Randomized trial of 1% povidone-iodine irrigation to reduce pain, swelling, and dry socket after mandibular third molar surgery

Background: Postoperative infection, pain, and dry socket remain common complications after surgical removal of impacted mandibular third molars. Povidone-iodine (PVP-I) is a broad-spectrum antiseptic with proven bactericidal and anti-inflammatory properties, but its intraoperative use as an irrigant remains under-investigated. Objective: To evaluate the efficacy of 1% PVP-I irrigation compared with normal saline in reducing postoperative sequelae following surgical extraction of impacted mandibular third molars. Study Design: This randomized controlled trial enrolled 162 healthy patients (96 females, 66 males; mean age 28 yr) requiring mandibular third molar removal. Patients were randomly assigned to receive either 1% PVP-I (study group, n = 81) or normal saline (control group, n = 81) for intraoperative socket irrigation. Postoperative pain, swelling, and incidence of dry sockets were recorded on days 2 and 7 using a visual analogue scale. Data were analyzed using t-tests and Mann–Whitney U tests with a significance level of p <0.05. Results: The PVP-I group demonstrated significantly lower mean pain scores on day 2 (p = 0.01) and day 7 (p = 0.02). Swelling was significantly reduced in the PVP-I group compared to saline across all time points (p <0.001). The incidence of dry socket was also lower in the PVP-I group (6.2%) compared with controls (19.7%; p = 0.01). Conclusion: Intraoperative irrigation with 1% povidone-iodine significantly reduces postoperative pain, swelling, and dry socket incidence following third molar surgery compared with saline irrigation. These findings suggest that PVP-I irrigation may be a simple and cost-effective adjunct to improve postoperative outcomes. Larger multicenter trials are warranted to validate these results.