Clinical Wound Healing After Lower 3rd Molar Fully-impacted Surgery With 2 Types of Flap

• lower third molar extraction (Procedure): the extraction is performed with one of the two type of flap based non randomization.

Primary outcomes

• wound healing day 2 [2 days after surgery]: a clinical chart is complete to evaluate if in the group of lower third molar extracted with a bayonet flap the proportion of healing without dehiscence (good healing index) is significant greater than in the group of third molar extracted with an envelope flap.
• wound healing day 7 [7 days after surgery, at suture removal]: a clinical chart is complete to evaluate if in the group of lower third molar extracted with a bayonet flap the proportion of healing without dehiscence (good healing index) is significant greater than in the group of third molar extracted with an envelope flap.
• wound healing day 14 [14 days after surgery]: a clinical chart is complete to evaluate if in the group of lower third molar extracted with a bayonet flap the proportion of healing without dehiscence (good healing index) is significant greater than in the group of third molar extracted with an envelope flap.

Secondary outcomes

• quality of life day 2 [2 days after surgery]: the patient complete a HRQOL questionnaire (modify from Shugars DA et al 1996) to evaluate if differences exist in the patient's quality of post-operative life in relation with two types of flap; we use visual analog scales (VAS) for post-operative pain and five-points Likert-Type for swelling, chewing, speaking, sleeping, sport and daily routine activity; higher scores mean a worse outcome.
• quality of life day 5 [5 days after surgery]: the patient complete a HRQOL questionnaire (modify from Shugars DA et al 1996) to evaluate if differences exist in the patient's quality of post-operative life in relation with two types of flap; we use visual analog scales (VAS) for post-operative pain and five-points Likert-Type for swelling, chewing, speaking, sleeping, sport and daily routine activity; higher scores mean a worse outcome.
• quality of life day 7 [7 days after surgery, at suture removal]: the patient complete a HRQOL questionnaire (modify from Shugars DA et al 1996) to evaluate if differences exist in the patient's quality of post-operative life in relation with two types of flap; we use visual analog scales (VAS) for post-operative pain and five-points Likert-Type for swelling, chewing, speaking, sleeping, sport and daily routine activity; higher scores mean a worse outcome.
• quality of life day 14 [14 days after surgery]: the patient complete a HRQOL questionnaire (modify from Shugars DA et al 1996) to evaluate if differences exist in the patient's quality of post-operative life in relation with two types of flap; we use visual analog scales (VAS) for post-operative pain and five-points Likert-Type for swelling, chewing, speaking, sleeping, sport and daily routine activity; higher scores mean a worse outcome.
• dehiscence [2 days after surgery]: a clinical chart is complete to evaluate if the presence of the dehiscence makes differences in surgical wound healing
• dehiscence [7 days after surgery, at suture removal]: a clinical chart is complete to evaluate if the presence of the dehiscence makes differences in surgical wound healing
• dehiscence [14 days after extraction]: a clinical chart is complete to evaluate if the presence of the dehiscence makes differences in surgical wound healing
• pre-operative symptoms [pre-operative]: the presence or not of pre operative Symptoms
• interincisive height [pre-operative]: the distance between upper and lower central incisors
• Full Mouth Plaque Score [pre-operative]: Full-mouth plaque score was recorded dichotomously (presence/absence of plaque) on six sites per tooth and was then calculated as the percentage of total tooth surfaces that revealed the presence of plaque; higher percentage mean higher presence of plaque
• Partial Plaque Score [pre-operative]: Partial plaque score was recorded dichotomously (presence/absence of plaque) on six sites per tooth in the arch of extraction and was then calculated as the percentage of total tooth surfaces that revealed the presence of plaque; an higher percentage means higher presence of plaque
• type of impaction [pre-operative]: on orthopantomography
• Pell & Gregory class [intra-operative]: on orthopantomography
• depth of impaction [pre-operative]: on orthopantomography
• tooth position [pre-operative]: on orthopantomography
• description root morphology [pre-operative]: on orthopantomography; apical anomalies yes/no
• description number of roots [pre-operative]: on orthopantomography; 1/2/3/more than 3
• description of relationship with the second molar [pre-operative]: on orthopantomography; no contact/contiguity/overlap
• probing depth distal to the second molar [pre-operative]
• quantity of keratinized gingiva [pre-operative]
• position of the gingiva with respect to the CEJ (cemento-enamel junction) of the second molar [pre-operative]
• maximum diameter of the bone cavity [intra-operative]
• maximum depth of the bone cavity [intra-operative]: maximum depth of the bone cavity with respect to the CEJ of the second molar
• position of the gingiva [intra-operative]: position of the gingiva after the suture with respect to the CEJ (cemento-enamel junction) of the second molar
• duration of surgery [intra-operative]: extraction and suture

Sex: All, ages: 18 Years to 35 Years, accepts healthy volunteers

Inclusion Criteria:

* fully-impacted lower third molar
* patients aged between 18 and 35

Exclusion Criteria:

* patients undergoing drug treatment for systemic diseases that can influenced the healing process,
* pregnant women,
* smoking habits
* patients with disabilities
* all interventions in which intraoperative accidents involving the soft tissues occurred (laceration of the mucosa / flap).

• Roberto Pippi, MDDS, Principal investigator, University of Roma La Sapienza