OBJECTIVE:

The aim of my study is to compare the Comma Incision versus Ward’s Incision in Third Molar
Extraction in terms of post-operatively VAS score for pain, trismus, and swelling at the
operating site.

NULL HYPOTHESIS:
There is no difference in third molar extraction when the Comma Incision technique is
compared with the conservative Ward’s Incision.

ALTERNATE HYPOTHESIS:
In this study my hypothesis will be, the Comma Incision is a better technique as compared
to the Ward’s Incision in third molar extraction.

OPERATIONAL DEFINITIONS:
Comma Incision: In this type of incision, it is made in the anterior direction, starting from
deep vestibular reflection, posterior to the distal part of 2nd molar tooth. The incision is
curved to meet the gingival crest at the level of 2nd molar tooth (at the angle made by
distobuccal line) and continued around the distal part of adjacent 2nd molar tooth. After the
incision is made, flap is removed followed by the steps used for extraction of impacted third
molar tooth. Then the flap is sutured using 3/0 silk suture. (8-9)

Ward’s Incision: This is an anterior incision which curves in front of distobuccal corner of the
crown of 2nd molar ending at mesiobuccal cusp. This incision is extended distally along the
buccal side of the tooth to the ridge made by external oblique. Posterior part of the incision
is directed backwards and outwards. (10)


VAS score for pain: This is a visual analog scale for pain, manually filled by the patient. It’s
score ranges from zero (no pain) to 10 (worst pain).







Trismus: It is defined as painful restricted mouth opening, and will be assessed by
measuring the distance between upper and lower incisors by using centimetre scale. (5)

Swelling: The swelling will be assessed and noted in the performa by evaluating the distance
between tragus notch and base of ala, angle of mouth and along the surface of skin
(reproducible soft tissue pogonion). It will be measured as mild (up-to 1cm) moderate (up-to
2cm) and severe (up-to 3cm) by a cm scale.(5)

MATERIAL AND METHODS:

Study Design:
Randomized clinical trial
Setting: The study will be conducted in the Oral & Maxillofacial Department on the patients
visiting Dr Ishrat-ul-Ebad Khan Institute of Oral Health Sciences/ DUHS Karachi on outdoor
basis or indoor basis.

Duration of Study:
Six months after the approval of synopsis.

Sample Size:
A total of 163 cases (82 in group A and 81 in group B) is calculated from online calculator
(from www.openepi.com) keeping confidence level of 95% and confidence limit of 5%, while
taking frequency 12% of the patients experiencing moderate pain 7 days post-operatively
after the standard Ward’s incision, according to Anisuzzaman MM et al., 2019. (5)

Sampling Technique:
Purposive non-probability sampling technique would be used for the selection of patients.

Sample Selection:
Inclusion Criteria:
Patients having age from 18 to 40 years with either gender
Patients having good oral hygiene with no preoperative pain or swelling at the operating site
Patients with partially erupted 3rd molar or impacted 3rd molar
Exclusion Criteria:
Patients who will be on anticoagulation medications
Patients with known case of complicated T2DM (having evidence of stroke, myocardial
infarction, retinopathy, or nephropathy)

 PERFORMA

COMPARISON OF COMMA INCISION VERSUS WARD’S INCISION IN THIRD

MOLAR EXTRACTION IN TERMS OF POSTOPERATIVE SEQUEL
___________________________________________________________________________

CASE NO: ______________________________
Name of Patient: __________________________ S/D/O: ___________________________
Age: ____________________________________ Weight: ___________________________
Date of Admission: _______________________ Contact: ___________________________
Address:____________________________________________________________________
MR no.: ___________________

Gender: Male □ Female □

Group A: Comma Incision □

Group B: Ward’s Incision □

VAS Pain Score: ______________

Mild Moderate Severe
Swelling (Pre-op)
Swelling (Post-op)
Swelling (7 daysPost-op)


Yes No
Trsimus (Pre-op)
Trsimus (Post-op)
Trsimus (7 days Post-op)