Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study

Siji J. Chiramel, Shaju Chammanam, Ranjith Kalliath, Arjun Gopinath


Background: Manipulation of both hard and soft tissues during the surgical removal of mandibular third molars is usually associated with a number of postoperative complications. This study was aimed to compare the effects of two types of flap designs used during the impacted mandibular third molar removal and the consequences of choosing Szmyd incision over envelope incision in terms of primary wound healing and periodondal healing.

Methods: A prospective, randomized study was conducted in healthy 50 patients with partially or completely impacted mandibular third molars were selected. The patients were divided into two groups of 25 each. In one group envelope flap design was used and in the other group Szmyd flap design was used. The influence of these incisions on accessibility to third molar, primary wound healing and periodontal healing was evaluated and compared.

Results: The incidence of wound dehiscence at 7th day follow-up is more in envelop incision (p=0.123) and 20% more at 14th day follow-up (p=0.087) when compared to Szmyd design. Significant differences were noted with respect to the periodontal healing distal to adjacent second molar. Distal periodontal pocket depth was significantly lower for the Szmyd incision as compared to the Envelop incision. Effect size of Envelop flap is 1.84 times more than Szmyd flap.

Conclusions: The Szmyd flap design makes primary wound healing easier, less wound dehiscence and periodontal complication than envelop flap design.


Envelope flap design, Flap design, Periodontal healing, Periodontal pocket depth, Primary wound healing, Szmyd flap design, Third molar, Wound dehiscence

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