Improving healing after surgical extraction of partially impacted lower third molar by modification of three sided...

Sulcular deepitheliazation (SD) means the formation, maintenance, and regeneration of the thin, non-keratinized epithelial lining (sulcular epithelium) that covers the soft tissue wall of the gingival sulcus. SD is a critical, rapid healing process following periodontal surgery, where epithelial cells migrate to cover denuded connective tissue and re-establish a barrier against bacteria. To assess the healing outcomes of SD during the extraction of partially impacted mandibular third molars. This clinical pilot study enrolled forty patients at the Oral Surgery Clinic, College of Dentistry, University of Sulaimani, Sulaimaniyah, Iraq, from January 2024 to June 2025. Participants were randomly assigned to a control group treated with a modified three-sided flap (n = 20) or a study group receiving additional SD (n = 20), as an approach for surgical extraction of partially erupted lower third molars. Then, surgical difficulties were assessed, postoperative care was recommended, and postoperative assessments (pain, mouth opening, facial swelling, and soft-tissue healing) were evaluated using different protocols. Finally, the correlations between different variables were determined and compared. SD did not significantly affect postoperative pain, swelling, trismus, or mouth opening, but eliminated dry socket, impaired healing, and second-molar sensitivity, which occurred in the control group at rates of 10%, 15%, and 25%, respectively. Postoperative pain correlated significantly with tooth splitting (p = 0.000) and difficulty score (p = 0.001), while limitation of mouth opening was associated with tooth splitting (p = 0.001). SD can improve soft-tissue healing and might prevent socket-related complications, whereas postoperative morbidity is mainly driven by surgical difficulty.