Preoperative Phase:
Consent Patient signs the informed consent form. Imaging
Cone-beam computed tomography (CBCT) is performed for:
Surgical planning Later comparison
Antiseptic Mouth Rinse Patient rinses with 0.12% chlorhexidine gluconate.
Surgical Procedure:
Operatory Setup All surgeries are done by the same oral surgeon. A sterilized operatory is used to maintain asepsis. Patient Preparation Pre-op instructions are given. Aseptic protocols followed. Sterile drapes placed. Anesthesia Topical anesthetic gel applied at injection site. Local anesthesia administered. Surgery begins only after anesthesia is confirmed effective. Surgical Access A mucoperiosteal flap is raised to expose the impacted lower third molar.
Tooth Removal Bone removal done using a high-speed surgical bur. Tooth extraction. Socket Cleaning
Socket is curetted to remove:
Granulation tissue Bone debris Tooth fragments Irrigated with sterile saline. CGF Based Sticky Bone Placement and Closure A CGF Based Sticky Bone is inserted into the socket. The wound is sutured using Vicryl sutures.
CGF (Concentrated Growth Factor) Preparation:
Blood Collection Blood drawn into a sterile 10 mL tube (no anticoagulant). Centrifugation Sample centrifuged using a CGF-specific machine. Tubes counterbalanced with another tube (blood or water). Clot Handling After centrifugation, CGF clot is removed. Red blood cell (RBC) layer is separated from fibrin matrix using a PRF tray. Sticky Bone Formation The CGF membrane is gently compressed using a sterile press to remove excess liquid.
The compressed CGF membrane is mixed thoroughly with bovine xenograft bone particles.
The mixture becomes cohesive and elastic, forming Sticky Bone, ready for surgical placement.
Postoperative Phase:
Medications Prescribed Antibiotic prophylaxis Analgesia medication Postoperative Instructions Standard care instructions are given to all patients. Pain Evaluation
Pain assessed using the Verbal Numeric Rating Scale (VNRS):
0 = No pain, 10 = Worst imaginable pain
Assessment on:
Day 1 Day 3 Day 7
Radiographic Evaluation:
Post-op Imaging
CBCT taken:
Immediately after surgery At 3 months post-op Purpose To assess changes in bone density over time.