DYNAMICS OF CLINICAL INDICATORS OF HEALING POST-EXTRACTION WOUNDS AFTER REMOVAL OF MESIALLY INCLINED IMPACTED LOWER THIRD MOLARS
Authors: Avetikov G.D. , Lokes K.P. 
Published: December 2024

This article highlights changes in clinical indicators, including the depth of periodontal pockets, thickness of attached gums, and the condition of the lower second molar, during the postoperative period. The purpose of the study was to evaluate the clinical indicators of healing in post-extraction wounds following the removal of mesially inclined impacted lower third molars, using both a standard protocol and a protocol with supplemental treatment, in a comparative perspective.
Subjects and Methods. The patients were divided into two groups: the main group, which followed the protocol with supplemental treatment, and the control group, which underwent the standard atypical tooth extraction protocol. The condition of the tissues around the post-extraction wound was assessed on the 1st, 2nd, 5th, 7th, and 30th days post-operation. Clinical indicators included the evaluation of the volume and topography of attached gums, depth of periodontal pockets, as well as functional and biomechanical indicators of the lower second molar.
Results. The results of the study indicate that the use of the proposed protocol led to improvements in the condition of the attached gums and periodontal pockets, as well as a reduction in the mobility of the second molar. In the main group of patients, by the 30th day, the indicators of electric pulp testing (EPT) returned to physiological levels, demonstrating the effectiveness of the proposed surgical treatment method.
 The study has revealed that in the control group, the indicators of the volume and topography of attached gums decreased by an average of 20.0% of the initial volume by the 7th day, unlike the main group, where this indicator significantly decreased by an average of 15.0% from baseline values. It has been proven that on the 2nd day after the surgical intervention, an increase in the depth of periodontal pockets by up to 15% from the initial level was observed in 24 patients (80% of cases) in the main group, whereas in the control group, this was noted in 27 patients (90% of cases). Normalization of this indicator in the main group was noted by the 30th day while small changes persisted in 6 patients (20% of cases), as opposed to 16 patients (53.3% of cases) in the control group. Significant differences between the groups were determined from the analysis of second molar mobility and EPT. The absence of mobility of the second molar was found in 25 patients in the main group (83.3% of cases), compared to the control group where this indicator was observed in 70% of cases. Physiological electrical conductivity of the tooth remained below 5 units in 27 patients from the main group (90.0% of cases) by the 30th day, while in the control group it was found in 23 patients (69.0% of cases), validating the effectiveness of our modified protocol for the atypical removal of mesially inclined lower third molars.
Conclusion. The implementation of an improved standardization table for clinical indicators to assess tissue condition after the removal of mesially inclined impacted lower third molars enhances postoperative monitoring of reparative processes, enables timely detection of potential complications, and supports the development of algorithms for their resolution.