Objective To compare the effect of collagen sponge and gelatin sponge on preventing complications and improving aesthetics after impacted teeth extraction. Methods From January 2021 to December 2023, 100 patients with the same classification of bilateral mandibular third molar impaction and in need of extraction admitted to Chaoyang District Jiangtai Community Health Service Center were selected as the research subjects, and they were randomly divided into group A and group B, with 50 patients in each group. After impacted teeth extraction, group A was filled with traumatic collagen sponge for hemostasis, and group B was filled with traumatic gelatin sponge for hemostasis. The spontaneous pain score, aesthetics (PES), swelling degree, mouth opening degree and complication rate were compared between the two groups. Results The spontaneous pain score of group A was lower than that of group B, and the PES score was higher than that of group B (P <0.05). The swelling degree of group A on the day after surgery and at 3 and 7 days after surgery were lower than those of group B, and the mouth opening degree were higher than those of group B (P <0.05). The incidence of complications in group A was 20.00%, which was lower than 36.00% in group B (P <0.05). Conclusion Compared with gelatin sponge, collagen sponge can reduce the degree of pain after impacted teeth extraction, enhance aesthetic effect, improve swelling degree and mouth opening degree, and reduce the incidence of complications.