The goal of this clinical trial is to learn if Concentrated Growth Factor (CGF) plugs help improve bone healing and reduce pain after the surgical removal of impacted lower third molars.

The study aims to answer the following:

Does packing CGF plugs into the extraction site improve bone density? Does the use of CGF plugs reduce postoperative pain for the patient?

Researchers will evaluate the healing outcomes of patients receiving this treatment in a prospective case series study. Because this is a case series, all participants will receive the CGF plug intervention rather than being compared to a placebo group.

Participants in this study will:

Undergo a blood draw to create the autologous CGF plug from their own growth factors.

Undergo the surgical extraction of an impacted lower third molar under local anesthesia.

Have a CGF plug placed in the extraction socket immediately following the tooth removal.

Report their pain levels using a numeric scale on Day 1, Day 3, and Day 7 after surgery.

Return for a follow-up CBCT scan three months after the procedure to evaluate bone density changes.

The surgical removal of impacted lower third molars, commonly known as wisdom teeth, is one of the most frequent procedures in oral surgery. While routine, this procedure often leads to significant postoperative challenges, including pain and substantial bone loss in the extraction area. This bone loss can compromise the health of the adjacent teeth and the surrounding periodontal tissue.

To improve healing outcomes, this study investigates the use of Concentrated Growth Factor (CGF). CGF is a third-generation autologous platelet concentrate-meaning it is derived from the patient's own blood. Unlike earlier versions like PRP or PRF, CGF is created using a specialized variable-speed centrifugation process that results in a denser fibrin matrix. This matrix is rich in growth factors and regenerative cells, which may offer superior mechanical properties and a more sustained release of healing factors to promote bone regeneration and reduce pain.

The researchers aims to evaluate the clinical and radiographic effectiveness of using CGF in a "plug" form. The CGF plug is valued for its stability and ease of handling within the surgical site. The study specifically looks at:

Bone Density Improvement: Measuring how well the extraction site fills with new bone over three months.

Pain Management: Assessing whether the biological properties of CGF can lower the intensity of pain experienced by patients in the week following surgery.

On the day of surgery, the Principal Investigator will collect a small sample (10mL) of the participant's blood into a sterile tube without anticoagulants. This sample is then processed in a centrifugation machine under dedicated CGF extraction settings. Once the blood has been separated, the resulting fibrin clot is removed and placed into a specialized mold to compress it into a stable "plug" shape, ready for immediate placement into the tooth socket.

All surgeries will be performed under local anesthesia in a sterile minor surgery setting. After ensuring the area is fully anesthetized, the Principal Investigator will Carefully remove the impacted wisdom tooth using standard surgical techniques.

Clean the extraction socket to remove any debris or fragments. Pack the prepared CGF plug directly into the fresh extraction site. Suture the wound closed using absorbable sutures.

Following the procedure, the Principal Investigator will monitor the participants' recovery through two primary parameters:

Pain Assessment: Participants will record their pain levels using the Verbal Numeric Rating Scale (VNRS), where 0 represents no pain and 10 represents the worst imaginable pain. These assessments occur on Day 1, Day 3, and Day 7 post-surgery.

Radiographic Evaluation: To measure bone healing, Cone-Beam Computed Tomography (CBCT) scans will be taken immediately after surgery and again at 3 months. These scans allow for the calculation of changes in bone density using Hounsfield units.

The study is conducted with strict adherence to patient safety and ethical standards. Any potential risks, such as postoperative infection or bleeding, will be managed through prophylactic antibiotics, sterile protocols, and clear emergency contact instructions. Participation is voluntary, and all participants must provide written informed consent before the study begins.

Inclusion Criteria:

• Patients aged 18 years or older
• Both male and female patients
• Patients requiring odontectomy of an impacted lower third molar

Exclusion Criteria:

• Patients who are pre-surgically symptomatic
• Use of medications that affect bleeding time or bone remodeling
• Patients with a history of radiotherapy or chemotherapy
• Patients who are pregnant or lactating
• Patients using oral contraceptives
• Patients with acute or chronic infections
• Patients with any kind of pathology confirmed radiographically