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Submitted On:

March 21, 2025

Published On:

April 22, 2025

Updated On:

April 22, 2025

Correspondence:

Adel Bouguezzi, University Dental Clinic, Medicine and Oral Surgery Department, Oral Health and Orofacial Rehabilitation Laboratory Research (LR12ES11), University of Monastir, Tunisia

Citation

Bouguezzi A, Selmi J, Hentati H. Surgical management of impacted third molars: envelope flap vs. triangular flap: a comparative analysis of outcomes. J Dent Sci Oral Care. 2025;1(1):1–6.

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Surgical management of impacted third molars: envelope flap vs. triangular flap: a comparative analysis of outcomes

Abstract
Background: The surgical removal of impacted third molars is a common procedure in oral and maxillofacial surgery. The choice of flap design significantly influences surgical exposure, complication rates, postoperative healing, and patient satisfaction. The envelope flap and triangular flap are two widely used techniques, yet their comparative clinical outcomes remain an area of debate.
Methods: A systematic review was conducted across PubMed, Scopus, and Cochrane Library databases. Studies comparing envelope and triangular flaps in third molar surgery, published from 2000 to 2023, were included. Outcomes such as surgical exposure, complications (e.g., infection, flap necrosis), postoperative pain, swelling, recovery time, and patient satisfaction were analyzed. Statistical heterogeneity was assessed using the I² statistic, and meta-analysis was performed using odds ratios (ORs) for categorical outcomes and mean differences (MDs) for continuous outcomes.
Results: A total of 12 studies involving 1,452 patients were analyzed. The triangular flap provided better surgical access (MD=1.2; 95% CI: 0.8–1.6) but had higher postoperative pain (MD=1.5; 95% CI: 1.0–2.0) and swelling (MD=2.3; 95% CI: 1.5–3.0). The envelope flap had lower infection rates (OR=0.45; 95% CI: 0.28–0.72) and shorter recovery time (MD=2.1 days; 95% CI: 1.4–2.8). Patient satisfaction was significantly higher with the envelope flap (MD=1.5; 95% CI: 1.0–2.0).
Conclusion: While both flap designs are effective, the envelope flap is associated with fewer complications, faster recovery, and greater patient satisfaction, making it ideal for routine cases. The triangular flap remains preferred for complex extractions requiring enhanced surgical exposure.

Keywords: Envelope flap, Triangular flap, Surgical management, Meta-analysis

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