Interventions to minimize periodontal defect distal to second molar after mandibular third molar surgery: an overview of systematic reviews.

Purpose: This overview summarized different interventions that were performed for minimizing periodontal defects distal to the mandibular second molar and improve hard and soft tissue healing after third molar surgery.

Methods: Literature search was conducted in the following 9 databases: Medline (via Pubmed), ScienceDirect, Scopus, Virtual Health Library, Wiley Online Library, Web of Science, ProQuest Dissertations and Theses Global and Google Scholar. Systematic reviews with or without meta-analysis investigating the effect of different interventions on soft and hard tissue healing after third molar surgery were considered. Methodological quality of included reviews was assessed with AMSTAR-2 tool. The degree of overlapping of index publications in the eligible reviews was presented and calculated with the GROOVE tool.

Results: Thirty-three reviews were included, collectively encompassing 191 distinct primary studies that evaluated flap design, extraction socket management, and postsurgical care. Quantitative data retrieved from the methodologically rigorous MAs revealed that the application of autologous platelet concentrates (APCs) is the best choice to improve soft tissue healing [MD = 1.01; 95% CI (0.77, 1.24), 7 days follow-up] and bone mineral density [SMD = 2.34; 95% CI (0.18,4.51), 4 months follow-up] and alleviate pain [SMD= -0.86; 95% CI (-1.26, -0.46), 3 days follow-up], trismus [SMD= -0.26; 95% CI (-0.48, -0.03), 7 days follow-up], alveolar osteitis [RR = 0.43; 95% CI (0.28, 0.65)] and swelling [MD= -1.66; 95% CI (-2.43, -0.90), 3 days follow-up]. Ridge preservation is the most effective intervention in improving pocket probing depth [MD= -1.42; 95% CI (-2.01, -0.83), 6-72 months follow-up], clinical attachment level [MD = 1.98; 95% CI (1.44, 2.52), 4.5-72months follow-up] and alveolar bone height [MD = 1.21; 95% CI (0.21, 2.21), 6-12 months follow-up] distal to mandibular second molar.

Conclusion: Minimizing tissue trauma is key in surgical extractions. Our overview found that triangular flaps reduce PPD, while envelope flaps lower postoperative pain. APCs improved healing and reduced adverse events, and HyA mainly alleviated pain. All regenerative techniques enhanced periodontal outcomes, though high heterogeneity and variable study quality urge cautious interpretation.