Objective: To investigate the efficacy of a propensity score matching-based intragingival groove cut pocket-shaped flap procedure in mandibular low retaining tooth extraction. Methods: 360 patients with mesioangular and low-to-moderate impacted mandibular third molars were enrolled and divided into an observation group (sulcular envelope flap, n=180) and a control group (conventional triangular flap, n=180) based on different treatment methods. The clinical data of the patients were collected retrospectively, and the basic data of the two groups were matched 1∶1 using the propensity score matching method to compare the operation time, bleeding, postoperative swelling, probing depth, degree of restriction of the opening, pain, quality of life, and the occurrence of complications between the two groups. Results: The levels of bleeding and postoperative swelling were lower in the observation group than in the control group (P<0.05). At 3 months postoperatively, the depth levels of buccal distal-medial, central, and proximal-medial and lingual distal-medial, central, and proximal-medial probing in the observation group were lower than those in the control group (P<0.05). At 7 d postoperatively, the degree of opening restriction and the level of visual pain analog score (VAS) were lower in the observation group than in the control group (P<0.05). At 3 d postoperatively, the level of the Comprehensive Quality of Life Assessment Questionnaire (GQOLI-74) score was higher in the observation group than in the control group (P<0.05). The complication rate was lower in the observation group than in the control group (P<0.05). Conclusion: The use of the pocket-shaped flap technique for mandibular low retaining teeth extraction in the gingival sulcus effectively reduces surgical bleeding and postoperative swelling, improves the patient’s quality of life, and reduces pain, as well as reduces the incidence of restricted opening and related complications, which is of value for promotion.