Objective To compare the efficacy and safety of collagen sponge (CS) and gelatin silver sponge (GSS) in the treatment of impacted mandibular third molar extraction. Methods A total of 158 patients with impacted mandibular third molar admitted to Jieyang People's Hospital from February 2023 to February 2024 were randomly divided into control group and observation group, with 79 patients in each group. Both groups received mandibular impacted third molar extraction. After operation, the control group was filled with gelatin silver sponge, and the observation group was filled with collagen sponge. The bleeding, degree of facial swelling, pain level, infection and healing time of the two groups were compared. Results There was no significant difference in tooth extraction bleeding between the two groups at 30 min, 2 h and 24 h after operation (P >0.05). There was no significant difference in facial circumference between the two groups on the 1st, 4th and 7th day after operation (P >0.05). The VAS score of the observation group was lower than that of the control group on the 1st, 4th and 7th day after operation (P <0.05). The incidence of infection in the observation group was 1.27%, which was lower than 3.80% in the control group, but the difference was not statistically significant (P >0.05). The soft tissue healing time and complete healing time of the observation group were shorter than those of the control group (P <0.05). There was no significant difference in the healing time of hard tissue between the two groups (P >0.05). Conclusion The application effects of gelatin silver sponge and collagen sponge in the extraction of impacted mandibular teeth are good, both of which can improve the bleeding of extraction wound and the degree of facial swelling. However, collagen sponge has better effect in reducing pain and promoting healing, and will not increase the incidence of infection, which is worthy of clinical application.