Gömülü Üçüncü Molar Dişlerin Cerrahi Prensipleri: Flep Tasarımı, Osteotomi ve Dişin Seksiyonlanması
Özet
Referanslar
Zhao J, Zhang Y, Cheng Y, Xie S, Li D, Zhang P, et al. Effects of modified triangular flap for third molar extraction on distal periodontal health of second molar: A randomized controlled study. Heliyon . 2023;9(5). https://doi.org/10.1016/j.heliyon.2023.e16161 .
Marco GD, 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. Journal of Applied Oral Science . 2021;29. https://doi.org/10.1590/1678-7757-2020-0932 .
Sifuentes-Cervantes JS, Carrillo-Morales F, Castro-Núñez J, Cunningham LL, Sickels JEV. Third molar surgery: Past, present, and the future. Oral Surgery Oral Medicine Oral Pathology and Oral Radiology . 2021;132(5): 523. https://doi.org/10.1016/j.oooo.2021.03.004 .
Spirito FD, Lorenzo PD, Rizki IN, Acerra A, Giordano F, Amato M, et al. Impacted Mandibular Third Molar: Approaches and Current Perspectives in Surgical Therapy. Medicina . 2025;61(9): 1683. https://doi.org/10.3390/medicina61091683 .
Menziletoğlu D, Güler AY, Baştürk F, IŞIK BK, Erdur EA. Comparison of two different flap designs for bilateral impacted mandibular third molar surgery. Journal of Stomatology Oral and Maxillofacial Surgery . 2019;121(4): 368. https://doi.org/10.1016/j.jormas.2019.08.006 .
Silva BCL da, Machado GF, Miranda EFP, Galvão EL, Falci SGM. Envelope or triangular flap for surgical removal of third molars? A systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery . 2020;49(8): 1073. https://doi.org/10.1016/j.ijom.2020.01.001 .
Glera-Suárez P, Soto‐Peñaloza D, Peñarrocha‐Oltra D, Diago MP. Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis. Medicina oral, patología oral y cirugía bucal . 2020;25(2): 0. https://doi.org/10.4317/medoral.23320 .
Zhu J, Yuan X, Yan L e, Li T, Guang M, Zhang Y. Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. Journal of Oral and Maxillofacial Surgery . 2019;78(4): 515. https://doi.org/10.1016/j.joms.2019.11.026 .
Daftary M, Donepudi N, Thakur D, Agrawal SN, Chaudhary N, Jain S. Comparative Analysis of Envelope and Triangular Flap Designs in Reducing Postoperative Sequelae Following Mandibular Third Molar Disimpaction. Cureus . 2025;17(9). https://doi.org/10.7759/cureus.91573 .
Miloro M, E. Ghali G, E. Larsen P, Waite P. Peterson’s Principles of Oral and Maxillofacial Surgery .. 4th ed. Springer Nature; 2022.
Steel B, Surendran K, Braithwaite C, Mehta D, Keith D. Current thinking in lower third molar surgery. British Journal of Oral and Maxillofacial Surgery . 2021;60(3): 257. https://doi.org/10.1016/j.bjoms.2021.06.016 .
Wang Y, Lei B, Cheng Z, Yao T, Cheng B. Comparative study on the short-term clinical effects of distal incision flap technique in the extractions of mesially/horizontally impacted mandibular third molar with high or medium position. Oral Surgery Oral Medicine Oral Pathology and Oral Radiology . 2024;139(5): 521. https://doi.org/10.1016/j.oooo.2024.11.090 .
Passarelli PC, López MA, Netti A, Rella E, Leonardis MD, Ferro LS, et al. Effects of Flap Design on the Periodontal Health of Second Lower Molars after Impacted Third Molar Extraction. Healthcare . 2022;10(12): 2410. https://doi.org/10.3390/healthcare10122410 .
Chen Y, Lee CA, Hum L, Chuang SK. Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery . 2016;46(3): 363. https://doi.org/10.1016/j.ijom.2016.08.005 .
Caputo AA, Rubino E, Marcianò A, Peditto M, Bellocchio AM, Nucera R, et al. Three-dimensional facial swelling evaluation of piezo-electric vs conventional drilling bur surgery of impacted lower third molar: a randomized clinical trial. BMC Oral Health . 2023;23(1): 233. https://doi.org/10.1186/s12903-023-02910-6 .
Siroraj P, G.V.V G, Ramkumar S, Narasimhan M. Extraction of impacted mandibular third molars - the effect of osteotomy at two speeds on peripheral bone: a histopathological analysis. British Journal of Oral and Maxillofacial Surgery . 2016;54(4): 449. https://doi.org/10.1016/j.bjoms.2016.02.008 .
Ahmed F, Baliga SD, Baliga S, Rathi P, Jha G. Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial. Cureus . 2024;16(2). https://doi.org/10.7759/cureus.53370 .
Çanakçı FG, Er N, Duygu G, Karaca GT. Does Saline Irrigation at Different Temperatures Affect Pain, Edema, and Trismus After Impacted Third Molar Surgery: A Clinical Trial. Journal of Oral and Maxillofacial Surgery . 2022;81(1): 88. https://doi.org/10.1016/j.joms.2022.08.015 .
Yaedú RYF, Mello M de AB, Silveira JSZ da, Valente ACB. Edema Management in Oral and Maxillofacial Surgery. In: IntechOpen eBooks . IntechOpen; 2019. https://doi.org/10.5772/intechopen.80971 . [Accessed September 2025].
Qi W, Jing Q, Zhou W, Li J, Mao B, Wen A, et al. 3D-printed titanium surgical guides for extraction of horizontally impacted lower third molars. Clinical Oral Investigations . 2022;27(4): 1499. https://doi.org/10.1007/s00784-022-04769-3 .
Keyhan SO, Fallahi HR, Cheshmi B, Mokhtari S, Zandian D, Yousefi P. Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery? Maxillofacial Plastic and Reconstructive Surgery . 2019;41(1): 29. https://doi.org/10.1186/s40902-019-0212-6 .
Silva Ld, Reis EN, Bonardi J, Lima V, Aranega AM, Ponzoni D. Influence of surgical ultrasound used in the detachment of flaps, osteotomy and odontosection in lower third molar surgeries. A prospective, randomized, and “split-mouth” clinical study. Medicina oral, patología oral y cirugía bucal . 2020;25(4). https://doi.org/10.4317/medoral.23447 .
Cıvak T, Üstün T, Yılmaz HN, Gürsoy B. Postoperative evaluation of Er:YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions. Journal of Cranio-Maxillofacial Surgery . 2020;49(1): 64. https://doi.org/10.1016/j.jcms.2020.11.010 .
Menziletoğlu D, Baştürk F, IŞIK BK, Esen A. A prospective split-mouth clinical study: comparison of piezosurgery and conventional rotary instruments in impacted third molar surgery. Oral and Maxillofacial Surgery . 2019;24(1): 51. https://doi.org/10.1007/s10006-019-00817-7 .
Topcu SIK, Palancıoğlu A, Yaltırık M, Koray M. Piezoelectric Surgery Versus Conventional Osteotomy in Impacted Lower Third Molar Extraction: Evaluation of Perioperative Anxiety, Pain, and Paresthesia. Journal of Oral and Maxillofacial Surgery . 2018;77(3): 471. https://doi.org/10.1016/j.joms.2018.11.015 .
Al‐Moraissi EA, El-Mansi Y, Al-Sharaee Y, Alrmali A, Alkhutari AS. Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis. International Journal of Oral and Maxillofacial Surgery . 2015;45(3): 383. https://doi.org/10.1016/j.ijom.2015.10.005 .
Patil C, Jadhav A, Kambala R, Bhola N, Borle R, Mishra A. “Piezosurgery vs bur in impacted mandibular third molar surgery: Evaluation of postoperative sequelae.” Journal of Oral Biology and Craniofacial Research . 2019;9(3): 259. https://doi.org/10.1016/j.jobcr.2019.06.007 .
Tamboli AN, Kumar GP, Kanani R, Bhattacharjee AK, Mannivannan PC, Shah SJ, et al. Evaluation of Different Surgical Removal Techniques for Impacted Mandibular Third Molar Impactions: A Comparative Study. Journal of Pharmacy And Bioallied Sciences . 2025;17. https://doi.org/10.4103/jpbs.jpbs_1854_24 .
Synan WJ, Stein K. Management of Impacted Third Molars. Oral and Maxillofacial Surgery Clinics of North America . 2020;32(4): 519. https://doi.org/10.1016/j.coms.2020.07.002 .
Bhati B, Kukreja P, Kumar S, Rathi VC, Singh K, Bansal S. Piezosurgery versus rotatory osteotomy in mandibular impacted third molar extraction. Annals of Maxillofacial Surgery . 2017;7(1): 5. https://doi.org/10.4103/ams.ams_38_16 .
Referanslar
Zhao J, Zhang Y, Cheng Y, Xie S, Li D, Zhang P, et al. Effects of modified triangular flap for third molar extraction on distal periodontal health of second molar: A randomized controlled study. Heliyon . 2023;9(5). https://doi.org/10.1016/j.heliyon.2023.e16161 .
Marco GD, 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. Journal of Applied Oral Science . 2021;29. https://doi.org/10.1590/1678-7757-2020-0932 .
Sifuentes-Cervantes JS, Carrillo-Morales F, Castro-Núñez J, Cunningham LL, Sickels JEV. Third molar surgery: Past, present, and the future. Oral Surgery Oral Medicine Oral Pathology and Oral Radiology . 2021;132(5): 523. https://doi.org/10.1016/j.oooo.2021.03.004 .
Spirito FD, Lorenzo PD, Rizki IN, Acerra A, Giordano F, Amato M, et al. Impacted Mandibular Third Molar: Approaches and Current Perspectives in Surgical Therapy. Medicina . 2025;61(9): 1683. https://doi.org/10.3390/medicina61091683 .
Menziletoğlu D, Güler AY, Baştürk F, IŞIK BK, Erdur EA. Comparison of two different flap designs for bilateral impacted mandibular third molar surgery. Journal of Stomatology Oral and Maxillofacial Surgery . 2019;121(4): 368. https://doi.org/10.1016/j.jormas.2019.08.006 .
Silva BCL da, Machado GF, Miranda EFP, Galvão EL, Falci SGM. Envelope or triangular flap for surgical removal of third molars? A systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery . 2020;49(8): 1073. https://doi.org/10.1016/j.ijom.2020.01.001 .
Glera-Suárez P, Soto‐Peñaloza D, Peñarrocha‐Oltra D, Diago MP. Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis. Medicina oral, patología oral y cirugía bucal . 2020;25(2): 0. https://doi.org/10.4317/medoral.23320 .
Zhu J, Yuan X, Yan L e, Li T, Guang M, Zhang Y. Comparison of Postoperative Outcomes Between Envelope and Triangular Flaps After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. Journal of Oral and Maxillofacial Surgery . 2019;78(4): 515. https://doi.org/10.1016/j.joms.2019.11.026 .
Daftary M, Donepudi N, Thakur D, Agrawal SN, Chaudhary N, Jain S. Comparative Analysis of Envelope and Triangular Flap Designs in Reducing Postoperative Sequelae Following Mandibular Third Molar Disimpaction. Cureus . 2025;17(9). https://doi.org/10.7759/cureus.91573 .
Miloro M, E. Ghali G, E. Larsen P, Waite P. Peterson’s Principles of Oral and Maxillofacial Surgery .. 4th ed. Springer Nature; 2022.
Steel B, Surendran K, Braithwaite C, Mehta D, Keith D. Current thinking in lower third molar surgery. British Journal of Oral and Maxillofacial Surgery . 2021;60(3): 257. https://doi.org/10.1016/j.bjoms.2021.06.016 .
Wang Y, Lei B, Cheng Z, Yao T, Cheng B. Comparative study on the short-term clinical effects of distal incision flap technique in the extractions of mesially/horizontally impacted mandibular third molar with high or medium position. Oral Surgery Oral Medicine Oral Pathology and Oral Radiology . 2024;139(5): 521. https://doi.org/10.1016/j.oooo.2024.11.090 .
Passarelli PC, López MA, Netti A, Rella E, Leonardis MD, Ferro LS, et al. Effects of Flap Design on the Periodontal Health of Second Lower Molars after Impacted Third Molar Extraction. Healthcare . 2022;10(12): 2410. https://doi.org/10.3390/healthcare10122410 .
Chen Y, Lee CA, Hum L, Chuang SK. Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery . 2016;46(3): 363. https://doi.org/10.1016/j.ijom.2016.08.005 .
Caputo AA, Rubino E, Marcianò A, Peditto M, Bellocchio AM, Nucera R, et al. Three-dimensional facial swelling evaluation of piezo-electric vs conventional drilling bur surgery of impacted lower third molar: a randomized clinical trial. BMC Oral Health . 2023;23(1): 233. https://doi.org/10.1186/s12903-023-02910-6 .
Siroraj P, G.V.V G, Ramkumar S, Narasimhan M. Extraction of impacted mandibular third molars - the effect of osteotomy at two speeds on peripheral bone: a histopathological analysis. British Journal of Oral and Maxillofacial Surgery . 2016;54(4): 449. https://doi.org/10.1016/j.bjoms.2016.02.008 .
Ahmed F, Baliga SD, Baliga S, Rathi P, Jha G. Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial. Cureus . 2024;16(2). https://doi.org/10.7759/cureus.53370 .
Çanakçı FG, Er N, Duygu G, Karaca GT. Does Saline Irrigation at Different Temperatures Affect Pain, Edema, and Trismus After Impacted Third Molar Surgery: A Clinical Trial. Journal of Oral and Maxillofacial Surgery . 2022;81(1): 88. https://doi.org/10.1016/j.joms.2022.08.015 .
Yaedú RYF, Mello M de AB, Silveira JSZ da, Valente ACB. Edema Management in Oral and Maxillofacial Surgery. In: IntechOpen eBooks . IntechOpen; 2019. https://doi.org/10.5772/intechopen.80971 . [Accessed September 2025].
Qi W, Jing Q, Zhou W, Li J, Mao B, Wen A, et al. 3D-printed titanium surgical guides for extraction of horizontally impacted lower third molars. Clinical Oral Investigations . 2022;27(4): 1499. https://doi.org/10.1007/s00784-022-04769-3 .
Keyhan SO, Fallahi HR, Cheshmi B, Mokhtari S, Zandian D, Yousefi P. Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery? Maxillofacial Plastic and Reconstructive Surgery . 2019;41(1): 29. https://doi.org/10.1186/s40902-019-0212-6 .
Silva Ld, Reis EN, Bonardi J, Lima V, Aranega AM, Ponzoni D. Influence of surgical ultrasound used in the detachment of flaps, osteotomy and odontosection in lower third molar surgeries. A prospective, randomized, and “split-mouth” clinical study. Medicina oral, patología oral y cirugía bucal . 2020;25(4). https://doi.org/10.4317/medoral.23447 .
Cıvak T, Üstün T, Yılmaz HN, Gürsoy B. Postoperative evaluation of Er:YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions. Journal of Cranio-Maxillofacial Surgery . 2020;49(1): 64. https://doi.org/10.1016/j.jcms.2020.11.010 .
Menziletoğlu D, Baştürk F, IŞIK BK, Esen A. A prospective split-mouth clinical study: comparison of piezosurgery and conventional rotary instruments in impacted third molar surgery. Oral and Maxillofacial Surgery . 2019;24(1): 51. https://doi.org/10.1007/s10006-019-00817-7 .
Topcu SIK, Palancıoğlu A, Yaltırık M, Koray M. Piezoelectric Surgery Versus Conventional Osteotomy in Impacted Lower Third Molar Extraction: Evaluation of Perioperative Anxiety, Pain, and Paresthesia. Journal of Oral and Maxillofacial Surgery . 2018;77(3): 471. https://doi.org/10.1016/j.joms.2018.11.015 .
Al‐Moraissi EA, El-Mansi Y, Al-Sharaee Y, Alrmali A, Alkhutari AS. Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis. International Journal of Oral and Maxillofacial Surgery . 2015;45(3): 383. https://doi.org/10.1016/j.ijom.2015.10.005 .
Patil C, Jadhav A, Kambala R, Bhola N, Borle R, Mishra A. “Piezosurgery vs bur in impacted mandibular third molar surgery: Evaluation of postoperative sequelae.” Journal of Oral Biology and Craniofacial Research . 2019;9(3): 259. https://doi.org/10.1016/j.jobcr.2019.06.007 .
Tamboli AN, Kumar GP, Kanani R, Bhattacharjee AK, Mannivannan PC, Shah SJ, et al. Evaluation of Different Surgical Removal Techniques for Impacted Mandibular Third Molar Impactions: A Comparative Study. Journal of Pharmacy And Bioallied Sciences . 2025;17. https://doi.org/10.4103/jpbs.jpbs_1854_24 .
Synan WJ, Stein K. Management of Impacted Third Molars. Oral and Maxillofacial Surgery Clinics of North America . 2020;32(4): 519. https://doi.org/10.1016/j.coms.2020.07.002 .
Bhati B, Kukreja P, Kumar S, Rathi VC, Singh K, Bansal S. Piezosurgery versus rotatory osteotomy in mandibular impacted third molar extraction. Annals of Maxillofacial Surgery . 2017;7(1): 5. https://doi.org/10.4103/ams.ams_38_16 .