Summary of findings 1. Choice of surgical flap type for the removal of mandibular wisdom teeth.
| Triangular flap compared with envelope flap for the removal of mandibular wisdom teeth | ||||||
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Population: adults with mandibular third molars requiring removal Setting: oral surgery Intervention: triangular flap1 Comparison: envelope flap | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Envelope flap | Triangular flap | |||||
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Alveolar osteitis (1‐week follow‐up) |
132 per 10002 | 48 per 1000 (19 to 73) | OR 0.33 (0.09 to 1.23) | 187 (5 studies) | ⊕⊕⊝⊝ low3 | Triangular (short) vs envelope. Insufficient evidence to claim either is better |
|
Wound infection (1‐week follow‐up) |
46 per 10002 | 14 per 1000 (2 to 90) | OR 0.29 (0.04 to 2.06) | 65 (2 studies) | ⊕⊕⊝⊝ low4 | Triangular (long) vs envelope. Insufficient evidence to claim either is better |
|
Permanent altered tongue, chin, or lip sensation (more than 6 months) |
20 per 1000 2 | 90 per 1000 (1 to 1000) | Peto OR 4.48 (0.07 to 286.49) | 45 (1 study) | ⊕⊝⊝⊝ verylow5 | Triangular (long) vs envelope. Insufficient evidence to claim either is better |
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Adverse effects ‐ reactionary bleeding (up to 30 days) |
Not reported | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OD: odds ratio | ||||||
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GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1A further four studies evaluated other flap design comparisons but did not report outcome data suitable for inclusion in meta‐analysis. The narrative results of these studies are reported in Effects of interventions. 2Incidence estimated by median of envelope flap group. 3Certainty of evidence downgraded twice due to studies at high or unclear risk of bias and high heterogeneity and imprecision. 4Certainty of evidence downgraded twice due to studies at high or unclear risk of bias and imprecision. 5Certainty of evidence downgraded three times due to single small study at high risk of bias with imprecision.