The Effect of Topical Application of Hyaluronic Acid and Melatonin Mixture Following Surgical Extraction of Impacted Mandibular Third Molars .

This randomized controlled clinical trial aims to evaluate the clinical and radiographical effects of the application of a mixture of hyaluronic acid and melatonin after surgical extraction of impacted mandibular third molars. Participants are randomly allocated to receive either gel foam loaded with a topical mixture of hyaluronic acid and melatonin ( intervention group ) or gel foam alone ( control group ) following surgical extraction. Clinical outcomes, including postoperative pain, facial swelling, and maximum mouth opening, are assessed on postoperative days 1, 3, and 7. Radiographic bone healing is evaluated using cone-beam computed tomography (CBCT), with a baseline scan obtained within one week after surgery and a follow-up scan performed 6 months postoperatively to assess changes in bone density. The clinical and radiographic outcomes of both groups are compared to determine whether the combined treatment improves postoperative healing following surgical extraction of impacted mandibular third molars

Inclusion Criteria: * Patients aged 18-35 years. * patients requiring surgical extraction of impacted mandibular third molars classified as Pell and Gregory class II, position B, irrespectiver of the impaction type. * Patients with normal moueh opening at the time of extraction. * Surgical site free of active infections. * Patients free from systemic diseases that may affect the healing process. * Patients without known allergy for melatonin, local anesthetic agents, amoxicillin, or acetaminophen (paracetamol ) . Exclusion Criteria: * Heavy smokers (\>cigarettes / day) . * Pregnant patients. * Patients with local infections ('e.g pericoronitis) . * Patients who used melatonin for more than 6 months prior to the study. * Patients with poor oral hygiene or active periodontal disease. * Patients with limited mouth opening * Surgical procedures exceeding 30 minutes.