CC BY-NC-ND 4.0 · Dental Journal of Advance Studies 2022; 10(03): 150-153
DOI: 10.1055/s-0042-1758760
Case Report

Tunneled Envelope Flap—Novel Flap Modification for Removal of Impacted Lower Third Molars

Ivan Hristov Arabadzhiev
1   Oral Surgery Office Dr. Carsten Nix, Landstuhl, Germany
Carsten Nix
1   Oral Surgery Office Dr. Carsten Nix, Landstuhl, Germany
› Author Affiliations


Introduction Although surgical extraction of retained lower third molars is one of the most frequently undertaken surgical interventions in oral and maxillofacial surgery, presented in numerous scientific publications every year, there is no unanimous standpoint on the type of flap providing optimal results. This article presents a technique, modified through tunneling involving an envelope and triangular flap.

Clinical Case This article presents a clinical case of extraction of tooth 48 describing step by step in details the implementation of a tunneled envelope flap.

Discussion Each of those two techniques—envelope flap and triangular flap—has its advantages and disadvantages. The presented technique aims to combine the positive features of those two frequently implemented techniques, adding a novel tunneling element.

Conclusion This article aims to demonstrate and describe in details the technique, developed by the author. Further studies are necessary to analyze the results of its implementation.

Authors' Contributions

I.H.A contributed to conceptualization of the technique, first implementation of the technique, investigation, literature research, and writing of the original draft. C.N. helped in methodology, resources—equipment, organization, materials, writing—review and editing, and supervision.

The clinical research was conducted in accordance with the World Medical Association's Declaration of Helsinki.

Publication History

Article published online:
23 November 2022

© 2022. Bhojia Dental College and Hospital affiliated to Himachal Pradesh University. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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