Gogulanathan 2015.

Study characteristics
Methods	Study design: RCT split‐mouth method Conducted in: India
Participants	Inclusion criteria: over 18 years of age; ASA 1 (American Society of Anesthesiology) patient with no systemic diseases or conditions; patient requiring surgical removal of bilaterally impacted mandibular third molars; bilateral impactions with a relatively similar classification and degree of difficulty, based on the Pell and Gregory system; patient agreement to the surgical procedure and clinical trial, providing informed consent Exclusion criteria: presence of systemic diseases; presence of bleeding disorders; patients on antiplatelet or anticoagulant therapy; pregnant or nursing mothers; patients with a known history of allergy to lidocaine; patient not consenting to the procedure or study Number randomised: 30 participants/60 teeth Number evaluated: 30 participants
Interventions	Fibrin sealant versus conventional suturing using 3–0 black silk Group A (n = 30): fibrin sealant Group B (n = 30): primary closure by suturing Using a split‐mouth study design, wound closure following extraction was done using fibrin sealant on the study side and primary closure suturing on the control side. Procedure was carried out under local anaesthetic.
Outcomes	Primary outcome measures were (1) the time taken to achieve wound closure and haemostasis and (2) postoperative mouth opening, pain, and swelling.
Notes	As this was a split‐mouth study, the paired t‐test was used to compare the mean values between the control and experimental groups. The paired t‐test was also applied for comparisons between time points. The level of significance was fixed as a = 0.05 (2‐ tailed). IBM SPSS Statistics for Windows, version 20.0 (IBM Corp, Armonk, NY, USA) was used for the data analysis. Sample size calculation: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "The patient pool was sequentially numbered 1–30. Lots were drawn, one for each patient, from sealed envelopes that contained combinations of the agent (fibrin sealant/suturing) and the side to be operated (right/left)" Comment: sequentially numbered, sealed envelopes were used
Allocation concealment (selection bias)	Low risk	Comment: sealed envelopes were used
Blinding (performance bias and detection bias) patient	Unclear risk	Comment: it is unclear if participants were blinded to the procedure. This is not stated specifically; it is possible the participant would be aware of the presence (or absence) of sutures in mouth.
Blinding (performance bias and detection bias) assessor	Unclear risk	Comment: unclear if the assessor was different to the operating surgeon
Incomplete outcome data (attrition bias) All outcomes	Low risk	Quote: "no patients discontinued the trial or were lost to follow‐up" Comment: all participants were analysed
Selective reporting (reporting bias)	Low risk	All planned outcomes were reported.
Other bias	Unclear risk	This was a cross‐over trial. The order of the receiving of treatments was randomised. There is potential bias from a carry‐over effect; carry‐over effect was not evaluated.