Assessment of Post Operative Swelling Among Patients Following Extraction of Impacted Third Molars (APOSTM)

June 12, 2026 updated by: Faiz ur rahman, College of Physicians and Surgeons Pakistan
This randomized controlled trial aims to compare Ward's incision and Comma incision regarding postoperative swelling following extraction of impacted mandibular third molars. Secondary outcomes include pain and bleeding assessed 48 hours after surgery. The findings will help identify the incision technique associated with better postoperative outcomes

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
116

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:Patients aged 18-50 years. Male and female patients. Patients undergoing extraction of impacted mandibular third molars irrespective of angulation as evaluated radiographically.

Patients with no periodontal pathology related to the involved tooth on clinical examination.

-

Exclusion Criteria:

  • Patients with congenital or acquired bleeding disorders. Patients with any bony lesion adjacent to the impacted third molar. Medically immunocompromised patients.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Ward's Incision Group
Standard Ward's incision with mucoperiosteal flap elevation for extraction of impacted mandibular third molar.
Procedure: Ward's Incision
Patients allocated to Group A will undergo extraction of impacted mandibular third molars using Ward's incision. Depending on the degree of impaction, a sulcular incision will be made from the mesiobuccal aspect of the first or second molar extending distally. A relieving incision will be placed mesially without severing the interdental papilla, followed by a distal releasing incision on the mandibular ramus. A full-thickness mucoperiosteal flap will then be elevated to facilitate tooth extraction.
Procedure: Comma Incision
Patients allocated to Group B will undergo extraction of impacted mandibular third molars using the Comma incision technique. The incision will begin below the second molar and extend to its distobuccal line angle, then curve smoothly upward to the gingival crest. The incision will continue as a crevicular incision around the distal aspect of the second molar. A distolingually based flap will be elevated to provide adequate exposure for extraction of the impacted third molar.
Active Comparator: Comma Incision Group
Comma incision flap design for extraction of impacted mandibular third molar.
Procedure: Ward's Incision
Patients allocated to Group A will undergo extraction of impacted mandibular third molars using Ward's incision. Depending on the degree of impaction, a sulcular incision will be made from the mesiobuccal aspect of the first or second molar extending distally. A relieving incision will be placed mesially without severing the interdental papilla, followed by a distal releasing incision on the mandibular ramus. A full-thickness mucoperiosteal flap will then be elevated to facilitate tooth extraction.
Procedure: Comma Incision
Patients allocated to Group B will undergo extraction of impacted mandibular third molars using the Comma incision technique. The incision will begin below the second molar and extend to its distobuccal line angle, then curve smoothly upward to the gingival crest. The incision will continue as a crevicular incision around the distal aspect of the second molar. A distolingually based flap will be elevated to provide adequate exposure for extraction of the impacted third molar.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Postoperative Swelling
Time Frame: 48 hours after surgery
Degree of postoperative swelling assessed using a Visual Analog Scale (VAS) ranging from 0 to 5, where 0 indicates no swelling and 5 indicates extremely severe swelling following extraction of impacted mandibular third molars
48 hours after surgery
Postoperative Swelling
Time Frame: 48 hours after surgery
Degree of postoperative swelling assessed 48 hours after extraction of impacted mandibular third molars using a Visual Analog Scale (VAS) ranging from 0 to 5, where 0 indicates no swelling and 5 indicates extremely severe swelling.
48 hours after surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
College of Physicians and Surgeons Pakistan

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
July 5, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
August 5, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
August 5, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 6, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 12, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 17, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 17, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 12, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • DSG-2022-024-4359

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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