Postoperative Pain and Swelling After Flap vsFlapless Technique For Mandibular Third Molar Surgery

Comparison of Postoperative Pain and Swelling in Flap Versus Flapless Technique for Surgical Removal of Partially Impacted Mandibular Third Molars: A Randomized Controlled Trial

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.

Study Overview

• Status: Recruiting
• Conditions: Pain (Visceral, Somatic, or Neuropathic)
• Intervention / Treatment: Procedure: flap technqiue for mandibular third molar extraction Arm A; Procedure: flapless technquie arm b

Detailed Description

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
• Enrollment (Estimated): 160
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: dr huma bajar huma bajar, bds; Phone Number: 00923243322292; Email: humabajar@yahoo.com

Study Locations

• Pakistan
  • Islamabad
    • Islamabad, Islamabad, Pakistan, 44000
      • Recruiting
      • Watim Medical College&Dental Hospital
      • Contact: dr huma bajar huma bajar, bds; Phone Number: 00923243322292; Email: humabajar@yahoo.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 18-45 years

  • Either gender
  • Partially impacted mesioangular mandibular third molar confirmed clinically and radiographically
  • Second episode of pericoronitis
  • Swelling present on the affected side
  • No bone recession or periodontal disease on radiograph

Exclusion Criteria:

• HIV or HBV infection

  • Diabetes or other metabolic disorders
  • Bleeding disorders including von Willebrand disease, thalassemia, hemophilia, thrombocytosis, or thrombocytopenia
  • Periapical infection or acute pericoronitis at time of surgery
  • Severe trismus
  • Immunocompromised status

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: flap technqiue; Surgical extraction with mucoperiosteal flap elevation, bone guttering, tooth sectioning, and suturing.	Procedure: flap technqiue for mandibular third molar extraction Arm A; 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.
Experimental: flapless technquie; Surgical extraction without flap elevation, minimal gingival reflection, bone guttering, and no suturing.	Procedure: flapless technquie arm b; 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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
postoperative 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.	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.	2nd postoperative day

Collaborators and Investigators

• Sponsor: Watim Medical & Dental College

Study record dates

Study Major Dates

• Study Start (Actual): August 15, 2024
• Primary Completion (Estimated): February 15, 2026
• Study Completion (Estimated): April 15, 2026

Study Registration Dates

• First Submitted: November 14, 2025
• First Submitted That Met QC Criteria: November 20, 2025
• First Posted (Actual): November 25, 2025

Study Record Updates

• Last Update Posted (Actual): November 25, 2025
• Last Update Submitted That Met QC Criteria: November 20, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain
• Other Study ID Numbers: WMC-OMFS-FLAPvsFLAPLESS-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No