Background/Objectives: This study evaluated autologous platelet concentrates (APCs), including advanced platelet-rich fibrin (A-PRF+) and concentrated growth factors (CGFs), as biologically active matrices, and photobiomodulation (PBM) as a biophysical stimulus affecting soft and hard tissue regeneration following mandibular third molar extraction. Methods: A six-arm parallel randomised controlled trial was conducted including 135 patients. A total of 122 participants completed follow-up and were analysed: control (n = 22), photobiomodulation (n = 20), A-PRF+ (n = 19), CGF (n = 20), A-PRF+ plus photobiomodulation (n = 22), and CGF plus photobiomodulation (n = 19). The primary endpoint was postoperative pain intensity assessed on postoperative day 3 using an 11-point visual analogue scale (VAS). Secondary outcomes included swelling, trismus, wound healing assessed by the early healing index, and bone regeneration assessed by CBCT-based fractal dimension analysis at 4 months. Results: On postoperative day 3, mean VAS pain was 2.95 ± 2.65 in the control group and 1.00 ± 1.65 in the photobiomodulation group, corresponding to a mean difference of 1.95 VAS points. The overall between-group difference for day 3 pain was statistically significant. In swelling outcomes, no statistically significant between-group differences were observed at days 1, 3, or 7 across facial measurement lines. In CBCT fractal analysis, a significant group effect was detected for the mid socket region, with higher fractal dimension at 4 months in the CGF plus photobiomodulation group compared with the control. Conclusions: Both APCs and PBM positively influenced postoperative healing. Their combined application, particularly CGF with PBM, showed the most consistent regenerative effects, although not all outcomes differed significantly between groups. These minimally invasive strategies may support soft and hard tissue regeneration.

Background/Objectives: Surgical extraction of impacted mandibular third molars is frequently associated with postoperative morbidity, including swelling, trismus, and pain. However, the extent to which osteotomy contributes to these outcomes remains unclear. The aim of this study was to evaluate osteotomy as an intraoperative determinant of early postoperative morbidity following mandibular third molar extraction. Methods: This study represents a secondary analysis of data obtained from a randomized clinical trial. Patients undergoing surgical removal of impacted mandibular third molars were categorized according to whether osteotomy was required during the procedure. Postoperative outcomes included surgical duration, facial swelling (primary outcome) assessed by linear facial measurements, maximal mouth opening (trismus), postoperative pain intensity, and early soft tissue healing evaluated using the Early Healing Index. Results: Procedures involving osteotomy were associated with significantly longer surgical duration, as well as greater postoperative swelling and trismus during the early postoperative period. The most pronounced difference in swelling was observed along facial measurement line A on postoperative day 3. Multivariable analysis confirmed that osteotomy remained independently associated with increased postoperative swelling and trismus after adjustment for age, sex, and the original six-arm treatment allocation. In contrast, no statistically significant differences were found between the groups in postoperative pain intensity or early soft tissue healing. Conclusions: Osteotomy during mandibular third molar extraction is independently associated with increased early postoperative morbidity, particularly in terms of swelling and trismus. However, bone removal does not appear to negatively affect early soft tissue healing of the surgical site.