Background/Objectives: Surgical extraction of impacted mandibular third molars is frequently associated with postoperative morbidity, including swelling, trismus, and pain. However, the extent to which osteotomy contributes to these outcomes remains unclear. The aim of this study was to evaluate osteotomy as an intraoperative determinant of early postoperative morbidity following mandibular third molar extraction. Methods: This study represents a secondary analysis of data obtained from a randomized clinical trial. Patients undergoing surgical removal of impacted mandibular third molars were categorized according to whether osteotomy was required during the procedure. Postoperative outcomes included surgical duration, facial swelling (primary outcome) assessed by linear facial measurements, maximal mouth opening (trismus), postoperative pain intensity, and early soft tissue healing evaluated using the Early Healing Index. Results: Procedures involving osteotomy were associated with significantly longer surgical duration, as well as greater postoperative swelling and trismus during the early postoperative period. The most pronounced difference in swelling was observed along facial measurement line A on postoperative day 3. Multivariable analysis confirmed that osteotomy remained independently associated with increased postoperative swelling and trismus after adjustment for age, sex, and the original six-arm treatment allocation. In contrast, no statistically significant differences were found between the groups in postoperative pain intensity or early soft tissue healing. Conclusions: Osteotomy during mandibular third molar extraction is independently associated with increased early postoperative morbidity, particularly in terms of swelling and trismus. However, bone removal does not appear to negatively affect early soft tissue healing of the surgical site.
Niemczyk et al. (2026) studied this question.