Comparing flap closure methods after impacted lower wisdom tooth removal

The Effect of Different Flap Closure Techniques on Postoperative Morbidity: A Randomized Controlled Trial for Impacted Third Molar Surgery

This trial will test whether four flap closure methods—traditional sutures, leaving the wound open, a small surgical drain, or a cyanoacrylate tissue adhesive—reduce pain, swelling, limited mouth opening, and improve recovery for healthy adults (18–40) having an impacted lower third molar removed.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 148 (estimated)
• Ages: 18 Years to 40 Years
• Sex: All
• Sponsor: Recep Tayyip Erdogan University (other)
• Locations: 1 site (Rize, Rize Province)
• Trial ID: NCT07198282 on ClinicalTrials.gov

What this trial studies

This is a randomized controlled trial that assigns patients to one of four commonly used flap closure techniques following extraction of a similarly positioned impacted mandibular third molar. Outcomes include postoperative pain, facial swelling, trismus (limited mouth opening), wound healing, and patient-reported oral health quality of life (GOHAI) measured at scheduled follow-ups. The four interventions compared are conventional silk suturing, a sutureless approach (secondary intention), placement of a surgical drain, and closure with a high-viscosity cyanoacrylate tissue adhesive. Eligible participants are healthy adults (ASA I) aged 18–40 with specific impaction classifications, and the procedures and follow-ups take place at a single university oral surgery department.

Who should consider this trial

Good fit: Healthy adults aged 18–40 (ASA I) with an impacted mandibular third molar in similar positions (Pell & Gregory Class 2, Position B; vertical or mesioangular) are ideal candidates.

Not a fit: Patients who are older or have systemic illness (ASA II–IV), active local infection, heavy tobacco or alcohol use, pregnancy, anticoagulant or antiplatelet therapy, coagulation or immunosuppressive disorders, or known allergy to acrylates are unlikely to qualify or benefit from this protocol.

Why it matters

Potential benefit: If successful, the best flap closure method could reduce early postoperative pain and swelling and speed recovery after impacted lower wisdom tooth extraction.

How similar studies have performed: Previous clinical comparisons of sutures versus sutureless closure, tissue adhesives, and drains exist with mixed results—some trials report modest improvements with cyanoacrylate or sutureless techniques but findings are inconsistent.

Eligibility criteria

Inclusion Criteria:

* Patients aged 18-40 years.
* Patients with no systemic diseases (ASA I).
* Patients with impacted mandibular third molars indicated for extraction, with bone and/or mucosal retention, in similar positions (Pell \& Gregory Class 2, Position B; Winter classification vertical or mesioangular).

Exclusion Criteria:

* Patients classified as ASA II, III, or IV.
* Known allergy to anesthetic solutions.
* Allergy to acrylate.
* Pregnant or breastfeeding women.
* Individuals with tobacco use ≥10 cigarettes/day.
* Alcohol users.
* Patients using antiplatelet agents.
* Patients using anticoagulants.
* Patients with coagulation disorders.
* Patients with immunosuppressive diseases or receiving immunosuppressive therapy.

Patients with acute pain or local infection at the surgical site.

Where this trial is running

Rize, Rize Province

• Recep Tayyip Erdoğan University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery — Rize, Rize Province, Turkey (Türkiye) (RECRUITING)

Study contacts

• Study coordinator: Alperen Kalyoncu, Assistant Professor

Conditions: Impacted Mandibular Third Molar, Postoperative Morbidity, Oral Surgery, Impacted third molar, Flap closure techniques, Cyanoacrylate, Sutureless technique, Surgical drain