Comparison of Electrocautery and Scalpel Incisions in the Surgical Removal of Impacted Mandibular Third Molars: A Prospective Randomized Clinical Study.

Background Surgical removal of impacted mandibular third molars is routinely performed using scalpel blade incisions; however, electrocautery has been proposed as an alternative due to its hemostatic advantage. Limited evidence exists comparing both techniques with respect to intraoperative efficiency and postoperative outcomes. Aim The main aim of this study is to compare electrocautery and scalpel blade incisions during surgical removal of impacted mandibular third molars in terms of operative time, blood loss, postoperative pain, facial swelling, trismus, and wound healing. Materials and methods A prospective split-mouth randomized study was conducted on 40 patients with bilateral impacted mandibular third molars. Each patient received an electrocautery incision on one side (study site) and a scalpel blade incision on the contralateral side (control site). The time taken for flap elevation and intraoperative blood loss were recorded. Postoperative pain was assessed using the Visual Analog Scale (VAS) at preoperative and 6, 12, 24, and 48 hours and at 7 days. Facial swelling and mouth opening were evaluated preoperatively and on postoperative days 3 and 7. Wound healing was assessed using the Landry healing index on days 7 and 14. Statistical analysis was performed using an independent t-test and repeated-measures ANOVA (p < 0.05). Results Electrocautery significantly reduced flap elevation time (6.65 ± 0.53 min vs. 7.31 ± 0.57 min; p < 0.001) and intraoperative blood loss (1.11 ± 0.42 mL vs. 1.66 ± 0.42 mL; p < 0.001). Pain scores peaked within 48 hours in both groups, with significantly lower pain in the electrocautery group at 24 hours (p = 0.047). No significant intergroup differences were observed for facial swelling or trismus at any time point (p > 0.05). Wound healing on day 7 was significantly better in the scalpel group (p < 0.001); however, by day 14, healing outcomes were comparable between the two groups (p = 0.562). Conclusion Electrocautery provides superior intraoperative efficiency by reducing surgical time and blood loss, with comparable postoperative outcomes to scalpel blade incisions. Although early wound healing may be delayed with electrocautery, long-term healing is unaffected. Electrocautery can be considered a safe and effective alternative for incisions in mandibular third molar surgery.