Abstract: PURPOSE: To explore the efficacy and safety of buccal triangular flap transfer and suturing for wound repair after extraction of partially erupted mandibular impacted third molars(MITM), and to propose a personalized suturing scheme for clinical reference. METHODS: A total of 90 patients with mesially/horizontally impacted MITM (partially erupted crowns) treated in Changsha Stomatological Hospital from January 2024 to January 2025 were randomly divided into two groups: the experimental group(n=47, buccal triangular flap transfer and suturing) and the control group(n=43, primary approximation and suturing). The primary wound healing rate after surgery, the incidence of food impaction and the occurrence of postoperative complications were compared between the two groups of patients. RESULTS: There were no significant differences in baseline data (gender, age, impaction type) between the two groups (P>0.05), but the proportion of patients with maximum gingival flap defect width >5 mm was significantly higher in the experimental group (P=0.043). The primary healing rate was significantly higher in the experimental group(82.97%) than in the control group (32.55%), while the secondary healing rate was significantly lower (17.02% vs 67.45%, P<0.001) in the experimental group. Subgroup analysis showed that the primary healing rate was 100% in both groups when the defect width ≤5 mm(P>0.05), but significantly higher in the experimental group (81.82%) than in the control group (14.71%) when the defect width >5 mm (P<0.001). The incidence of food impaction in the experimental group was 50.4% lower than that in the control group(P<0.001). Facial swelling in the experimental group was slightly more severe than that in the control group on postoperative day 3 (P=0.025), but no differences were observed on day 1 or days 7-10(P>0.05). There were no significant differences in pain scores or mouth opening between the two groups at any time point(P>0.05). The incidence of postoperative bleeding was significantly lower in the experimental group than in the control group(P<0.01). No dry socket osteitis occurred in either group. CONCLUSIONS: Despite more severe gingival flap defects at baseline, buccal triangular flap transfer suturing significantly improves the primary healing rate of MITM extraction wounds (especially when the defect width>5 mm), effectively reduces food impaction and postoperative bleeding, and has high safety, which is worthy of clinical promotion.

Key words: Buccal triangular flap, Gingival flap transfer and suturing, Mandibular impacted third molar, Primary healing, Food impaction