الفهرس 
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Abstract
Objectives: To correlate between different treatment modalities used for impacted mandibular third molar removal and their impact on associated postoperative sequelae. Patients and Methods: Sixty four patients of a similar range of difficulty index were randomly divided into two main groups (envelope group and triangular group). Each group were furtherly subdivided into four equal subgroups (n=8). The submucosal injection subgroup received dexamethasone injection in the buccal vestibule preoperatively, the Twinmix subgroup received Twin Mix solution injection in the pterygomandibular space preoperatively, and the drain subgroup received a tube drain placed submucosally at the buccal vestibule while the control subgroup had a conventional surgical technique applied. The participants were assessed for pain, swelling and trismus immediately postoperative, after two and seven days of follow up periods. Results: Within the envelope flap main group, the VAS analysis showed statistical significant differences in values recorded at all time intervals (P=0.030,<0.001, <0.001 atT1, T2 and T3 respectively) Meanwhile, the evaluation of edema revealed a significant statistical difference between the included groups for values recorded at the second day follow up (P=0.005). Furthermore, No statistical significant difference was showed regarding MIO between all subgroups at all time intervals (P=0.094, 0.108, 0.179 at T1, T2 and T3 respectively). Regarding the triangular flap main group, the VAS analysis showed statistical significant differences in values recorded at all time intervals (P=0.005, 0.004, 0.001 at T1, T2 and T3 respectively). Meanwhile, there were no statistical significant differences between the included subgroups when comparing values recorded all time intervals with edema (P=0.393, 0.494, 0.460 at T1, T2 and T3 respectively) as well as MIO (P=0.326, 0.538, 0.631 at T1, T2 and T3 respectively). Conclusions: In relation to the envelope flap group, the study revealed that submucosal and Twin Mix groups had a better pain control than the drain and control groups. The submucosal group showed the best outcome with regards to swelling. None of the studied groups showed a significant difference concerning trismus. But, among the triangular flap, the submucosal group had the best pain control than other studied groups. The twin Mix group showed a slight improvement regarding pain over the drain and control groups but not reaches the level of significance. None of the studied groups showed a significant difference concerning edema and trismus