This randomized controlled trial evaluates postoperative pain and facial swelling following surgical removal of partially impacted mandibular third molars using flap versus flapless techniques. The aim is to determine which method results in lower postoperative morbidity on the second postoperative day.
Impacted mandibular third molars frequently require surgical extraction, often involving mucoperiosteal flap elevation and bone removal. These steps may contribute to postoperative complications such as pain, swelling, and trismus. Minimally invasive alternatives, including flapless extraction, aim to reduce surgical trauma. This study compares postoperative pain and swelling after flap versus flapless techniques in patients with partially impacted mesioangular mandibular third molars. Pain will be assessed using a 10-point Visual Analogue Scale (VAS), and swelling will be measured using standardized anthropometric facial measurements. A total of 160 participants will be randomized into two equal groups. All procedures will be performed by a single surgeon to reduce bias.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
160
Surgical extraction performed using a mucoperiosteal flap. A Ward's or modified Ward's incision is placed with a No. 15 blade. The flap is elevated to expose bone, followed by bone guttering with a straight fissure bur under saline irrigation. Tooth sectioning is carried out and fragments are removed. The socket is irrigated with saline and the flap is repositioned and sutured with 3-0 black braided silk.
Surgical extraction of partially impacted mandibular third molar without raising a mucoperiosteal flap. Only minimal gingival reflection is performed using a periosteal elevator. Bone guttering and tooth sectioning are carried out using a bur under saline irrigation. Tooth fragments are removed. The socket is irrigated with saline and 0.2% chlorhexidine. No sutures are placed, and the site is allowed to heal by secondary intention
Watim Medical College&Dental Hospital
Islamabad, Islamabad, Pakistan
RECRUITINGpostoperative pain score
Pain will be assessed on the 2nd postoperative day using the Visual Analogue Scale (VAS) ranging from 0 = no pain to 10 = worst pain. Patients will be instructed to rate their pain by marking a score on the 10-point VAS.
Time frame: 2nd postoperative day
facial swelling measurement
Measurements will be recorded in millimeters as: A = Gonion-Tragus B = Gonion-Outer canthus C = Gonion-Ala D = Gonion-Angle of mouth E = Gonion-Pogonion Total swelling = A + B + C + D + E. This method is described in the Operational Definition section of your synopsis.
Time frame: 2nd postoperative day
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