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

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

116

Phase

  • 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

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

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
Intervention / Treatment
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

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

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)

July 5, 2026

Primary Completion (Estimated)

August 5, 2026

Study Completion (Estimated)

August 5, 2026

Study Registration Dates

First Submitted

June 6, 2026

First Submitted That Met QC Criteria

June 12, 2026

First Posted (Actual)

June 17, 2026

Study Record Updates

Last Update Posted (Actual)

June 17, 2026

Last Update Submitted That Met QC Criteria

June 12, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID 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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