Pachipulusu 2018.

Study characteristics
Methods	Study design: parallel‐arm RCT Conducted in: India
Participants	Inclusion criteria: Patients willing to give their consent for the procedure Patients with an indication for extraction of impacted lower third molars with a symmetrical grade of impaction, assessed using the Pell and Gregory classification Patients with ASA physical status of I Patients in age group of 18 to 50 years Patients free from systemic disease Exclusion criteria: Patients with systemic diseases that can interfere with surgical therapy Patients not willing to be included in the study Patients with deleterious habits like smoking, tobacco, and betelnut chewing Age: mean 29.3 years Number randomised: 60 Number evaluated: 60
Interventions	Primary versus secondary closure of surgical wound Group A: 30 participants in which primary closure was done after surgical extraction Group B: 30 participants in which secondary closure was done after surgical extraction Suturing was done using round bodied 3–0 black silk or polyglactin 910 (Vicryl). Postoperative instructions were given, and the same course of antibiotics (amoxicillin with clavulanic acid 625 mg 3 times a day) and analgesics (aceclofenac with paracetamol 2 times a day) for 5 days were given for participants in both groups postoperatively after extraction.
Outcomes	Pain (0‐to‐10 VAS); swelling; trismus; periodontal healing
Notes	Sample calculation
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: the method of randomisation was not stated
Allocation concealment (selection bias)	Unclear risk	Comment: no mention of allocation concealment
Blinding (performance bias and detection bias) patient	Unclear risk	Comment: although it is unlikely that participants would have known which treatment they had received, this is not explicitly stated
Blinding (performance bias and detection bias) assessor	Unclear risk	Comment: it is unclear who assessed the participants postoperatively
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: no dropouts
Selective reporting (reporting bias)	Low risk	Comment: planned outcomes were reported
Other bias	Unclear risk	Quote: "using round bodied 3–0 black silk or vicryl, and sutures were removed after 1 week whether it is vicryl or silk" Comment: methodology was not consistent; the same sutures should have been used in the whole of Group A