Comparative Evaluation of Postoperative Pain, Swelling, and Trismus Fol lowing Impacted Mandibular Third Molar Surgery Using Platelet-Rich Fi brin and Ozone Therapy: A Randomized Clinical Study
DOI:
https://doi.org/10.48165/ajm.2026.9.01.42Keywords:
Platelet-Rich Fibrin, Ozone Therapy, Impacted Mandibular Third Molar, PainAbstract
Background: Postoperative pain, swelling, and trismus are common complications following impacted mandibular third molar surgery. Various adjunctive therapies have been introduced to improve healing and reduce postoperative discomfort. Platelet-rich fibrin (PRF) and ozone therapy have shown promising results due to their anti-inflammatory and healing-enhancing properties. Aim: To compare the effectiveness of PRF and ozone therapy in reducing postoperative pain, swelling, and trismus after impacted mandibular third molar surgery. Materials and Methods: This randomized clinical study included 45 patients requiring surgical extraction of impacted mandibular third molars. Participants were randomly divided into three groups: Group I (control), Group II (PRF), and Group III (ozone therapy). Postoperative pain was assessed using the Visual Analog Scale (VAS), swelling was measured using facial reference points, and trismus was evaluated by measuring maximum mouth opening on postoperative days 1, 3, and 7. Statistical analysis was performed using ANOVA and post hoc tests, with p < 0.05 considered statistically significant. Results: Both PRF and ozone therapy groups demonstrated reduced postoperative pain, swelling, and trismus compared to the control group. The PRF group showed superior improvement in soft tissue healing and reduction in pain scores, while the ozone therapy group demonstrated better reduction in swelling during the early postoperative period. The differences between the study groups were statistically significant (p < 0.05). Conclusion: Both PRF and ozone therapy are effective adjuncts in minimizing postoperative complications following impacted mandibular third molar surgery. PRF showed comparatively better overall healing outcomes, whereas ozone therapy was more effective in controlling early postoperative swelling.
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Bhatt S, Gill S, Boya C, Simre S, Sagar S. Effect of ice pack application on post-extraction pain and swelling: A randomized clinical study. Acad J Med. 2026;9(1):9-12.
Tamboli AN, Kumar GP, Kanani R, Bhattacharjee A, Mannivannan PC, Shah SJ, Angeles MDG. Evaluation of different surgical removal techniques for impacted mandibular third molar impactions: A comparative study. J Pharm Bioallied Sci. 2025 Sep;17(Suppl 3):S2448-S2450.
Bai KP, Ranjit N, Gite S, Kaur G, Gill S, Patel V. Incidence and pattern of dry socket following mandibular third molar extraction: A prospective clinical study. Int J Life Sci Biotechnol Pharma Res. 2026;15(2):661-665.
Gupta H, Bhatt S, Patel V, Gill S, Bai KP, Sagar S. Effect of immediate versus delayed chlorhexidine rinse on post-extraction pain: A randomized clinical study. Acad J Med. 2026;9(1):48-51.
Menziletoglu D, Guler AY, Basturk F, Isik BK, Erdur EA. Comparison of two different flap designs for bilateral impacted mandibular third molar surgery. J Stomatol Oral Maxillofac Surg. 2020;121:368-372.
Konuk B, Senturk MF. Three-dimensional evaluation of the effect of platelet-rich fibrin on edema in lower impacted third molar surgery performed with piezosurgery. Niger J Clin Pract. 2022;25:1107-1114.
Gill S, Pihulkar P, Bhatt S, Sagar S, Chandran H, Awati A. Effect of preoperative dexamethasone on postoperative sequelae following mandibular third molar surgery: A randomized clinical study. Int J Life Sci Biotechnol Pharma Res. 2026;15(2):915-918.
Abdul NS, Almughaiseeb AA, Alghannam SM, Alshaikh AB. Unlocking Healing: Ozone Therapy’s Breakthrough in Oral Lesion Management - A Narrative Review. J Pharm Bioallied Sci. 2025 Jun;17(Suppl 2):S1076-S1079.
Alling CC III, Catone GA. Management of impacted teeth. Oral Maxillofac Surg. 1993;51(1 Suppl 1):3-6. doi:10.1016/0278-2391(93)90004-.
Chukwuma BC, Taiwo AO, Akinmoladun VI, Ibikunle AA, Bala M. Postoperative sequelae following surgical extraction of impacted mandibular third-molar extraction using the complete closure versus the sutureless techniques. J West Afr Coll Surg. 2022 Oct-Dec;12(4):12-19.
Ozgul O, Senses F, Er N, Tekin U, Tuz HH, Alkan A, Kocyigit ID, Atil F. Efficacy of platelet rich fibrin in the reduction of pain and swelling after impacted third molar surgery: Randomized multicenter split-mouth clinical trial. Head Face Med. 2015 Nov 26;11:37.
Zhang Y, Tangl S, Huber CD, Lin Y, Qiu L, Rausch-Fan X. Effects of Choukroun’s platelet-rich fibrin on bone regeneration in combination with deproteinized bovine bone mineral in maxillary sinus augmentation: A histological and histomorphometric study. J Cranio-Maxillofac Surg. 2012;40(4):321-328.
Mozzatti M, Martinasso G, Pol R, Polastri C, Cristiano A, Muzio G, et al. The impact of plasma rich in growth factors on clinical and biological factors involved in healing processes after third molar extraction. J Biomed Mater Res. 2010;95(3):741-746.
Shekhar A, Sikdar C, Srivastava S, Chaturvedi A, Bhatia LK, Sarkar D. The efficacy of ozone therapy on pain and soft tissue healing associated with the surgical placement of dental implants: A randomized controlled trial. Cureus. 2025 Jun 6;17(6):e85482.
Dixit A, Agarwal B, Singh K, Chand P, Rao J, Mishra N. Comparative evaluation of normal saline gel and ozone therapy on soft and hard tissue health in dental implant surgery. Indian J Dent Res. 2024 Jan 1;35(1):2-6.
Starzyńska A, Kaczoruk-Wieremczuk M, Lopez MA, Passarelli PC, Adamska P. The growth factors in advanced platelet-rich fibrin (A-PRF) reduce postoperative complications after mandibular third molar odontectomy. Int J Environ Res Public Health. 2021;18:13343.
