## 4 Discussion
This indicates that HA can help lower the infection risk in surgical procedures. Additionally, HA-based mouthwashes significantly reduce bacterial growth and can be a valuable biomaterial for infection control and healing support in medical applications [32]. However, our study did not assess the infection rates post-surgery, which could be an important parameter in evaluating HA's bacteriostatic benefits. Future studies should incorporate infection rate assessments to fully understand HA's role in postoperative care. Hyaluronic acid promotes cell migration, supports cell proliferation, and helps organize the granulation tissue [33; 34]. Studies in rats have shown that wounds treated with hyaluronic acid (HA) heal faster [35]. In periodontal treatments, subgingival HA gel application effectively reduces inflammation and improves gingival health [36]. Despite these biological mechanisms suggesting a potential benefit in postoperative tissue healing, the present study's outcomes indicate that these theoretical advantages did not translate into statistically significant clinical improvements. Several treatments, including platelet-rich fibrin (PRF), collagen-based dressings, chitosan-based dressings, and aloe vera gels, have been explored to mitigate postoperative complications following third molar extraction. PRF, rich in growth factors, enhances tissue regeneration and reduces inflammation, potentially offering more sustained benefits than hyaluronic acid (HA) [37]. Collagen dressings provide scaffolds for cellular growth, while chitosan dressings offer antimicrobial properties and promote wound healing [38]. Aloe vera gels' anti-inflammatory and soothing effects enhance patient comfort post-surgery [39]. We selected hyaluronic acid for its roles in tissue hydration, wound healing, and bacteriostatic effects against oral pathogens [33; 34]. However, the limited and transient benefits observed highlight the need for optimized HA applications or combination therapies. Comparative studies evaluating HA alongside alternatives like PRF are essential to determine their relative efficacies and potential synergistic effects. This study is not without limitations. Despite conducting a power analysis, the sample size may have been too small to detect minor effects. Additionally, the study protocol was not registered in a public database, which may affect transparency. The follow-up period was limited to seven days, potentially missing long-term outcomes and late complications. Moreover, HA was administered only once immediately post-extraction, which might have restricted its therapeutic benefits. Hyaluronic acid (HA) exhibits anti-inflammatory, antioxidant, and bacteriostatic properties, which have made it attractive for enhancing postoperative comfort [30]. However, our study revealed limited benefits of HA in reducing pain, swelling, and trismus, with only a slight improvement in trismus on day 7. These findings raise concerns about the routine use of HA, particularly given its high cost [13]. Without clear and clinically significant advantages, incorporating HA into standard postoperative protocols may not be economically justified. This study underscores the importance of evidence-based medical practices. Although HA's biological mechanisms suggest potential benefits, its clinical effectiveness requires rigorous validation. The lack of significant improvements in our results highlights the need for more refined research methodologies to fully assess HA's potential.