Efficacy and Safety of Modification of Ward’s Incision Without Distal Release Versus Conventional Ward’s Incision in Surgical Extraction of Impacted Mandibular Third Molars: A Randomized Controlled Trial

This research project investigates the postoperative outcomes of two surgical flap designs, the conventional Ward’s incision and a modified version without a distal releasing incision for the extraction of impacted mandibular third molars. Surgical removal of these teeth is a routine procedure but often leads to complications such as pain, swelling, and restricted jaw movement (trismus). While the conventional Ward’s flap provides excellent surgical access, it may contribute to greater postoperative discomfort due to its extensive tissue reflection. A modified approach that eliminates the distal releasing incision has been proposed to reduce these complications while maintaining sufficient surgical access. However, there is a lack of high-quality comparative studies on this topic.

The primary objective of this study is to determine whether the modified Ward’s incision results in reduced postoperative morbidity compared to the conventional method. Secondary objectives include comparing pain lefvels, facial swelling, operative efficiency, and complication rates between the two techniques. The study will be conducted as a randomized controlled trial at the Department of Dentistry, AIIMS Bibinagar, involving 54 participants (27 in each group) aged 18–35 years. Patients will be randomly assigned to either the conventional or modified flap group, with outcomes assessed at multiple time points post-surgery.

The findings are expected to provide evidence-based recommendations for oral surgeons, potentially improving patient comfort and recovery after third molar surgery. By addressing a gap in current research, this study could influence clinical practice by supporting the adoption of a less invasive flap design with comparable efficacy. Key measurements will include interincisal mouth opening (to assess trismus), pain scores using a visual analogue scale (VAS), and facial swelling through standardized linear measurements. Operative time, need for bone removal, and complications such as infection or dry socket will also be recorded. Statistical analysis will compare outcomes between groups, with adjustments for baseline differences. The study anticipates that the modified flap will lead to better postoperative recovery, including less trismus, reduced pain, and decreased swelling, without compromising surgical success