# Evaluation of the Distal Periodontal Bone Defect Associated with Lower Third Molar Extraction
## 4 Discussion  
This study examines periodontal conditions distal to the lower second molar at least 12 months after surgical extraction of the lower third molars. Although third molar extraction is often not recommended in asymptomatic cases, our findings highlight that periodontal issues affecting the adjacent second molar may remain silent for a long time, potentially compromising its health and survival. One objective of this study was to assess the prevalence and severity of these periodontal issues and identify influencing factors. This information is critical for determining whether third molar extraction is warranted. Preventive extraction of mandibular third molars is commonly performed to mitigate risks such as periodontal damage to the second molar, root resorption, distal caries, and orthodontic considerations. Additional reasons include the potential for pathological follicular evolution (e.g., cysts formation), increased risk of mandibular angle fracture, and greater surgical difficulty with advancing age [30]. The imaging modalities used, orthopantomography (OPG) and cone beam computed tomography (CBCT), represent standard practices for assessing third molar impactions and their associated periodontal impacts. OPG provides a convenient and low-radiation panoramic view, CBCT offers enhanced three-dimensional imaging crucial for evaluating anatomical proximity and predicting surgical complications. However, these methods have limitations, such as OPG's two-dimensional representation and CBCT radiation exposure [30]. Emerging imaging technologies, as highlighted in the recent literature, including [PERSON] et al. [30], demonstrate significant advancements that could complement these traditional methods. Optical biosensing systems, such as fluorescence and surface-enhanced Raman scattering (SERS)-based imaging, provide molecular-level insights that can identify early inflammatory changes or bacterial colonization distal to the second molar. Unlike CBCT, these systems offer real-time diagnostics with high specificity and sensitivity, reducing reliance on radiation-based methods. Comparative analysis underscores a key trade-off: while OPG and CBCT are indispensable for structural assessments, integrating next-generation technologies like optical biosensing could enhance diagnostic precision by detecting biological and molecular changes. This integration could optimize clinical decision-making, particularly in identifying at-risk second molars post-extraction. Future studies should focus on hybrid approaches that leverage the strengths of both traditional and advanced imaging technologies, paving the way for more comprehensive periodontal evaluations and improved patient outcomes. Guidelines from the German Society of Dental, Oral, and Maxillofacial Medicine (DGZMK) emphasize the link between untreated third molars and periodontal damage in second molars [31]. Consistent with these guidelines, our findings suggest that periodontal complications, especially in high-risk horizontal and mesioangular impactions, warrant early surgical intervention  
This study grouped clinical cases based on the preoperative inclination of the third molar, as classified by [PERSON]'s system, to investigate differences in periodontal healing among mesioangular, horizontal, and vertical impactions. The findings suggest that age, distributed uniformly across groups (predominantly under 25 years), did not significantly affect outcomes. This is consistent with previous research by [PERSON] et al. [11], which found that surgical extraction of third molars in younger patients (<25 years) resulted in better healing over time, with reduced probingpocket depths (PPDs) and improved distal bone peaks (POD). The depth of impaction and initial bone density also emerged as critical factors in post-extraction healing [32]. Fully impacted teeth often create a unilateral bony defect, while semi-impacted or partially erupted teeth may result in bone loss of two walls (coronal and buccal).