# Evaluation of the Distal Periodontal Bone Defect Associated with Lower Third Molar Extraction
## 5 Conclusions  
This study provides valuable insights into periodontal conditions distal to the second molar following lower third molar extraction, addressing an area of limited research. Despite the pilot nature of this study and its small sample size, the findings align with the existing literature and offer meaningful directions for future investigation.  
Our results underscore the significant impact of lower third molar extraction on the periodontal health of adjacent second molars. Specifically, mesioangular and horizontal impactions were associated with greater risk of periodontal damage, including deeper probing-pocket depths (PPDs) and lower distal bone peaks (POD), compared to vertical impactions. Younger patients demonstrated superior healing outcomes, further supporting the rationale for early intervention strategies.  
These findings emphasize the importance of individualized treatment planning, which accounts for factors such as impaction type, anatomical conditions, and preoperative periodontal health. Preventive extraction in high-risk cases, particularly for mesoangular and horizontal impactions, may help optimize long-term periodontal outcomes and protect the adjacent second molars.  
Expanding the study sample size to at least 100 participants would increase statistical power, allowing for more definitive conclusions regarding the relationship between impaction type and post-extraction healing. This would also help to confirm trends observed in this study, such as differences in periodontal and bone healing among various impaction types.  
Future research should incorporate advanced imaging modalities, such as cone-beam computed tomography (CBCT) and surface-enhanced Raman scattering (SERS)-based techniques, to improve diagnostic precision and provide a more comprehensive understanding of healing dynamics. Additionally, exploring the use of adjunctive therapies, including guided tissue regeneration and biomaterials, may enhance postoperative outcomes.  
Epidemiological factors, such as angle classification, deserve further exploration to clarify their role in predicting periodontal health outcomes following third molar extractions. Similarly, studies are needed to investigate the causal relationship between third molar inclination and postoperative complications, as well as the impact of effective plaque control strategies on healing outcomes.  
Ultimately, this study highlights the need for a tailored approach to third molar management. By considering patient-specific factors, such as impaction type and anatomical conditions, clinicians can optimize treatment planning to safeguard the periodontal health of second molars and achieve improved overall outcomes.  
Conceptualization, P.B. and U.C.; Methodology, P.B., S.K. and U.C.; Validation, S.K.; Formal analysis, S.K.; Investigation, P.B., S.K. and G.S.; Resources, S.C., C.B. and M.R.; Data curation, S.K.; Writing--original draft, P.B. and S.K.; Writing--review & editing, G.S., S.C., C.B., M.R. and U.C.; Visualization, G.S. All authors have read and agreed to the published version of the manuscript.  
This research received no external funding.  
This study was approved by the Area Vasta Emilia Nord (AVEN) Ethics Committee under project identification code Pratica C.E. N. 1060/2019. Approval was granted during the session on 7 April 2020 (protocol no. 10171 dated 8 April 2020).  
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.  
The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.  
The authors declare no conflicts of interest.