flap and the other using a reversed triangular flap. Post operative complications such as dehiscence, reactionary bleeding, and clinical attachment loss were recorded 1, 3, 7, 14, and 30 days post odontectomy.

Results

Chi square test result shows that there were fewer incidences of dehiscence seven days post surgery using the reversed triangular flap (p=0.032). Mann Whitney-U test result shows that the reversed triangular flap exhibited less bleeding score on day 1 (p=0.002) and day 2 (p=0.035) post surgery. There were no statistically significant differences according to Mann Whitney-U test between the flap designs for the clinical attachment loss on distal of second molar on day 14 (p=0.512) and day 30 (p=0.902) post surgery.

Conclusions

The reversed triangular flap design is preferable to triangular flap for impacted third molar surgery, escpecially in terms of wound dehisence and reactionary bleeding.

Key words:Flap design, third molar impaction, odontectomy, post odontectomy complications.

Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis

BACKGROUND

To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction.

MATERIAL AND METHODS

An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus.

RESULTS

From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs.

CONCLUSIONS

Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs.

Envelope or triangular flap for surgical removal of third molars? A systematic review and meta-analysis

The aim of this systematic review was to compare the triangular and envelope flaps in mandibular third molar surgery with regard to pain, oedema, and trismus. Secondary outcomes assessed were dehiscence, ecchymosis, alveolar osteitis, periodontal condition, and surgical time. The PRISMA guidelines and recommendations in the Cochrane Handbook were followed, and the review was registered before commencement (PROSPERO; CRD42018112373). The literature search was conducted in the Web of Science, PubMed, Virtual Health Library, Cochrane Library, and Scopus databases and in the grey literature; randomized clinical trials, indexed through November 2018 were included. Three reviewers independently examined the studies. Twenty studies were included in the qualitative analysis, of which 18 were included in the meta-analyses. The flap design did not influence pain, oedema, trismus, dehiscence, or osteitis. The triangular flap was associated with a greater occurrence of postoperative ecchymosis (odds ratio 4.58, 95% confidence interval 1.34 to 15.91, I²=0) and lower periodontal probing depth on day 7 postoperative (standardized mean difference -1.36, 95% confidence interval -2.68 to -0.03, I²=88%) when compared to the envelope flap in mandibular third molar surgeries.

Comparison of Different Kinesio Taping Techniques After Third Molar Surgery

PURPOSE

Elastic therapeutic taping method has been shown to reduce pain and edema after surgery. The purpose of the present study was to compare the effects of 2 different Kinesio taping (KT) techniques on swelling, pain, and trismus after third molar surgery.

PATIENTS AND METHODS

The study was designed as a split-mouth, single-blinded, and controlled randomized clinical trial. Patients undergoing lower impacted third molar extraction at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, were included in the present study. Group I included 30 patients and was used to compare the classic KT technique (technique A) and the new KT technique (technique B). Group II included 15 patients and was used to compare the classic KT technique (technique A) and no KT (No-KT [control]). Group III included 15 patients and was used to compare the new KT technique (technique B) and No-KT (control). Swelling was assessed using the 3dMD Face System (3dMD, Atlanta, GA). The maximum interincisal distance was recorded using a digital caliper preoperatively (T0) and at postoperative days 2 (T1) and 7 (T2). The visual analog scale for pain scores were recorded postoperatively at 30 minutes, 1, 2, 3, 4, 5, 6, 8, 10, 12, and 24 hours, and 1, 2, 3, 4, 5, 6, and 7 days. The effects of operative time, patient age, and patient gender were also evaluated.

RESULTS

The data from 60 patients (27 men and 33 women) with a mean age of 22.28 years (range, 18 to 31 years) were analyzed in the present study. The amount of swelling and the interincisal distance were less with technique B than with technique A and no KT (control group).

CONCLUSIONS

KT is a useful method for reducing postoperative morbidity after impacted third molar extraction. In particular, the application of KT using the new technique described in the present study could be more effective than the classic methods.

Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

PURPOSE

The objective of the present systematic review was to compare the postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery.

MATERIALS AND METHODS

The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from the inception date to November 2018. Randomized and nonrandomized controlled trials were included if they had met certain inclusion and exclusion criteria. The predictor variable was the flap design, envelope or triangular. The outcome variables were operation time, pain, trismus, alveolar osteitis (AO) incidence, wound dehiscence, and swelling. The methodologic quality assessment was performed in accordance with the Cochrane Collaboration guidelines. The meta-analysis was performed using Review Manager, version 5.2.

RESULTS

A total of 21 studies were included for qualitative synthesis, 18 of which were included in the meta-analysis. The use of envelope flaps required less operation time than triangular flaps (P < .00001; I² = 9%). In the Pell and Gregory A and B subgroups, envelope flaps were associated with a significantly lower visual analog scale score at 3 (P = .05, I² = 0%) and 7 (P = .02; I² = 0%) postoperative days and with a greater postoperative interincisal distance at 7 postoperative days (P = .04; I² = 0%). In contrast, envelope flaps were associated with a greater AO incidence in the subgroup of split-mouth randomized controlled trials (P = .001; I² = 0%).

CONCLUSIONS

Envelope flaps required a shorter operation time than triangular flaps and were associated with less postoperative pain and trismus when applied to impacted mandibular third molars of Pell and Gregory Class A or B. In contrast, triangular flaps were associated with a decreased incidence of AO compared with envelope flaps.

The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split-mouth randomised clinical trial

BACKGROUND

Surgical removal of impacted mandibular third molar is one of the most frequently performed interventions in oral and maxillofacial surgery.

OBJECTIVES

To compare two different flap designs in terms of sequelae and quality of life following surgical removal of impacted third molars.

METHODS

This prospective, randomised, split-mouth clinical study involved patients referred for surgical removal of bilateral symmetrical impacted mandibular third molars. Envelope flap and modified triangular flap techniques were used. The effects of flap design on trismus, swelling, wound dehiscence, alveolar osteitis, haematoma, infection and quality of life were evaluated on post-operative days 3 and 7. Pain levels were assessed on post-operative days 1, 3 and 7.

RESULTS

Significant differences were determined between the two groups in terms of trismus, pain and wound dehiscence scores on post-operative day 3. However, on post-operative day 7, this difference was observed only in trismus. Statistically significant differences were also determined between the two groups on post-operative day 3 for social isolation and eating subscale scores as well as total quality of life score.

CONCLUSION

Based on the study findings, the modified triangular flap may be superior to the envelope flap in terms of pain, trismus, and wound dehiscence in the first 3 days after impacted third molar surgery and may have a better impact on quality of life during this process.

Retrospective comparative clinical study for silk mat application into extraction socket

Background

Silk mats have been approved for clinical trials by the Korean Food and Drug Administration as membranes for guided tissue regeneration (GTR). In this study, silk mat application was compared to high-density polytetrafluoroethylene (dPTFE) membrane application or no membrane group.

Methods

To compare the silk mat group to the dPTFE group or the no membrane group, a retrospective sample collection was conducted. Bony defects were measured at the time of extraction (T0) and then at 3 months (T1) and 6 months after extraction (T2) on a digital panoramic view. Bone gain (BG) was calculated by subtracting from the bony defect at T0 to the bony defect at each follow-up.

Results

The BG at T2 was 2.44 ± 2.49 mm, 4.18 ± 1.80 mm, and 4.24 ± 2.05 mm in the no membrane group, silk mat group, and dPTFE group, respectively. Both membrane groups had significantly higher BG than BG in the no membrane group at T2 (P < 0.05).

Conclusions

Both membrane groups showed higher BG than the no membrane group.

Clinical Study for Silk Mat Application into Extraction Socket: A Split-Mouth, Randomized Clinical Trial

Silk mat originates from the cocoon of the silkworm and is prepared by a simple method. The material has been used for guided bone regeneration (GBR) in animal models. In this study, the silk mat used for a clinical application was compared with a commercially available membrane for GBR. A prospective split-mouth, randomized clinical trial was conducted with 25 patients who had bilaterally impacted lower third molars. High-density polytetrafluoroethylene (dPTFE) membrane or silk mat was applied in the extraction socket randomly. Probing depth (PD), clinical attachment level (CAL), and bone gain (BG) were measured at the time of extraction (T0) and then at three months (T1) and six months after extraction (T2). There was no missing case. GBR with silk mat was non-inferior to GBR with dPTFE for PD reduction at T1 and T2 (pnon-inferiority < 0.001). PD and CAL were significantly decreased at T1 and T2 when compared with those at T0 in both membrane groups (p < 0.001). BG at T2 was 3.61 ± 3.33 mm and 3.56 ± 3.30 mm in the silk mat group and dPTFE group, respectively. There was no significant complication from the use of silk mat for the patients. The results for patients undergoing GBR with silk mat for third-molar surgery were non-inferior to GBR with dPTFE for PD reduction.