Effect of concentrated growth factor(CGF) on postoperative patient comfort in impacted lower third molars undergoing coronectomy: a prospective clinical study

Effect of concentrated growth factor(CGF) on postoperative patient comfort in impacted lower third molars undergoing coronectomy: a prospective clinical study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of concentrated growth factor(CGF) on postoperative patient comfort in impacted lower third molars undergoing coronectomy: a prospective clinical study Muharrem Ergun Dudak, Aylin Calis, Huseyin Koca This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4130259/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives The aim of this study was to evaluate the effect of CGF on post-operative patient comfort following coronectomy in impacted third molars with roots associated with the nervus alveolaris inferior. Materials and Methods Thirty-five patients with bilateral vertical impacted wisdom teeth with roots associated with the nervus alveolaris inferior were included in the study with an indication for coronectomy. Coronectomy was performed on both sides followed by cgf on one side. Pain levels were monitored with the VAS scale for 7 post-operative days. In addition, the amount of edema occurring on post-operative days 2 and 7 was also measured. All data were statistically evaluated. Statistical significance was determined as p<0.001. Results The first 6 days showed significantly lower (p<0.001) pain on the CGF-treated side, while the difference between the sides was not significant on the 7th day (p=0.627). On the 2nd day, significantly lower (p<0.001) edema occurred in the tragus-pogonion and angulus-lateral canthus planes on the CGF treated side. On day 7, there was no significant difference in edema between the sides. Uneventful healing was observed in all patients. Conclusion It is possible to prevent possible nerve damage with coronectomy. In addition, CGF can successfully improve patient comfort in the early post-operative period. Clinical Relevance Post-operative pain and edema, which are very important for patients, can be significantly reduced with the application of CGF, an easily obtainable autogenous product. The results obtained may provide valuable contributions to clinicians. Coronectomy Impacted mandibular third molar Concantred growth factor Pain Edema Paresthesia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction The impaction of third molars is a common occurrence due to various reasons. In addition to systemic and local factors, different theories such as Mendelian Theory, Phylogenetic Theory, Pathological Theory, Endocrine Theory, and Orthodontic Theory have been proposed for its etiology [ 1 , 2 ]. Impacted mandibular third molars can lead to pathologies such as pain, swelling, and infection, as well as caries formation in adjacent teeth, pericoronitis, periodontal damage, trismus, cysts, and other pathological formations, affecting neighboring anatomical structures. Treatment usually involves extraction of the affected teeth following clinical and radiological examination [ 3 , 4 ]. In radiological examinations, cases have been observed where the roots of impacted mandibular third molars are associated with the inferior alveolar nerve (IAN). Extraction of impacted mandibular third molars carries a risk of postoperative paresthesia due to IAN injury, ranging from 0.35–8.4% [ 5 ], [ 6 , 7 ]. Therefore, the extraction of mandibular third molars with roots associated with the IAN may be significantly advantageous to be replaced by a different surgical method called 'coronectomy' [ 8 , 9 ]. Coronectomy was first introduced as an alternative surgical method to extraction of mandibular third molars by Ecuyer and Debien in France in 1984 [ 10 – 12 ]. It involves the surgical removal of the enamel part without touching the root section of the tooth [ 11 ]. Directly related to the IAN, mandibular third molar surgery can be preferred in cases where it is deeply impacted to prevent the risk of postoperative fracture, the coronectomy method can also be applied [ 3 ]. A detailed evaluation of clinical and radiological examinations is crucial for the success of the procedure. Dental volumetric tomography, one of the three-dimensional radiological assessment methods, is frequently used to determine the relationship between the root and the nerve (Fig. 1 ). In addition to radiological assessment, the patient's age, lifestyle, and occupational conditions should not be overlooked before deciding on surgical intervention [ 12 , 13 ]. After surgical removal of impacted third molars, postoperative complications such as pain, swelling, bleeding, infection, and alveolitis can also occur following a coronectomy procedure. In addition to these, specific complications related to coronectomy, such as root migration and root mobility, may also arise [ 12 , 14 – 17 ] While coronectomy application can prevent a significant postoperative complication like paresthesia, reducing levels of pain and swelling is also crucial. Although postoperative medication and recommendations may help reduce these levels, it is necessary and important to identify more effective methods. Studies investigating the effects of various platelet concentrates on postoperative swelling and pain following surgical removal of impacted teeth are available. Platelets not only play a role in hemostasis but also in angiogenesis, inflammation, antibacterial defense, and tissue regeneration. During inflammation, platelets release various growth factors that attract inflammatory cells. These cells secrete cytokines such as interleukin and tumor necrosis factor-alpha (TNF-α), which enhance angiogenesis and tissue healing [ 18 ]. In many studies on growth factors, it has been concluded that the best stimulus for tissue regeneration is provided by autologous growth factors. Through platelet activation and degranulation, this process leads to the release of various biological factors, including Platelet-Derived Growth Factor (PDGF), Vascular Endothelial Growth Factor (VEGF), Insulin-like Growth Factor (IGF), Transforming Growth Factor (TGF), Tumor Necrosis Factor (TNF), Brain-Derived Neurotrophic Factor (BDNF), and Bone Morphogenetic Proteins (BMP), among others. Growth factors are bioactive proteins that control the regeneration process occurring in both hard and soft tissues [ 19 ]. In the practice of oral and maxillofacial surgery, various platelet concentrates have been applied to date. In a period where current studies are focusing on increasing the effectiveness of growth factors and cytokines, a new generation platelet concentrate called "Concentrated Growth Factors" (CGF) was introduced by Sacco in 2006. CGF is obtained by centrifuging blood samples at varying speeds using a special centrifuge device (Medifuge, Silfradentsrl, Italy). This technique, with its different and controlled centrifuge speeds, allows for the production of a much larger and denser fibrin matrix with abundant growth factors [ 19 – 21 ]. Additionally, studies have found the presence of CD34 + stem cells, which play an important role in angiogenesis, in PRF concentrates. Furthermore, the presence of TGF-β1 and VEGF in PRF was reported in a study published by Borsani and colleagues in 2015 [ 21 – 24 ]. While there are few studies describing the effectiveness of platelet concentrates in preventing postoperative pain and swelling in oral surgical procedures such as impacted tooth extraction, there is currently no study evaluating the effectiveness of the new generation CGF in combination with coronectomy surgery [ 25 – 27 ]. In our study, we aimed to evaluate the effect of Concentrated Growth Factors (CGF) on postoperative complications when applied in conjunction with coronectomy surgery on third molars associated with the inferior alveolar nerve. Materials and methods Our study was conducted in the Department of Oral and Maxillofacial Surgery at Ege University Faculty of Dentistry. As a routine procedure, patients presenting with complaints related to lower third molars underwent clinical examination and radiological investigations. Subsequently, 35 patients with lower third molars determined to be associated with the inferior alveolar nerve and deemed suitable for "coronectomy" were included in the study. To ensure standardization, patients with bilaterally impacted teeth in a vertical position were carefully selected, and all surgeries were performed by the same surgeon. Patients between 18 and 65 years old, who were systemically healthy and had bilateral lower third molars with roots associated with the inferior alveolar nerve indicated for coronectomy, were included in the study. Patients over 65 years old, those with acute pericoronitis, individuals who have undergone head and neck radiotherapy for any reason within the last 2 years, and patients for whom surgical intervention is contraindicated due to systemic diseases as determined by consultation will not be included in the study. The study was conducted in full compliance with the principles of the "Helsinki Declaration." After obtaining approval from the Ege University Faculty of Medicine Clinical Research Ethics Committee (decision number 21-6/45, dated June 1, 2021) and the Turkish Ministry of Health (approval number 56733164/203, dated October 19, 2021), patients were included in the study. They were prepared for the surgical procedure and scheduled for surgery accordingly. Three-dimensional tomography images were obtained from the patients to evaluate the relationship between the impacted third molars and the inferior alveolar nerve (Fig. 2). During the operation, a full-thickness triangular mucoperiosteal flap was raised under local anesthesia. Osteotomy was performed with physiological saline irrigation to expose the crown (enamel) part of the tooth. During the decortication phase, cuts were made with a Lindemann bur at approximately a 45-degree angle from the enamel-cementum junction of the tooth to separate the coronal part. Maximum attention was taken to avoid any damage to the anatomical structures in the lingual region during this process. Using a dental elevator, the coronal segment was carefully separated without causing any movement in the root by applying careful force (Fig. 3). After successful removal of the crown portion, any remaining enamel remnants were completely removed with a round bur, and the segment to be left in the alveolar crest was continued to be milled 3 mm apically. All sharp bone edges were smoothed, and the osteotomy procedures were completed (Fig. 3). Subsequently, to obtain CGF for application to the selected side according to the envelope technique, blood samples were taken from the antecubital fossa veins of the patients during the surgery and placed in 9cc tubes without anticoagulants. A specialized centrifuge device (MEDIFUGE, Silfradentsrl, S. Sofia, Italy) developed for the production of concentrated growth factors was used. The centrifuge device was set to the CGF program, which automatically ran at 2700 rpm for 2 minutes, 2400 rpm for 4 minutes, 2700 rpm for 4 minutes, and 3000 rpm for 3 minutes to obtain CGF. The buffy coat layer rich in growth factors, which was carefully separated from the layer containing red blood cells using scissors with the assistance of surgical forceps, was placed in a special box to be transformed into a membrane. After waiting for 2-3 minutes, it was prepared for use (Fig. 4). The prepared CGF membrane was applied to the predetermined side, and the surgical site was primarily closed. While CGF was applied to one side, the other side was left empty. The raised flaps on both sides were repositioned in their original positions and the surgical site was primarily closed with 4/0 polytetrafluoroethylene (PTFE) sutures. For postoperative infection control, a prescription for amoxicillin/clavulanate (875/125mg, 2x1) and an oral gargle containing chlorhexidine digluconate was provided. Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) with paracetamol (500mg, 2x1) were recommended for pain relief if needed. All patients were scheduled for follow-up appointments on the second and seventh days to evaluate postoperative pain and swelling. After seven days, the stitches were removed, and the patients were placed under routine follow-up. The evaluation of postoperative pain using the visual analog scale (VAS) After the operation, patients were given a Visual Analog Scale (VAS) to measure their pain levels. They were asked to mark a numerical value from 0 to 10 on the scale based on their current pain levels, where 0 indicated no pain and 10 indicated severe pain. This process was repeated and recorded until the seventh postoperative day. The recorded data was used for statistical analysis. The assessment of postoperative swelling To evaluate swelling, reference points such as the tragus, pogonion, lateral canthus, mandibular angle, and oral commissure were used on the patient's face. Measurements were taken on the following three planes: 1. Angulus-Lateral canthus (Fig. 5, a) 2. Tragus-Oral commissure (Fig. 5, b) 3. Tragus-Soft tissue pogonion (Fig. 5, c) Measurements were recorded on the second and seventh days postoperatively using these reference points to assess swelling. Measurement values obtained before the procedure and on the second and seventh days postoperatively were subjected to statistical analysis to compare the extent of swelling between the sides where CGF was applied and those where it was not applied. The statistical analysis For statistical analysis, IBM SPSS Statistics 25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.) and R Software version 3.5.2 were used. The normality of the swelling variables occurring after the operation was evaluated using the Shapiro-Wilk test, and no conformity issues were observed in any of the variables (p>0.05). Parametric hypothesis testing methods were used for the analysis of the variables. Swelling levels obtained for both the right and left sides at three different time points on three different planes were included in the analysis. For each plane, the levels of swelling were statistically evaluated using a Repeated Measures Analysis of Variance (ANOVA) method for the effects of side (CGF present x absent), time (Pre-Op x Post-Op Day 2 x Post-Op Day 7), and side x time interaction*. In cases where the interaction was not significant, differences between sides and between times were interpreted based on this analysis. When differences between times were found to be significant, pairwise comparisons were conducted using the Bonferroni test. In variables where the interaction was significant, each side was evaluated separately for time using Repeated Measures Analysis of Variance followed by the Bonferroni method. Additionally, differences between the sides at each time point were compared using the Paired Samples t-Test. Due to the non-normal distribution of pain levels (VAS), the analyses were conducted using the R program (version 4.5.0) with the nparLD package (Foundation for Statistical Computing, Vienna, Austria; http://r-project.org ). The non-parametric Brunner and Langer model (LD-F2) was used to test the side, time, and side x time interaction effects. The analysis revealed a significant interaction* (p<0.001). Considering this interaction, pairwise comparisons between sides at each time point and between times for each side were corrected using the Benjamini–Hochberg procedure. All hypothesis tests were conducted at a significance level of 0.05, using a two-tailed approach. Results The distributions of VAS scores by days in the groups with and without application of CGF are summarized in Fig. 6 . When the pain intensities in the first 6 postoperative days are examined, a significant difference between the two groups is observed, while on the 7th day, it is noteworthy that the values are close to each other (Fig. 6 ). According to the median VAS score levels graph, it can be observed that in the group where CGF was not applied, the median VAS value is 1 point higher than the side where CGF was applied from postoperative day 1 to day 6. However, it is also noteworthy that the mean pain scores on both sides decreased over time. On postoperative day 7, there is no difference in median pain scores between the two sides (Fig. 7 ). The statistical analysis revealed a significant Side-Time interaction (p < 0.001). Therefore, initially, pairwise and multiple comparisons between days were evaluated separately for both sides. In the comparisons made, differences between days were found to be statistically significant at the p < 0.001 level for both sides. In the second stage, pain scores between the sides where CGF was applied and not applied were compared for each day. According to the results obtained, the difference between the sides where CGF was applied and not applied was found to be statistically significant in the first 6 days (p < 0.001). However, on postoperative day 7, there was no statistically significant effect of CGF application on pain levels (p = 0.62650). For the comparison of the effectiveness of concentrated growth factor, measurements were completed in three dimensions on the sides where concentrated growth factor was applied and not applied, followed by statistical analysis. Measurements at three different time points on the sides where CGF was applied and not applied in the Angulus-Lateral Cantus plane were evaluated using a paired t-test. According to the results, the measurements obtained between the preoperative assessments of the samples where CGF was applied and not applied were statistically insignificant (p = 0.844). However, the data from measurements taken on postoperative day 2 showed a significant difference based on the application of CGF (p < 0.001). On the other hand, the data obtained on postoperative day 7 did not show a significant difference based on the application of CGF (p = 0.454). As a result of the variance analysis conducted for repeated measurements, the interaction between the application of CGF and the time factor was found to be significant (p < 0.001). Due to the significance of the interaction, pairwise comparison of days was separately performed for both groups using the Bonferroni Test. According to the results, the difference between the 1st and 3rd time points in the CGF-applied group was significant at p = 0.001, while all other pairwise differences between days were significant at p < 0.001 in both groups. In the statistical analysis of measurements in the Tragus-Commissura plane, the differences resulting from time variations in the sides where CGF was applied and not applied occurred in a similar direction and magnitude. Therefore, the analysis did not find a significant interaction (p = 0.389). Consequently, there was no need for additional separate analysis for inter-group differences for the three measurement times, nor was there a need to analyze pairwise differences between the three measurement times separately for the two groups. It was observed that there was no superiority of the samples where CGF was applied over those where it was not applied, based on measurements taken preoperatively, on postoperative day 2, and on postoperative day 7 (p = 0.758). However, the changes between different time points were significant on both sides (p < 0.001). The pairwise comparisons of the three different time points were evaluated in the Bonferroni test. According to this analysis, it was observed that the differences between the 1st and 2nd time points, the 1st and 3rd time points, and the 2nd and 3rd time points were significant (p < 0.001). Measurements at three different time points in the Tragus-Pogonion plane were evaluated using a paired t-test for the sides where CGF was applied and not applied. According to this analysis, a significant difference was obtained in the Tragus-Pogonion plane with the application of CGF on postoperative day 2 (p = 0.007), while the differences between the results obtained from the samples where CGF was applied and not applied were statistically insignificant for the preoperative (p = 0.293) and postoperative day 7 (p = 0.119) measurements. As a result of the variance analysis conducted for repeated measurements, the interaction between the application of CGF and the time factor was found to be significant at p < 0.001. Therefore, for inter-day differences, pairwise comparison of days was separately performed for both groups using the Bonferroni Test. According to this analysis, all pairwise differences between days were significant at p < 0.001 for both sides. Discussion One of the most commonly performed surgical procedures to treat pathologies arising from embedded third molar teeth is the surgical extraction of the third molars [ 3 , 28 , 29 ]. However, for teeth with roots directly associated with the inferior alveolar nerve, coronectomy, rather than complete extraction, is an alternative method for the treatment of deeply impacted mandibular third molar teeth with a high risk of nerve injury [ 11 , 30 , 31 ]. After the extraction of impacted mandibular third molars, the frequency of temporary inferior alveolar nerve paresthesia ranges from 0.41–8.1%, and the risk of permanent damage varies between 0.014% and 3.6%. However, in cases where the roots are in contact with the cortical bone of the inferior alveolar nerve, this rate can increase up to 20–50% [ 6 , 7 , 31 , 32 ]. Studies evaluating the effect of extraction versus coronectomy on the development of post-operative paresthesia related to impacted teeth [ 33 – 37 ] have emphasized the positive impact of coronectomy on post-operative paresthesia. Researchers such as Hatano, Cilasun, Kang, and Yiu Yan Leung reported in their studies examining the effect of both treatments on post-operative inferior alveolar nerve injury paresthesia that the paresthesia rate was higher in the extraction group [ 8 , 31 , 33 , 38 ]. In the systematic review conducted by Abu-Mostafa and colleagues, five studies were included [ 8 , 31 , 33 , 36 , 38 ], reporting temporary paresthesia rates ranging from 2.29–16.66% following extraction-related inferior alveolar nerve injury and permanent paresthesia rates ranging from 1.68–3.63% in four studies [ 31 , 33 , 36 , 38 ]. Successful coronectomy procedures, on the other hand, were reported to result in temporary inferior alveolar nerve damage ranging from 0% to a maximum of 2.20%, with no cases of permanent paresthesia recorded in the studies included in this review [ 30 ]. In surgical procedures involving impacted third molars, lingual nerve injuries can also occur. Hatano and colleagues did not report any cases of n. lingualis paresthesia in their comparative study of extraction and coronectomy group [ 38 ]. Zi Yu Yan and colleagues reported lingual nerve injury in one out of 47 patients (2.04%) in the extraction group, while no paresthesia developed in the coronectomy group [ 37 ]. Mukherjee and colleagues, on the other hand, reported lingual nerve paresthesia related to injury in one out of 20 patients (5%) following coronectomy [ 30 , 37 ]. In our study, no cases of temporary or permanent paresthesia related to the inferior alveolar and lingual nerves occurred in any of the 35 patients who underwent bilateral coronectomy. The impact of coronectomy on post-operative pain, which is one of the most important parameters affecting patient comfort, is also crucial. Kang and colleagues reported in their study comparing coronectomy and extraction procedures that postoperative pain lasted longer in the extraction group [ 31 ]. In a similar study, Long and colleagues stated that there was a faster decrease in pain levels in the coronectomy group [ 34 ]. Leung and Cheung reported that the number of cases reporting pain in the extraction group was statistically significantly higher at the 1st week postoperatively [ 33 ]. In contrast, Singh and colleagues showed in their study comparing pain intensity between the coronectomy and extraction groups that there was no statistically significant difference. Similarly, Renton and colleagues reported that there was no statistical difference in post-operative pain between the coronectomy group [ 30 , 36 ]. Hatano and colleagues, however, reported that the percentage of post-operative pain was higher in the coronectomy group and that the difference was statistically significant [ 38 ]. In recent years, A-PRF, i-PRF, and CGF, which are introduced as more bioactive forms of PRF, have become popular in the field of dentistry. Similar to PRF, CGF, a new generation platelet product obtained without the use of anticoagulants, etc., with single-step procedures, is obtained according to the principle of low-speed (different centrifugation periods). Thus, a more stable fibrin structure and a higher content of growth factors can be obtained [ 39 ]. In the studies of Masuki and colleagues, both A-PRF and CGF were reported to contain higher amounts of growth factors than PRP and PRF [ 40 ]. It has been reported that CGF, which can reduce postoperative complications such as pain, inflammation, and morbidity, contributes to tissue regeneration with the mitogenic and chemotactic effects of the growth factors in its content [ 40 , 41 ]. Various studies have been published aiming to evaluate the use of CGF as a barrier membrane or filling material in oral, dental, and maxillofacial surgery, and its post-operative effects. Yan Dai and colleagues reported a rapid decrease in pain levels from the second day onwards in patients who underwent bone augmentation with concentrated growth factors, with CGF applied. Additionally, the amount of postoperative edema between the 2nd and 5th days was less in the study group where CGF was applied [ 42 ]. In our study, the amount of edema obtained on the 2nd postoperative day in two different planes in the CGF-applied side was significantly lower than in the non-CGF-applied side. In this respect, although the surgical procedure applied in our study is different, our study shows similarity with the significant results obtained by Dai and colleagues with the application of CGF in terms of the amount of edema. In a study published by Keranmu and colleagues in 2021, they reported a series of 52 cases of autotransplantation. In 26 of these cases, CGF was applied along with the autotransplantation procedure, while in the control group, CGF was not applied. In cases where CGF was applied, the level of pain on the 1st and 3rd postoperative days was significantly lower compared to the control group, while no significant difference was found between the two groups according to VAS on the 7th day [ 43 ]. In our study, when we look at the VAS values obtained for the postoperative 7 days, we found significantly lower scores on the CGF-applied side for the first 6 days postoperatively, with no significant difference on the 7th day. Therefore, although the surgical procedure applied in our study is different, our study is qualitatively similar to the results of Keranmu and colleagues in terms of postoperative VAS values after CGF application. Mozzati and colleagues evaluated the postoperative effects of CGF application following tooth extraction in a study they published. In the study, where the level of pain was evaluated with the visual analog scale (VAS), it was reported that the postoperative pain level was significantly lower in patients where CGF was applied within the first 5 days postoperatively [ 44 ]. The results of our study were also similar to the reported publication. Özveri Koyuncu and colleagues stated in their study, where they applied CGF following the extraction of 120 mandibular impacted third molars, that the postoperative pain intensity was significantly lower in the group where CGF was applied for 7 days compared to the group where CGF was not applied [ 45 ]. In our study, while there was a significant difference in terms of VAS during the first 6 days postoperatively, no difference was found in the pain values between the two sides on the 7th day. Although the surgical procedure applied was different from coronectomy, the data obtained are quite similar. In the related study, in addition to pain, the effect of CGF on postoperative edema was also evaluated. Accordingly, the degree of postoperative edema in the CGF group was found to be significantly lower than in the group where CGF was not applied [ 45 ]. In our study, when the amount of edema on the CGF-applied and non-applied sides was evaluated, there was no difference between the two sides in the data for the 7th postoperative day, while on the 2nd postoperative day, there was a significant lower level of edema in the angulus-lateral canthus and tragus-pogonion planes. Similar results were found in this regard. In a study by Elayah and colleagues, a total of 74 teeth were extracted in 37 patients with bilateral impacted lower third molars. After the extraction, concentrated growth factor was applied to one side, and postoperative outcomes such as wound healing, edema, and pain were evaluated. Regarding postoperative edema, significantly lower values were recorded on the CGF-applied side compared to the control side on the 1st and 3rd postoperative days. However, by the 7th day, swelling had subsided on both sides. The pain scores on the Visual Analog Scale (VAS), especially on the 3rd and 7th postoperative days, were found to be significantly lower in the CGF-applied sides compared to the control sides [ 19 ]. It is possible to mention results that are not similar to our study, especially in terms of pain outcomes. However, regarding postoperative edema, our study's results appear to be similar to those of Elayah and colleagues. In their study, Torul and colleagues found no significant difference in the effect of CGF on postoperative pain levels between groups [ 39 ]. The results of our study differ from those of Torul and colleagues. In the same study, when the effects of CGF on postoperative edema were compared in terms of different days and planes, it is possible to mention results that are not similar to our study. Conclusion Our study, which investigated the effectiveness of concentrated growth factor along with coronectomy to minimize postoperative complications and improve patient comfort after surgical removal of impacted mandibular third molars, suggests that coronectomy can eliminate the risk of a serious complication, namely paresthesia. Furthermore, it can positively affect postoperative pain and swelling levels, thereby enhancing patient comfort. However, to obtain more definitive results, conducting comprehensive studies with a larger number of patients would be beneficial in achieving meaningful conclusions. Declarations Funding There is no funding support for this study. Ethical approval All procedures related to clinical studies performed on patients were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ege University Faculty of Medicine Clinical Research Ethics Committee dated 01.06.2021 and decision number 21-6/45. However, since human biological material (CGF) was used, approval from the Ministry of Health of the Republic of Turkey dated 19.10.2021 and numbered 56733164/203 was obtained before starting the study. Conflict of interest All authors have no conflicts of interest. References F. Griess, “Causes, Classification and Correction of Mandibular Impaction,” The Journal of the American Dental Association , vol. 32, no. 21, pp. 1404–1411, Nov. 1945, doi: 10.14219/jada.archive.1945.0197. R. M. Kramer and A. C. 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Feng, “Coronectomy: A Useful Approach in Minimizing Nerve Injury Compared With Traditional Extraction of Deeply Impacted Mandibular Third Molars,” Journal of Oral and Maxillofacial Surgery , vol. 77, no. 11, p. 2221.e1-2221.e14, Nov. 2019, doi: 10.1016/j.joms.2019.06.186. T. G. Auyong and A. Le, “Dentoalveolar Nerve Injury,” Oral and Maxillofacial Surgery Clinics of North America , vol. 23, no. 3, pp. 395–400, Aug. 2011, doi: 10.1016/j.coms.2011.05.001. Y. Y. Leung and L. K. Cheung, “Safety of coronectomy versus excision of wisdom teeth: A randomized controlled trial,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology , vol. 108, no. 6, pp. 821–827, Dec. 2009, doi: 10.1016/j.tripleo.2009.07.004. H. Long, Y. Zhou, L. Liao, U. Pyakurel, Y. Wang, and W. Lai, “Coronectomy vs. Total Removal for Third Molar Extraction: A Systematic Review,” J Dent Res , vol. 91, no. 7, pp. 659–665, Jul. 2012, doi: 10.1177/0022034512449346. J. Moreno-Vicente, R. Schiavone-Mussano, E. Clemente-Salas, A. Marí-Roig, E. Jané-Salas, and J. López-López, “Coronectomy versus surgical removal of the lower third molars with a high risk of injury to the inferior alveolar nerve. A bibliographical review,” Med Oral Patol Oral Cir Bucal , vol. 20, no. 4, pp. e508-517, Jul. 2015, doi: 10.4317/medoral.20432. T. Renton, M. Hankins, C. Sproate, and M. McGurk, “A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars,” British Journal of Oral and Maxillofacial Surgery , vol. 43, no. 1, pp. 7–12, Feb. 2005, doi: 10.1016/j.bjoms.2004.09.002. Z.-Y. Yan, X.-Y. Yan, C.-B. Guo, Q.-F. Xie, G.-J. Yang, and N.-H. Cui, “Somatosensory changes in Chinese patients after coronectomy vs. total extraction of mandibular third molar: a prospective study,” Clin Oral Investig , vol. 24, no. 9, pp. 3017–3028, Sep. 2020, doi: 10.1007/s00784-019-03169-4. Y. Hatano, K. Kurita, Y. Kuroiwa, H. Yuasa, and E. Ariji, “Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study,” J Oral Maxillofac Surg , vol. 67, no. 9, pp. 1806–1814, Sep. 2009, doi: 10.1016/j.joms.2009.04.018. D. Torul, M. M. Omezli, and K. Kahveci, “Evaluation of the effects of concentrated growth factors or advanced platelet rich-fibrin on postoperative pain, edema, and trismus following lower third molar removal: A randomized controlled clinical trial,” Journal of Stomatology, Oral and Maxillofacial Surgery , vol. 121, no. 6, pp. 646–651, Dec. 2020, doi: 10.1016/j.jormas.2020.02.004. H. Masuki et al. , “Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF),” Int J Implant Dent , vol. 2, no. 1, p. 19, Dec. 2016, doi: 10.1186/s40729-016-0052-4. T. Fernández-Medina, C. Vaquette, and S. Ivanovski, “Systematic Comparison of the Effect of Four Clinical-Grade Platelet Rich Hemoderivatives on Osteoblast Behaviour,” Int J Mol Sci , vol. 20, no. 24, p. E6243, Dec. 2019, doi: 10.3390/ijms20246243. Y. Dai, X.-H. Han, L.-H. Hu, H.-W. Wu, H. Shengyun, and Y.-P. Lü, “Efficacy of concentrated growth factors combined with mineralized collagen on quality of life and bone reconstruction of guided bone regeneration,” Regenerative Biomaterials , vol. 7, pp. 313–320, Jun. 2020, doi: 10.1093/rb/rbaa007. D. Keranmu, A. Ainiwaer, N. Nuermuhanmode, and W. Ling, “Application of concentrated growth factor to autotransplantation with inflammation in recipient area,” BMC Oral Health , vol. 21, no. 1, p. 556, Oct. 2021, doi: 10.1186/s12903-021-01915-3. M. Mozzati et al. , “Healing of Alveolar Sockets Treated with Concentrated Growth Factors: A Split-Mouth Study,” Materials , vol. 15, no. 14, Art. no. 14, Jan. 2022, doi: 10.3390/ma15144859. B. Özveri Koyuncu, G. Işık, M. Özden Yüce, S. Günbay, and T. Günbay, “Effect of concentrated growth factor (CGF) on short-term clinical outcomes after partially impacted mandibular third molar surgery: A split-mouth randomized clinical study,” Journal of Stomatology, Oral and Maxillofacial Surgery , vol. 121, no. 2, pp. 118–123, Apr. 2020, doi: 10.1016/j.jormas.2019.07.002. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4130259","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":282702314,"identity":"8366232e-fe30-4260-ab73-4a63185df1c0","order_by":0,"name":"Muharrem Ergun 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Surgery","correspondingAuthor":false,"prefix":"","firstName":"Aylin","middleName":"","lastName":"Calis","suffix":""},{"id":282702316,"identity":"f41ccd61-9778-4063-b4af-85bb051d7f67","order_by":2,"name":"Huseyin Koca","email":"","orcid":"","institution":"Ege University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery","correspondingAuthor":false,"prefix":"","firstName":"Huseyin","middleName":"","lastName":"Koca","suffix":""}],"badges":[],"createdAt":"2024-03-19 12:29:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4130259/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4130259/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53666593,"identity":"21923714-58d0-4fa2-9fb8-fff2525311b4","added_by":"auto","created_at":"2024-03-28 16:58:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":215333,"visible":true,"origin":"","legend":"\u003cp\u003e3D CBCT view of the relationship between nervus alveolaris inferior and roots\u003c/p\u003e","description":"","filename":"Binder11.png","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/4382b961b5ce88324bfa6337.png"},{"id":53667414,"identity":"f9db70cb-aa90-451d-a657-f7d3785824b3","added_by":"auto","created_at":"2024-03-28 17:06:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":818388,"visible":true,"origin":"","legend":"\u003cp\u003e3D View of Bilateral Vertical Mandibular Third Molar Teeth. \u003cstrong\u003e(a)\u003c/strong\u003e Sagittal Section, \u003cstrong\u003e(b)\u003c/strong\u003e 48 Cross Section, \u003cstrong\u003e(c)\u003c/strong\u003e 38 Cross Section\u003c/p\u003e","description":"","filename":"Binder12.png","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/9675681e240005b2fb84e83e.png"},{"id":53666597,"identity":"e92bee87-87f0-4abd-9a6f-db93ef0bf9b3","added_by":"auto","created_at":"2024-03-28 16:58:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1020402,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003ePreparation of Triangular Incision and Mucoperiosteal Flap. \u003cstrong\u003e(b)\u003c/strong\u003e Appearance of the remaining segment after completion of osteotomy. \u003cstrong\u003e(c)\u003c/strong\u003e View of the extracted crown separated from the enamel-cementum junction\u003c/p\u003e","description":"","filename":"Binder13.png","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/6d8954ae2b56538ad027237d.png"},{"id":53666598,"identity":"68484603-b402-455b-828c-81c4dc3ada9c","added_by":"auto","created_at":"2024-03-28 16:58:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1050672,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003e Concentrated Growth Factor prepared on the box, \u003cstrong\u003e(b)\u003c/strong\u003e Application of the Concentrated Growth Factor obtained in membrane form to the surgical site\u003c/p\u003e","description":"","filename":"Binder14.png","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/31070efa5fe162be54c901df.png"},{"id":53666594,"identity":"91a9b14e-4178-4313-8c65-2c5493a04bc1","added_by":"auto","created_at":"2024-03-28 16:58:21","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":865507,"visible":true,"origin":"","legend":"\u003cp\u003eClinical application of measurements between \u003cstrong\u003e(a)\u003c/strong\u003e Angulus - Lateral Kantus, \u003cstrong\u003e(b)\u003c/strong\u003eTragus - Oral Commissure, \u003cstrong\u003e(c)\u003c/strong\u003e Tragus – Pogonion\u003c/p\u003e","description":"","filename":"Binder15.png","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/45040e34669eb320242b2fe5.png"},{"id":53666599,"identity":"c7941ceb-703f-4faa-96c6-d647003b98ce","added_by":"auto","created_at":"2024-03-28 16:58:22","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":683278,"visible":true,"origin":"","legend":"\u003cp\u003eVAS Score Range\u003c/p\u003e","description":"","filename":"Binder16.png","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/1211803dec899c3564ba5036.png"},{"id":53666596,"identity":"3e0253fc-f056-4d6f-a7cf-eed64255c74f","added_by":"auto","created_at":"2024-03-28 16:58:22","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":38975,"visible":true,"origin":"","legend":"\u003cp\u003eMedian VAS Levels\u003c/p\u003e","description":"","filename":"Binder17.png","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/7dd0d3d799d69f6a09bdbf34.png"},{"id":55265658,"identity":"93200c31-3004-4231-af26-0b5e271a4518","added_by":"auto","created_at":"2024-04-25 02:12:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5216397,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4130259/v1/2c1383a8-9c53-4eae-8dc6-428f892abec4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of concentrated growth factor(CGF) on postoperative patient comfort in impacted lower third molars undergoing coronectomy: a prospective clinical study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe impaction of third molars is a common occurrence due to various reasons. In addition to systemic and local factors, different theories such as Mendelian Theory, Phylogenetic Theory, Pathological Theory, Endocrine Theory, and Orthodontic Theory have been proposed for its etiology [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Impacted mandibular third molars can lead to pathologies such as pain, swelling, and infection, as well as caries formation in adjacent teeth, pericoronitis, periodontal damage, trismus, cysts, and other pathological formations, affecting neighboring anatomical structures. Treatment usually involves extraction of the affected teeth following clinical and radiological examination [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn radiological examinations, cases have been observed where the roots of impacted mandibular third molars are associated with the inferior alveolar nerve (IAN). Extraction of impacted mandibular third molars carries a risk of postoperative paresthesia due to IAN injury, ranging from 0.35\u0026ndash;8.4% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, the extraction of mandibular third molars with roots associated with the IAN may be significantly advantageous to be replaced by a different surgical method called 'coronectomy' [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCoronectomy was first introduced as an alternative surgical method to extraction of mandibular third molars by Ecuyer and Debien in France in 1984 [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It involves the surgical removal of the enamel part without touching the root section of the tooth [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDirectly related to the IAN, mandibular third molar surgery can be preferred in cases where it is deeply impacted to prevent the risk of postoperative fracture, the coronectomy method can also be applied [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A detailed evaluation of clinical and radiological examinations is crucial for the success of the procedure. Dental volumetric tomography, one of the three-dimensional radiological assessment methods, is frequently used to determine the relationship between the root and the nerve (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to radiological assessment, the patient's age, lifestyle, and occupational conditions should not be overlooked before deciding on surgical intervention [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter surgical removal of impacted third molars, postoperative complications such as pain, swelling, bleeding, infection, and alveolitis can also occur following a coronectomy procedure. In addition to these, specific complications related to coronectomy, such as root migration and root mobility, may also arise [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eWhile coronectomy application can prevent a significant postoperative complication like paresthesia, reducing levels of pain and swelling is also crucial. Although postoperative medication and recommendations may help reduce these levels, it is necessary and important to identify more effective methods.\u003c/p\u003e \u003cp\u003eStudies investigating the effects of various platelet concentrates on postoperative swelling and pain following surgical removal of impacted teeth are available. Platelets not only play a role in hemostasis but also in angiogenesis, inflammation, antibacterial defense, and tissue regeneration. During inflammation, platelets release various growth factors that attract inflammatory cells. These cells secrete cytokines such as interleukin and tumor necrosis factor-alpha (TNF-α), which enhance angiogenesis and tissue healing [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In many studies on growth factors, it has been concluded that the best stimulus for tissue regeneration is provided by autologous growth factors. Through platelet activation and degranulation, this process leads to the release of various biological factors, including Platelet-Derived Growth Factor (PDGF), Vascular Endothelial Growth Factor (VEGF), Insulin-like Growth Factor (IGF), Transforming Growth Factor (TGF), Tumor Necrosis Factor (TNF), Brain-Derived Neurotrophic Factor (BDNF), and Bone Morphogenetic Proteins (BMP), among others. Growth factors are bioactive proteins that control the regeneration process occurring in both hard and soft tissues [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the practice of oral and maxillofacial surgery, various platelet concentrates have been applied to date. In a period where current studies are focusing on increasing the effectiveness of growth factors and cytokines, a new generation platelet concentrate called \"Concentrated Growth Factors\" (CGF) was introduced by Sacco in 2006. CGF is obtained by centrifuging blood samples at varying speeds using a special centrifuge device (Medifuge, Silfradentsrl, Italy). This technique, with its different and controlled centrifuge speeds, allows for the production of a much larger and denser fibrin matrix with abundant growth factors [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Additionally, studies have found the presence of CD34\u0026thinsp;+\u0026thinsp;stem cells, which play an important role in angiogenesis, in PRF concentrates. Furthermore, the presence of TGF-β1 and VEGF in PRF was reported in a study published by Borsani and colleagues in 2015 [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile there are few studies describing the effectiveness of platelet concentrates in preventing postoperative pain and swelling in oral surgical procedures such as impacted tooth extraction, there is currently no study evaluating the effectiveness of the new generation CGF in combination with coronectomy surgery [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, we aimed to evaluate the effect of Concentrated Growth Factors (CGF) on postoperative complications when applied in conjunction with coronectomy surgery on third molars associated with the inferior alveolar nerve.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eOur study was conducted in the Department of Oral and Maxillofacial Surgery at Ege University Faculty of Dentistry. As a routine procedure, patients presenting with complaints related to lower third molars underwent clinical examination and radiological investigations. Subsequently, 35 patients with lower third molars determined to be associated with the inferior alveolar nerve and deemed suitable for \"coronectomy\" were included in the study. To ensure standardization, patients with bilaterally impacted teeth in a vertical position were carefully selected, and all surgeries were performed by the same surgeon.\u003c/p\u003e\n\u003cp\u003ePatients between 18 and 65 years old, who were systemically healthy and had bilateral lower third molars with roots associated with the inferior alveolar nerve indicated for coronectomy, were included in the study. Patients over 65 years old, those with acute pericoronitis, individuals who have undergone head and neck radiotherapy for any reason within the last 2 years, and patients for whom surgical intervention is contraindicated due to systemic diseases as determined by consultation will not be included in the study.\u003c/p\u003e\n\u003cp\u003eThe study was conducted in full compliance with the principles of the \"Helsinki Declaration.\" After obtaining approval from the Ege University Faculty of Medicine Clinical Research Ethics Committee (decision number 21-6/45, dated June 1, 2021) and the Turkish Ministry of Health (approval number 56733164/203, dated October 19, 2021), patients were included in the study. They were prepared for the surgical procedure and scheduled for surgery accordingly.\u003c/p\u003e\n\u003cp\u003eThree-dimensional tomography images were obtained from the patients to evaluate the relationship between the impacted third molars and the inferior alveolar nerve (Fig. 2).\u003c/p\u003e\n\u003cp\u003eDuring the operation, a full-thickness triangular mucoperiosteal flap was raised under local anesthesia. Osteotomy was performed with physiological saline irrigation to expose the crown (enamel) part of the tooth. During the decortication phase, cuts were made with a Lindemann bur at approximately a 45-degree angle from the enamel-cementum junction of the tooth to separate the coronal part. Maximum attention was taken to avoid any damage to the anatomical structures in the lingual region during this process.\u003c/p\u003e\n\u003cp\u003eUsing a dental elevator, the coronal segment was carefully separated without causing any movement in the root by applying careful force (Fig. 3). After successful removal of the crown portion, any remaining enamel remnants were completely removed with a round bur, and the segment to be left in the alveolar crest was continued to be milled 3 mm apically. All sharp bone edges were smoothed, and the osteotomy procedures were completed (Fig. 3).\u003c/p\u003e\n\u003cp\u003eSubsequently, to obtain CGF for application to the selected side according to the envelope technique, blood samples were taken from the antecubital fossa veins of the patients during the surgery and placed in 9cc tubes without anticoagulants. A specialized centrifuge device (MEDIFUGE, Silfradentsrl, S. Sofia, Italy) developed for the production of concentrated growth factors was used. The centrifuge device was set to the CGF program, which automatically ran at 2700 rpm for 2 minutes, 2400 rpm for 4 minutes, 2700 rpm for 4 minutes, and 3000 rpm for 3 minutes to obtain CGF.\u003c/p\u003e\n\u003cp\u003eThe buffy coat layer rich in growth factors, which was carefully separated from the layer containing red blood cells using scissors with the assistance of surgical forceps, was placed in a special box to be transformed into a membrane. After waiting for 2-3 minutes, it was prepared for use (Fig. 4).\u003c/p\u003e\n\u003cp\u003eThe prepared CGF membrane was applied to the predetermined side, and the surgical site was primarily closed. While CGF was applied to one side, the other side was left empty. The raised flaps on both sides were repositioned in their original positions and the surgical site was primarily closed with 4/0 polytetrafluoroethylene (PTFE) sutures.\u003c/p\u003e\n\u003cp\u003eFor postoperative infection control, a prescription for amoxicillin/clavulanate (875/125mg, 2x1) and an oral gargle containing chlorhexidine digluconate was provided. Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) with paracetamol (500mg, 2x1) were recommended for pain relief if needed. All patients were scheduled for follow-up appointments on the second and seventh days to evaluate postoperative pain and swelling. After seven days, the stitches were removed, and the patients were placed under routine follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe evaluation of postoperative pain using the visual analog scale (VAS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the operation, patients were given a Visual Analog Scale (VAS) to measure their pain levels. They were asked to mark a numerical value from 0 to 10 on the scale based on their current pain levels, where 0 indicated no pain and 10 indicated severe pain. This process was repeated and recorded until the seventh postoperative day. The recorded data was used for statistical analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe assessment of postoperative swelling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo evaluate swelling, reference points such as the tragus, pogonion, lateral canthus, mandibular angle, and oral commissure were used on the patient's face. Measurements were taken on the following three planes:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp;\u0026nbsp;Angulus-Lateral canthus (Fig. 5, a)\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp;\u0026nbsp;Tragus-Oral commissure (Fig. 5, b)\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp;\u0026nbsp;Tragus-Soft tissue pogonion (Fig. 5, c) Measurements were recorded on the second and\u003c/p\u003e\n\u003cp\u003eseventh days postoperatively using these reference points to assess swelling.\u003c/p\u003e\n\u003cp\u003eMeasurement values obtained before the procedure and on the second and seventh days postoperatively were subjected to statistical analysis to compare the extent of swelling between the sides where CGF was applied and those where it was not applied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor statistical analysis, IBM SPSS Statistics 25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.) and R Software version 3.5.2 were used.\u003c/p\u003e\n\u003cp\u003eThe normality of the swelling variables occurring after the operation was evaluated using the Shapiro-Wilk test, and no conformity issues were observed in any of the variables (p\u0026gt;0.05). Parametric hypothesis testing methods were used for the analysis of the variables. Swelling levels obtained for both the right and left sides at three different time points on three different planes were included in the analysis. For each plane, the levels of swelling were statistically evaluated using a Repeated Measures Analysis of Variance (ANOVA) method for the effects of side (CGF present x absent), time (Pre-Op x Post-Op Day 2 x Post-Op Day 7), and side x time interaction*. In cases where the interaction was not significant, differences between sides and between times were interpreted based on this analysis. When differences between times were found to be significant, pairwise comparisons were conducted using the Bonferroni test. In variables where the interaction was significant, each side was evaluated separately for time using Repeated Measures Analysis of Variance followed by the Bonferroni method. Additionally, differences between the sides at each time point were compared using the Paired Samples t-Test.\u003c/p\u003e\n\u003cp\u003eDue to the non-normal distribution of pain levels (VAS), the analyses were conducted using the R program (version 4.5.0) with the nparLD package (Foundation for Statistical Computing, Vienna, Austria;\u0026nbsp;\u003ca href=\"http://r-project.org\" target=\"_new\"\u003ehttp://r-project.org\u003c/a\u003e). The non-parametric Brunner and Langer model (LD-F2) was used to test the side, time, and side x time interaction effects. The analysis revealed a significant interaction* (p\u0026lt;0.001). Considering this interaction, pairwise comparisons between sides at each time point and between times for each side were corrected using the Benjamini–Hochberg procedure.\u003c/p\u003e\n\u003cp\u003eAll hypothesis tests were conducted at a significance level of 0.05, using a two-tailed approach.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe distributions of VAS scores by days in the groups with and without application of CGF are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. When the pain intensities in the first 6 postoperative days are examined, a significant difference between the two groups is observed, while on the 7th day, it is noteworthy that the values are close to each other (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the median VAS score levels graph, it can be observed that in the group where CGF was not applied, the median VAS value is 1 point higher than the side where CGF was applied from postoperative day 1 to day 6. However, it is also noteworthy that the mean pain scores on both sides decreased over time. On postoperative day 7, there is no difference in median pain scores between the two sides (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe statistical analysis revealed a significant Side-Time interaction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Therefore, initially, pairwise and multiple comparisons between days were evaluated separately for both sides. In the comparisons made, differences between days were found to be statistically significant at the p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 level for both sides.\u003c/p\u003e \u003cp\u003eIn the second stage, pain scores between the sides where CGF was applied and not applied were compared for each day. According to the results obtained, the difference between the sides where CGF was applied and not applied was found to be statistically significant in the first 6 days (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, on postoperative day 7, there was no statistically significant effect of CGF application on pain levels (p\u0026thinsp;=\u0026thinsp;0.62650).\u003c/p\u003e \u003cp\u003eFor the comparison of the effectiveness of concentrated growth factor, measurements were completed in three dimensions on the sides where concentrated growth factor was applied and not applied, followed by statistical analysis.\u003c/p\u003e \u003cp\u003eMeasurements at three different time points on the sides where CGF was applied and not applied in the Angulus-Lateral Cantus plane were evaluated using a paired t-test. According to the results, the measurements obtained between the preoperative assessments of the samples where CGF was applied and not applied were statistically insignificant (p\u0026thinsp;=\u0026thinsp;0.844). However, the data from measurements taken on postoperative day 2 showed a significant difference based on the application of CGF (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On the other hand, the data obtained on postoperative day 7 did not show a significant difference based on the application of CGF (p\u0026thinsp;=\u0026thinsp;0.454).\u003c/p\u003e \u003cp\u003eAs a result of the variance analysis conducted for repeated measurements, the interaction between the application of CGF and the time factor was found to be significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Due to the significance of the interaction, pairwise comparison of days was separately performed for both groups using the Bonferroni Test. According to the results, the difference between the 1st and 3rd time points in the CGF-applied group was significant at p\u0026thinsp;=\u0026thinsp;0.001, while all other pairwise differences between days were significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 in both groups.\u003c/p\u003e \u003cp\u003eIn the statistical analysis of measurements in the Tragus-Commissura plane, the differences resulting from time variations in the sides where CGF was applied and not applied occurred in a similar direction and magnitude. Therefore, the analysis did not find a significant interaction (p\u0026thinsp;=\u0026thinsp;0.389). Consequently, there was no need for additional separate analysis for inter-group differences for the three measurement times, nor was there a need to analyze pairwise differences between the three measurement times separately for the two groups.\u003c/p\u003e \u003cp\u003eIt was observed that there was no superiority of the samples where CGF was applied over those where it was not applied, based on measurements taken preoperatively, on postoperative day 2, and on postoperative day 7 (p\u0026thinsp;=\u0026thinsp;0.758). However, the changes between different time points were significant on both sides (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe pairwise comparisons of the three different time points were evaluated in the Bonferroni test. According to this analysis, it was observed that the differences between the 1st and 2nd time points, the 1st and 3rd time points, and the 2nd and 3rd time points were significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eMeasurements at three different time points in the Tragus-Pogonion plane were evaluated using a paired t-test for the sides where CGF was applied and not applied. According to this analysis, a significant difference was obtained in the Tragus-Pogonion plane with the application of CGF on postoperative day 2 (p\u0026thinsp;=\u0026thinsp;0.007), while the differences between the results obtained from the samples where CGF was applied and not applied were statistically insignificant for the preoperative (p\u0026thinsp;=\u0026thinsp;0.293) and postoperative day 7 (p\u0026thinsp;=\u0026thinsp;0.119) measurements.\u003c/p\u003e \u003cp\u003eAs a result of the variance analysis conducted for repeated measurements, the interaction between the application of CGF and the time factor was found to be significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Therefore, for inter-day differences, pairwise comparison of days was separately performed for both groups using the Bonferroni Test. According to this analysis, all pairwise differences between days were significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both sides.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOne of the most commonly performed surgical procedures to treat pathologies arising from embedded third molar teeth is the surgical extraction of the third molars [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, for teeth with roots directly associated with the inferior alveolar nerve, coronectomy, rather than complete extraction, is an alternative method for the treatment of deeply impacted mandibular third molar teeth with a high risk of nerve injury [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter the extraction of impacted mandibular third molars, the frequency of temporary inferior alveolar nerve paresthesia ranges from 0.41\u0026ndash;8.1%, and the risk of permanent damage varies between 0.014% and 3.6%. However, in cases where the roots are in contact with the cortical bone of the inferior alveolar nerve, this rate can increase up to 20\u0026ndash;50% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies evaluating the effect of extraction versus coronectomy on the development of post-operative paresthesia related to impacted teeth [\u003cspan additionalcitationids=\"CR34 CR35 CR36\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] have emphasized the positive impact of coronectomy on post-operative paresthesia. Researchers such as Hatano, Cilasun, Kang, and Yiu Yan Leung reported in their studies examining the effect of both treatments on post-operative inferior alveolar nerve injury paresthesia that the paresthesia rate was higher in the extraction group [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the systematic review conducted by Abu-Mostafa and colleagues, five studies were included [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], reporting temporary paresthesia rates ranging from 2.29\u0026ndash;16.66% following extraction-related inferior alveolar nerve injury and permanent paresthesia rates ranging from 1.68\u0026ndash;3.63% in four studies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Successful coronectomy procedures, on the other hand, were reported to result in temporary inferior alveolar nerve damage ranging from 0% to a maximum of 2.20%, with no cases of permanent paresthesia recorded in the studies included in this review [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn surgical procedures involving impacted third molars, lingual nerve injuries can also occur. Hatano and colleagues did not report any cases of n. lingualis paresthesia in their comparative study of extraction and coronectomy group [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Zi Yu Yan and colleagues reported lingual nerve injury in one out of 47 patients (2.04%) in the extraction group, while no paresthesia developed in the coronectomy group [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Mukherjee and colleagues, on the other hand, reported lingual nerve paresthesia related to injury in one out of 20 patients (5%) following coronectomy [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, no cases of temporary or permanent paresthesia related to the inferior alveolar and lingual nerves occurred in any of the 35 patients who underwent bilateral coronectomy. The impact of coronectomy on post-operative pain, which is one of the most important parameters affecting patient comfort, is also crucial.\u003c/p\u003e \u003cp\u003eKang and colleagues reported in their study comparing coronectomy and extraction procedures that postoperative pain lasted longer in the extraction group [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In a similar study, Long and colleagues stated that there was a faster decrease in pain levels in the coronectomy group [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Leung and Cheung reported that the number of cases reporting pain in the extraction group was statistically significantly higher at the 1st week postoperatively [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, Singh and colleagues showed in their study comparing pain intensity between the coronectomy and extraction groups that there was no statistically significant difference. Similarly, Renton and colleagues reported that there was no statistical difference in post-operative pain between the coronectomy group [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Hatano and colleagues, however, reported that the percentage of post-operative pain was higher in the coronectomy group and that the difference was statistically significant [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, A-PRF, i-PRF, and CGF, which are introduced as more bioactive forms of PRF, have become popular in the field of dentistry. Similar to PRF, CGF, a new generation platelet product obtained without the use of anticoagulants, etc., with single-step procedures, is obtained according to the principle of low-speed (different centrifugation periods). Thus, a more stable fibrin structure and a higher content of growth factors can be obtained [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the studies of Masuki and colleagues, both A-PRF and CGF were reported to contain higher amounts of growth factors than PRP and PRF [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. It has been reported that CGF, which can reduce postoperative complications such as pain, inflammation, and morbidity, contributes to tissue regeneration with the mitogenic and chemotactic effects of the growth factors in its content [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious studies have been published aiming to evaluate the use of CGF as a barrier membrane or filling material in oral, dental, and maxillofacial surgery, and its post-operative effects. Yan Dai and colleagues reported a rapid decrease in pain levels from the second day onwards in patients who underwent bone augmentation with concentrated growth factors, with CGF applied. Additionally, the amount of postoperative edema between the 2nd and 5th days was less in the study group where CGF was applied [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In our study, the amount of edema obtained on the 2nd postoperative day in two different planes in the CGF-applied side was significantly lower than in the non-CGF-applied side. In this respect, although the surgical procedure applied in our study is different, our study shows similarity with the significant results obtained by Dai and colleagues with the application of CGF in terms of the amount of edema.\u003c/p\u003e \u003cp\u003eIn a study published by Keranmu and colleagues in 2021, they reported a series of 52 cases of autotransplantation. In 26 of these cases, CGF was applied along with the autotransplantation procedure, while in the control group, CGF was not applied. In cases where CGF was applied, the level of pain on the 1st and 3rd postoperative days was significantly lower compared to the control group, while no significant difference was found between the two groups according to VAS on the 7th day [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In our study, when we look at the VAS values obtained for the postoperative 7 days, we found significantly lower scores on the CGF-applied side for the first 6 days postoperatively, with no significant difference on the 7th day. Therefore, although the surgical procedure applied in our study is different, our study is qualitatively similar to the results of Keranmu and colleagues in terms of postoperative VAS values after CGF application.\u003c/p\u003e \u003cp\u003eMozzati and colleagues evaluated the postoperative effects of CGF application following tooth extraction in a study they published. In the study, where the level of pain was evaluated with the visual analog scale (VAS), it was reported that the postoperative pain level was significantly lower in patients where CGF was applied within the first 5 days postoperatively [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. The results of our study were also similar to the reported publication.\u003c/p\u003e \u003cp\u003e\u0026Ouml;zveri Koyuncu and colleagues stated in their study, where they applied CGF following the extraction of 120 mandibular impacted third molars, that the postoperative pain intensity was significantly lower in the group where CGF was applied for 7 days compared to the group where CGF was not applied [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In our study, while there was a significant difference in terms of VAS during the first 6 days postoperatively, no difference was found in the pain values between the two sides on the 7th day. Although the surgical procedure applied was different from coronectomy, the data obtained are quite similar. In the related study, in addition to pain, the effect of CGF on postoperative edema was also evaluated. Accordingly, the degree of postoperative edema in the CGF group was found to be significantly lower than in the group where CGF was not applied [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In our study, when the amount of edema on the CGF-applied and non-applied sides was evaluated, there was no difference between the two sides in the data for the 7th postoperative day, while on the 2nd postoperative day, there was a significant lower level of edema in the angulus-lateral canthus and tragus-pogonion planes. Similar results were found in this regard.\u003c/p\u003e \u003cp\u003eIn a study by Elayah and colleagues, a total of 74 teeth were extracted in 37 patients with bilateral impacted lower third molars. After the extraction, concentrated growth factor was applied to one side, and postoperative outcomes such as wound healing, edema, and pain were evaluated. Regarding postoperative edema, significantly lower values were recorded on the CGF-applied side compared to the control side on the 1st and 3rd postoperative days. However, by the 7th day, swelling had subsided on both sides. The pain scores on the Visual Analog Scale (VAS), especially on the 3rd and 7th postoperative days, were found to be significantly lower in the CGF-applied sides compared to the control sides [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It is possible to mention results that are not similar to our study, especially in terms of pain outcomes. However, regarding postoperative edema, our study's results appear to be similar to those of Elayah and colleagues.\u003c/p\u003e \u003cp\u003eIn their study, Torul and colleagues found no significant difference in the effect of CGF on postoperative pain levels between groups [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The results of our study differ from those of Torul and colleagues. In the same study, when the effects of CGF on postoperative edema were compared in terms of different days and planes, it is possible to mention results that are not similar to our study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study, which investigated the effectiveness of concentrated growth factor along with coronectomy to minimize postoperative complications and improve patient comfort after surgical removal of impacted mandibular third molars, suggests that coronectomy can eliminate the risk of a serious complication, namely paresthesia. Furthermore, it can positively affect postoperative pain and swelling levels, thereby enhancing patient comfort. However, to obtain more definitive results, conducting comprehensive studies with a larger number of patients would be beneficial in achieving meaningful conclusions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no funding support for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures related to clinical studies performed on patients were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ege University Faculty of Medicine Clinical Research Ethics Committee dated 01.06.2021 and decision number 21-6/45. However, since human biological material (CGF) was used, approval from the Ministry of Health of the Republic of Turkey dated 19.10.2021 and numbered 56733164/203 was obtained before starting the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eF. Griess, \u0026ldquo;Causes, Classification and Correction of Mandibular Impaction,\u0026rdquo; \u003cem\u003eThe Journal of the American Dental Association\u003c/em\u003e, vol. 32, no. 21, pp. 1404\u0026ndash;1411, Nov. 1945, doi: 10.14219/jada.archive.1945.0197.\u003c/li\u003e\n \u003cli\u003eR. M. Kramer and A. C. 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Ivanovski, \u0026ldquo;Systematic Comparison of the Effect of Four Clinical-Grade Platelet Rich Hemoderivatives on Osteoblast Behaviour,\u0026rdquo; \u003cem\u003eInt J Mol Sci\u003c/em\u003e, vol. 20, no. 24, p. E6243, Dec. 2019, doi: 10.3390/ijms20246243.\u003c/li\u003e\n \u003cli\u003eY. Dai, X.-H. Han, L.-H. Hu, H.-W. Wu, H. Shengyun, and Y.-P. L\u0026uuml;, \u0026ldquo;Efficacy of concentrated growth factors combined with mineralized collagen on quality of life and bone reconstruction of guided bone regeneration,\u0026rdquo; \u003cem\u003eRegenerative Biomaterials\u003c/em\u003e, vol. 7, pp. 313\u0026ndash;320, Jun. 2020, doi: 10.1093/rb/rbaa007.\u003c/li\u003e\n \u003cli\u003eD. Keranmu, A. Ainiwaer, N. Nuermuhanmode, and W. Ling, \u0026ldquo;Application of concentrated growth factor to autotransplantation with inflammation in recipient area,\u0026rdquo; \u003cem\u003eBMC Oral Health\u003c/em\u003e, vol. 21, no. 1, p. 556, Oct. 2021, doi: 10.1186/s12903-021-01915-3.\u003c/li\u003e\n \u003cli\u003eM. Mozzati \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Healing of Alveolar Sockets Treated with Concentrated Growth Factors: A Split-Mouth Study,\u0026rdquo; \u003cem\u003eMaterials\u003c/em\u003e, vol. 15, no. 14, Art. no. 14, Jan. 2022, doi: 10.3390/ma15144859.\u003c/li\u003e\n \u003cli\u003eB. \u0026Ouml;zveri Koyuncu, G. Işık, M. \u0026Ouml;zden Y\u0026uuml;ce, S. G\u0026uuml;nbay, and T. G\u0026uuml;nbay, \u0026ldquo;Effect of concentrated growth factor (CGF) on short-term clinical outcomes after partially impacted mandibular third molar surgery: A split-mouth randomized clinical study,\u0026rdquo; \u003cem\u003eJournal of Stomatology, Oral and Maxillofacial Surgery\u003c/em\u003e, vol. 121, no. 2, pp. 118\u0026ndash;123, Apr. 2020, doi: 10.1016/j.jormas.2019.07.002.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Coronectomy, Impacted mandibular third molar, Concantred growth factor, Pain, Edema, Paresthesia","lastPublishedDoi":"10.21203/rs.3.rs-4130259/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4130259/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e The aim of this study was to evaluate the effect of CGF on post-operative patient comfort following coronectomy in impacted third molars with roots associated with the nervus alveolaris inferior.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e Thirty-five patients with bilateral vertical impacted wisdom teeth with roots associated with the nervus alveolaris inferior were included in the study with an indication for coronectomy. Coronectomy was performed on both sides followed by cgf on one side. Pain levels were monitored with the VAS scale for 7 post-operative days. In addition, the amount of edema occurring on post-operative days 2 and 7 was also measured. All data were statistically evaluated. Statistical significance was determined as p\u0026lt;0.001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e The first 6 days showed significantly lower (p\u0026lt;0.001) pain on the CGF-treated side, while the difference between the sides was not significant on the 7th day (p=0.627). On the 2nd day, significantly lower (p\u0026lt;0.001) edema occurred in the tragus-pogonion and angulus-lateral canthus planes on the CGF treated side. On day 7, there was no significant difference in edema between the sides. Uneventful healing was observed in all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e It is possible to prevent possible nerve damage with coronectomy. In addition, CGF can successfully improve patient comfort in the early post-operative period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Relevance\u003c/strong\u003e Post-operative pain and edema, which are very important for patients, can be significantly reduced with the application of CGF, an easily obtainable autogenous product. The results obtained may provide valuable contributions to clinicians.\u003c/p\u003e","manuscriptTitle":"Effect of concentrated growth factor(CGF) on postoperative patient comfort in impacted lower third molars undergoing coronectomy: a prospective clinical study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-28 16:58:13","doi":"10.21203/rs.3.rs-4130259/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45610402-09f0-4336-984e-f566b151dfcc","owner":[],"postedDate":"March 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-24T15:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-28 16:58:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4130259","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4130259","identity":"rs-4130259","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}