Comparison of the Effects of Hyaluronic Acid and Titanium-Prepared Platelet-Rich Fibrin on Postoperative Pain, Swelling, and Trismus Following Impacted Mandibular Third Molar Surgery: Assessor-Blinded Randomized Controlled Clinical Trial.

Background

Postoperative pain, swelling, and trismus are common sequelae following impacted mandibular third molar surgery. Biomaterials have been investigated to reduce postoperative morbidity.

Purpose

To measure and compare hyaluronic acid (HA) and titanium-prepared platelet-rich fibrin (T-PRF) with respect to pain, swelling, and trismus following mandibular third molar surgery. STUDY DESIGN, SETTING, AND SAMPLE This assessor-blinded, parallel-group randomized controlled trial was conducted at the Faculty of Dentistry, İnönü University, Malatya, Türkiye, between February 23 and April 20, 2026. The sample comprised patients presenting during this period for evaluation and surgical management of fully or partially impacted mandibular third molars requiring osteotomy. Exclusion criteria were age outside 18 to 32 years, systemic disease, pregnancy or lactation, smoking, and acute infection at the surgical site. INDEPENDENT VARIABLE The treatment protocol was the independent variable, with participants randomized to control, HA, or T-PRF groups. MAIN OUTCOME VARIABLE(S) The primary outcome was therapeutic effect measured using the visual analog scale (VAS) to assess pain on postoperative day (POD) 3. Secondary measures were VAS pain scores on PODs 1 and 7 and swelling and trismus measurements on PODs 1, 3, and 7. COVARIATES Covariates included age, sex, tooth side, Winter classification, Pederson Difficulty Index, and Pell-Gregory classification. ANALYSES Analyses included one-way and repeated-measures analysis of variance, Kruskal-Wallis and Friedman tests, and analysis of covariance, with statistical significance set at P < .05.

Results

Of 66 individuals assessed for eligibility, 60 subjects were analyzed [mean (SD) age, 22.55 (3.09) years; female, n = 30 (50.0%); male, n = 30 (50.0%)]. On POD 3, mean (SD) VAS pain scores were 3.85 (2.35) in the T-PRF group, 4.80 (1.79) in the HA group, and 4.50 (2.35) in the control group (P = .4). No statistically significant group × time interaction was observed for postoperative pain (P = .9) or trismus (P = .4). The unadjusted between-group difference in Tragus-Labial Commissure measurement on POD 3 was no longer statistically significant after baseline adjustment using analysis of covariance(P = .092).

Conclusions

AND RELEVANCE T-PRF and HA showed no statistically significant advantage over control (no local socket biomaterial) for postoperative pain, swelling, or trismus.