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Good evening, everyone. I'm Derek. Doctor Derek, about sushi. Um, sorry for sorry for the delay. We had some technical issues. So today, I'm going to be reviewing a banana or an article on evaluation of to flap designs on mandibular. A second molar after third molar extractions. Um, this study was done by a couple of people from the Caradon Ticks Communities, Dental Science and Department of Oral, um, artificial surgery at College of Dentistry, Kim College University in Saudi Arabia. So this is my outline introduction summary of the article, methodology, discussion, confusion and critic. Sorry, these slides are taking, um, alluding slowly. Okay. So as a form of introduction, I would give a brief, um, a brief summary on what an impacted tooth is. So an impacted tooth is a pathological condition where the tooth is completely or partially un erupted, and it's position against another tooth. The bone or the soft soft tissue such that it's for the eruption is unlikely. As described, It's anatomical position, which simply means that it has failed, erupted to its anatomical position. So third molars are the most commonly impacted teeth in the mouth and the age range for the eruption of this teeth is usually between 17 to 22 years. Impacted teeth may remain asymptomatic or may be associated with various pathologies, such as infections. Some of these infections include dental Caries or parties, typical period entities, pericoronitis, and sometimes we have space infections. You could also have some information from these teeth or two. Most, um sometimes it also causes the resumption of the adjustment to the treatment. Options include one. We could leave it alone and observe. This is usually done when it is symptomatic, or when the patient is between the age of 17 to 22 years and then you're just observing to see okay, are we going to have it is going to erupt into the anatomical position, so we just watch and then we observe. And then sometimes we if their symptoms, we just treat the symptoms. The other option is a surgical extraction, which is the go to treatment options for for impacted $30. In some cases, we would do an upper colectomy, which simply means we're removing the soft tissue. This is usually done when the soft tissue in the soft tissue in action, and then we excised the soft tissue and try to expose as much as the tooth as possible. As much of that as possible. Sometimes do an orthodontic exclusion, which simply means that we're using wires and we're taking advantage of tooth movements to move the tooth into this position. In some cases, a transportation is done, which means that we're taking the impacted tooth and we're moving it into another position in the dental arch. So let's assume that one of the tea type of dental Caries and was badly broken down and we had to extract that, too. So we moved the impacted treadmiller into that position. So this is this slide is just showing us, um, images. So the first images an impacted tooth. It's a clinical photograph of an impacted third molar in lower charge. The second image is showing us a three D in a three D reconstruction of the lower charge and issues the third molar being impacted in bone. So there's been covering most of these two. The third image shows a two dimensional X ray view of an impacted. You can see it's resting against the second, the second mullah and then the last image shoes, he normally erupted colon, where all the teeth at the same level and there's nothing resting against another island. There's enough space for it to come out. This is another image just showing us, Um, it's an auto plant tonograph so so two dimensional X ray, showing us the third molar so we can see the lower third molars hear both sides. Their boots impacted, their resting against the second mullah and then in the upper arch, their boots impacted. Consider it's not the same level as all the other seats, and then it's also resting against the roots of the second umbrella. So this side is showing us some of the complications of an impacted third molar. So this is an infection. This is dental Caries, which has affected the impacted, too, and has also affected the adjustment to. So this is dental carries. The next image is showing us it's an auto plant demographic in, but this time it's showing us a cyst formation around the impacted, too. So this is the last time American town assist involving the third molar. So we'll move into surgical extractions, so surgical extractions simply means that we're taking out that impacted truth we're removing it from the mouth. And to perform a surgical extractions, you have to take out whatever is obstructing the most common obstruction when we just, um, surgical bed mullah's bone. So it means that we're taking out the bone using, um, a hand drill and able to make it easier and more comfortable for patients to expose more of the tooth. And then we extracted. So the first step during the extraction during a surgical extractions is to give an anesthesia. So the anesthesia we use is local anesthesia. We usually give a block, which is the inferior dental of your lab work. After that, we would make our incision, and then we raised the fat. So we usually raises more cooperation flat, which means that we're taking the gun tissue and then the Paris um so you're just exposing the bone itself. So there's nothing covering the bone, so you move everything on top of the bone and you expose just the bone. Then we removed both, like I explained earlier, too, so that we can see more of the tooth, and it makes it easier for you to then take out the tooth manually. After that, you want to describe the wound and then when you've taken out the tooth, you know want to irrigate, you know, flush the area with normal saline so that the bone is clean. Then if you have any sharp points, you want to use your born rich to file them down so that the place is smooth and then can encourage good healing. So after that, you arrest your hemorrhage, and then you, um, do your wound closure. So the most common form of wound closure for third molar is by surgery. So we want to use, uh, most people use dissolvable stitches now, or you can use no reserve the Abel as well and the patient because patients going to come back in one week for a review so that you check that everything going as far in patients following the instructions. And then if you're satisfied, you can take out your sutures or you take out your sutures. There are other options that we can use, such as tissue addressing. So this is still upcoming, and lots of people haven't started using it. A lot of people started using it yet, and you use, um, sinal cream. So After that, you give your postop instructions and then you do your one week You subscribe notes after that, so I'm going to go into the the article. So third molar extractions or third molar extraction is a common surgical procedure. Um, and this study for Costa needs it study the effect of the design of the flap, the effect, the design of the flat part of the healing of the surgically created effect and the damage to the distal parodontal area of the medicine. Second molar. It just okay, let's see. I'm sorry about this, but there's been a mix up, so the justification of the study. So for the justification of the study, the study focused on the Sorry. What I'm going to be saying now is not on this particular slide. There's been a mix up. So they studied focused on the occurrence and the duration of the common post operative symptoms such as pain, swelling, wound healing and the health of the periodontal tissues of the Adjustance Mueller. Following the use of two different lab designs, the design of the flat influences the visibility and then the accessibility to the impacted tooth and also has an impact on subsequent healing, subsequent healing process of the surgical defects created following the surgery. Therefore, they are conflicting ideas in literature on the influence of these, these designs have, you know, So that's the That's the justification for this study. The name of the study was two comparatively evaluate the clinical outcomes and very gentle skaters of the address in second media went to different flag designs, namely the envelope flap and the modified triangular flag design to use methodology. A total of uh it was about a total of 70 female patients were used age between between the ages of 18 and 40. They presented with bilateral third Mullah bilateral third molar Impact 13 and we're enrolled in the study. So 70 patients who presented with bilateral third molar between the ages of 18 to 40 years were enrolled in the study. However, only six patients who completed the follow up three months were included in this study for the purpose of diagnosis and effective treatment. Planning records were obtained from all patients, including parodontal proven depths. Panoramic radiographs, intraoral paradoxical radiographs were taking preoperatively the inclusion criteria where one patient with bilaterally impacted inferior third molars who are patients with MS you angularly impacted, inferior 13 years. So for third molar classifications, we have different classification systems that we used to classify, So the classification helps with your treatment plan is because it helps you, um, to assess the level of difficulty to they used Mr Angularly impacted, meaning that it's based on the position of the tooth, so patients with no significant medical contributory histories were also included. Patients who are not taking any medications that could in for that could interfere with the surgical procedure or post operative healing process. We're also included, and the non smokers and patients with healthy dental status were included in this study. The exclusion criteria included pregnancy during the extraction. Parodontal surgery in the time interval between the extraction and the examination and patients with chronic periodontal disease is were excluded from this study. The demographic data of all the patients were recorded and in thorough history, was taking informed consents. Informed. Written contents were also obtained from the patient's prices for you. The surgery was performed on the local anesthesia using Little King using lidocaine in in a solution of 4% 4% solution with one in 100,000 epinephrine. A random selection of the questions were carried out. The envelope flam was envelope flap was randomly allocated to one side of the arch, and the modified triangular flap was allocated to the to the contralateral side. Four techniques were performed by the same surgeon on all patients. The patients will follow up were followed up on the first day the third day and the the for pain. Using the visual analog scale for swelling. Swelling was evaluated on the third day, the seventh day and 15 day postoperatively, and this was done subjectively. The parodontal pocket depth was evaluated preoperatively and then three months post operatively using a U. N. C 15 period on top, which, which the U. N. C. Means University of North Carolina, 15% our group. So it's just an instrument that we use to measure the because the pocket depth between the tooth and the boy so every getting along. The line of incision was also considered to define days and so far result not sure, really, like sliced very clear. So, for the results noted, it was noted that for the envelope flap, so the envelope flap is in blue, and then the modified triangular flap is in red. So for envelope flap, Moussawi envelope flap, we're starting with swelling, so the first graph is for swelling. So for envelope flap, we had a percentage of for grade one grade one swelling More of the patients who are more of the patient more, Um, besides that had that in the in the envelope flap was performed on performed on Add more patients that presented with grade one swelling while we had Grade two in 28 28.3%. So 71 71.7% of the patients at grade one or grade one swelling. And then there was no Grade three at all. So none of the patients that were treated with the envelope flap presented with grade three swelling. While for the modified triangular flag, we had patients presenting with grade one swelling and then more patients presented with Grade one. Although we did have patients that presented with Grade three as well, which comes to tell us that there were less, um so I go to the day since the next side is explaining the distribution of the essence between the two treatment groups. So for the envelope flap, we had more day since was absent in more patients. So more more patients that were treated with envelope flap do not have good days and wounded sensory well patients treated with a modified triangular flap. While while more patients treated with modified triangular flap um, hard day since absence, although the percentage of patients who are day since presents were more in the envelope flat. So we'll move on to the distribution of pain. So for the distribution of pain, all right, so for the distribution of pain, blue is envelope flap, and then blue is mild. Red is Mordred, and then green is severe, so envelope flap is the first this. The side closer to the left hand side represents an envelope flap, while the side on the right side represents the modified triangular flap, and they're divided into days. So day one and then three. So for the first day, we have fewer patients. Fewer patients experience severe severe pain on the side to the people that were treated with the modified triangular flab experience less pain, less severe pain compared to those treated with the envelope flap and then with the envelope flap. We have no patients complaining of severe pain. So none of the patients treated with envelope Flap computer complained of severe pain, while those treated with modified triangular flatter, although it was a small amount, a small about patients. But we did have patients will complain of severe pain. But by the three normalized and then none of the patients had severe pain anymore. The next one, we have the paradigm top probe in depth. So for the pain, I don't have the Vin death. But if I don't have proven debt, the color codes are for the, um, the measurement of the deaths. The pocket debt so blue is less than three. Red is three. Green is four. Purple is five, so envelope flap is on the left and then triangle. A flap is on the right. So when we evaluated the pocket deaths three months, post operatively more patients in the envelope lab. More patients that were treated with the envelope flap seem to have larger difference in their periodontal pocket death when compared to those treated with the modified triangular flab, which simply means that more patients that were treated with the envelope flap had an increase in their pocket debts, which shows that when the pocket of increases it means that there's some form of pathological is it? There's some form of pathology going on around that area compared to those that were treated with modified triangular flag. So the manufacturer and flap flap was more protective to the paradental tissues when compared to the envelope club. So for our discussion, the envelope flap with the circular the envelope flap with the circular incision from the first. The second mullah, followed by a diesel relieving incision to the removal of the mandible, has been more commonly employed for the removal of third impacted third molars. What I just described is the modified triangular flap, while the the envelope flap provides more disability as a larger area is uncovered, facilitating better removal of the third molar. Furthermore, this type of flare up with a broad based ensures increased vascularity to the flap, extending outwards to the tooth much to the wound margin. However, there are definite disadvantages to the use of the envelope flap. The most common complication complication reported in literature, includes pain, swelling, Christmas parodontal damage like we saw from our results of the adjust and then you're following the surgery. It has been reported as smaller incisions. Employing minimal reflection of the copper is still as you sit there with less post operative pain and swelling. The findings of this present study review that the results regarding swelling was statistically significant between the envelope and the modify actual regular flat. It was higher in the modified Triangular Flap Group compared to the envelope flap. The probable X The probable explanation for the increased swelling notice and triangular flag design could be attributed to the anterior releasing incision, which induces greater inflammatory response and resulting edema in the local tissues. According to the study, the pain scores were not scaly significant, which is similar to the widely accepted known. The Envelope Flap group responded better to pain compared to their counterparts. The essence is more commonly associated with envelopes Lab, which we see in the study as well. It's occurrence can be explained by the fact that the envelope flap is is speak anteriorly with a surplus iTunes and the results in post operative hematoma courses of tissue tension leading to rupture of the the wound margins right. In conclusion, patients treated with the envelope flap design feel better in terms of pain and swelling compared to those treated with modified triangular flab. Remember that for patients treated with envelope flap we didn't have. None of the patients complained of severe pain or patients treated with modified triangular lab. We had some patients complaining of severe pain in comparison to the envelope flap. The triangular flag design cost less damage to the adjustment. Second, UA Mullah's postoperative bird mental status and a sense following dealing, which also remember that we saw in our results because between depth for those treated with the envelope flap was we had increased proving depth where we compared as for three months. So I'll go down to the critic of the study. So the title, the title explained, Um, the title was brief, and it captures the objective of the study. The abstract was, well, well structured. It was incised and understandable. It also summarized article very well. The introduction of the study included the justification of the study. So for the research question, there was no specific research question here. It was more like a, um, like a statement they were trying to compare trying to assess and compare these symptoms when you used to different flat designs and the results how the patients would respond to the different flat, decide and flat designs. So the study also observe the basic components of a good research. Um, the objectives were clear. So for the methodology, the sampling techniques. So they, um, they explained something technique that they used when they were trying to decide for flab designed to use for there was no. They didn't tell us the way they chose. Okay, so they explained how they choose the patient for the study, but they didn't tell us if there was. I think they just picked the patients that came and they had a total of 70 patients who came, but they could only follow up with 60. But then they told us that they used random, random selection for picking the side Which side would have envelope flap and which side we have manufacturing glass flap. So there was also a um there wasn't a control group. It was because the study was trying to compare between the two. So one side had this and the other side had that and then just compared yes included the inclusion and exclusion criteria. They told us about the medical approval, and it was getting from, um, how they got their approval from the king. Saudi Arabia? Um, committee. They carried out their preoperative evaluations. They did clinical. They used clinical methods. They also had their X rays. They did the necessary, um, testing prepared on top. Okay. Debts we also tested during this. The operative method was explained. They told us, um, they explained how they use their anesthesia. They told us the the type of anesthesia. They use the solution then for the results. The analytical tools were very clear. They had they included chats and graphs, which was good and was simple to understand. For the post operative follow up, it was done. So for different symptoms, they use different, different days. And they also explained so, for instance, there swelling. They did the 13. They want a day three and the 15 for swelling. And then for pain. They did they want to. They also graded it. It's all those kind of skill that they used to read their symptoms. Like for pain. It was visual analog for swelling. It was subjective. so they were clear in those parts. So for their discussion, yes, they also included relevant literature's, which was also very good. Um, the objective of the study, I think it was partially partially achieved because it was in line. Yes, it was achieved because it was in line with the General accepted know, although it wasn't really significant, because I wouldn't say it was really significant because the differences between the two techniques, we're not The differences were not Grant, you know, they were just smiled here, here and there. I think the only thing that I would say that really stood out for me was the pain, the pain, and then maybe the swelling before the others. It wasn't really so. Yes, it does adopt the body of knowledge. It also helps to I mean, you know, we finally concluded we have not concluded. But we had a good idea about the pain. And then we could tell that Okay, for, you know, the modified triangle helps you to protect the parodontal ligaments More than the envelope flat. I feel like, Yes, the study can be replicated because it was very easy. And it was I mean, the techniques they use their sampling techniques. Even the way they chose the patient was very easy. So in conclusion, I feel like the study reflected their objectives. And they came and they give recommendations. Um, it was well referenced as well. So yes, thank you. I'm done with the critique. I would like to take questions now if anybody has questions for me. So if anybody's questions not be a good time to, um, presenter, I mean, uh, in the absence of any other questions, um, thank you very much for joining me. Um, I understand that the light chain the time they might have affected, uh, people joining, we kind of float it as a as a patch of content. And if you have, um, any other questions? Um, after watching the video, just drop it on the growth chart, and we'll get to the presenter. Um, And then also, if you'd like to present, just send me a message or send back a message or indicate on the WhatsApp group and find a way to get across to you. Thank you very much, Doctor, For a really wonderful um, present station. Um all right. That'll be all for today. Thank you very much. Everybody. See you later. Thank you very much. Thanks. So hello, everyone, I'm back. Hello. Okay, so high, Too low. So your question is What about bias in this study? So for me, I could only pick up the only basket I could study was the selection bias, how the patients were selected. I feel like there could have been some bias week patient selection, and then I do not think that's okay. Um, they used I don't think that the number of patients or participants is sufficient to make it conclusion. But I think it's, um it's good enough for your hypothesis, because 60 people is it's it's still it's kind of significant. I mean, maybe not confirmatory conclusion sense that you say Okay, so envelope flap is, you know, there's less pain, the envelope flap, for sure, or patients that have the envelope flap not feel any form of severe pain. But it's good enough to make the protesters at least to say that. Okay, maybe one in 10 patients will not have severe pain, that kind of thing. I don't know if that I don't know if that answers your question so Yeah. What? Yes, sir. Um, it's collecting the mission. Yes, the person is still burning. You can just type in the chart box. Um, so, like, if you don't speak just to know that you're okay, that answers. Um All right, well, feel free to, um, continue the conversation. Um, you know, on the word cap, if you need more clarification with that, we'll have more questions. Um, you have to answer any more questions. Um, for the second time, thank you very much. Thank everyone for, um hum. Thank you.