Aim <p>To compare phase-specific soft tissue healing (STH) and periodontal changes after mandibular impacted third molar (MITM) extraction with and without iPRF.</p> Materials and methods <p>This single-blind, single-center, split-mouth, randomized controlled trial included patients with bilateral MITMs. Extraction sites were randomly assigned using simple randomization to either the iPRF group (test; irrigation with iPRF) or the control group (irrigation with saline). The primary outcome was STH, using Inflammatory Proliferative Remodeling (IPR) scale on days 3 and 14 and at week 6. Secondary outcomes included complete wound epithelialization (CWE), (days 7 and 14); postoperative average pain (PAP) during the first 3 days; and periodontal parameters—gingival recession (GR), probing pocket depth (PPD), and clinical attachment level (CAL)— measured at baseline and 6 weeks at the distal aspect of the second molar.</p> Results <p>A total of 32 patients (mean age: 25.09 ± 5.16 years) were included. iPRF group showed significantly higher STH scores in the inflammatory and proliferative phases and lower PAP. No significant intergroup differences were observed in CWE. Both groups showed significant reductions in PPD and significant increases in GR at 6 weeks, while CAL improved significantly only in iPRF group. Intergroup comparisons revealed significantly higher baseline PPD and CAL values in iPRF group; however, no differences were observed between groups at 6 weeks. Change analysis demonstrated a significantly greater CAL gain in iPRF group.</p> Conclusion <p>The application of iPRF appears to enhance early STH, reduce PAP, and promote favorable changes in CAL following MITM extraction.</p> Trial registration <p>NCT07257328, registered retrospectively on November 20, 2025.</p>