What if a set of clinical photographs could make healing after wisdom-tooth surgery easier to judge consistently? This study tests that idea—and finds a useful tool with a real weakness in the middle stages. The study presents and validates a digital visual scale for evaluating mucosal wound repair after mandibular third molar extraction.

The scale seeks to establish a standard-based tool that improves communication in clinical practice and research by reducing subjectivity in postoperative assessments. In periodontal surgery, the Landry scale is frequently used to express gingival mucosa repair qualitatively, but oral and maxillofacial surgery has no valid and reliable scale for mucosa covering tooth-extraction wounds, particularly after third molar removal.

Usually, the mucosa takes two to three weeks to cover the dental socket, so tissue discontinuity is no longer visible on the fourteenth day, while alveolar bone takes more time to heal or regenerate properly. After impacted third molar surgery, pain, edema, and limitation of mouth opening are normal within seventy-two hours, and afterward the wound should progressively show decreased inflammatory signs over a period that can reach seven to ten days.

Inadequate mucosal repair can be associated with postoperative complications such as alveolitis, infection, or suture dehiscence, affecting patient recovery and quality of life. A scale that enables early and reliable detection of healing deviations therefore has practical and preventive value.

The study aims to use digital images to evaluate mucosal wound repair after mandibular third molar extraction and support standards-based communication in practice and research. The clinical scale was established from standardized digital images of six surgical sites at the seventh and fourteenth days after inferior third molar extraction, without local or associated systemic comorbidities.

Three experienced dental surgeons selected five images from seven days after surgery to provide a visual spectrum of inflammatory responses to tissue repair. A sixth image captured fourteen days after extraction showed fully repaired mucosa and served as a visual reference for complete healing and normal tissue appearance.

Figure two presents six clinical photographs of mucosal wounds after third-molar removal, assessed on the seventh and fourteenth days after suture removal. The examples show varied healing features, including partial epithelialization, necrotic tissue, hyperemia and swelling, keratosis, and discrete edema.

These images mattered because participants used them to assign scores from zero to three for stages of inflammation and mucosal repair, supporting agreement testing and construct validation of the visual scale. Examiners came from a database of general dentists and specialists in University Alumni Dental School registers formed before twenty seventeen, and the recruitment process ensured a diverse and representative sample of dental professionals.

The study used two parallel phases: assessing agreement with a consensus score and validating the scale’s construct as a measurement instrument. Both phases assessed the scale’s effectiveness and applicability in clinical and research settings.

Figure three maps how the three hundred electronic forms were distributed and followed up. The forms split into one hundred fifty for agreement, including sixty-seven non-respondents and eighty-three specialists and non-specialists, and one hundred fifty for construct validity, yielding sixty-seven specialists after exclusions.

This flow matters because it clarifies the participant pathway and shows the final group used for construct validation. Agreement with the consensus score and construct validity were evaluated for the proposed oral mucosa repair scale. Inter-rater agreement across the six clinical images was assessed with Fleiss’ Kappa, while agreement with the consensus classification was the percentage of individual ratings matching the modal score.

The modal score was an internal consensus reference, not an independent gold standard. Chi-Square tested associations between categorical variables, and Spearman’s rank correlation tested the relationship between visual quality and clinical representativeness.

The agreement analysis evaluated responses from eighty-three participants applying the proposed scale to clinical images, including specialists and non-specialists. Fleiss’ Kappa was zero point three zero one eight, which indicates fair agreement according to the Landis and Koch scale.

The overall average agreement was sixty-four point three percent, with mean agreement of sixty-three point five percent among specialists and sixty-four point six percent among non-specialists. There was no statistically significant difference in agreement between specialists and non-specialists.

Looking down the agreement column, images c, d, and f cluster above eighty percent, with image d at eighty-five point five percent and image f at eighty-one point nine percent. The lower rows show images a, b, and e at fifty-one point eight, forty-five point eight, and thirty-seven point three percent, respectively; image e also has the largest listed error frequency, at thirty-six point one percent.

Sixty-seven specialists participated in construct validation, and most participants strongly agreed with the proposed criteria, indicating robust face validity. The scale demonstrated elevated acceptance across all evaluated domains.

Looking across the response columns, every row has zero responses in the strongly disagree column, while only graphical/visual quality shows any partially disagree responses, at zero point five percent. The partially agree column ranges from six point zero percent for graphical/visual quality to twenty-nine point nine percent for reference for practice/research, showing where agreement was less emphatic.

Experts found the morphological transition between Score zero and Score one difficult to detect or analyze, suggesting a need for more distinct visual cues or descriptive descriptors. Suggestions included adding subclasses such as one-a and one-b for variables including food debris or exposed bone tissue.

Several respondents highlighted the scale’s potential to simplify clinical documentation and electronic oral health records. The study’s limitations include using six images and a single site of inferior third molars. The seventh postoperative day was chosen because it is commonly used for suture removal or follow-up assessment after one week, capturing routine clinical features at that stage.

After forty-eight hours, important clinical aspects of mucosa repair change, and that period would require another scale for a different analysis period. The visual scale showed high professional acceptance and potential to facilitate standardized assessment of mucosal healing after mandibular third molar surgery.

However, fair inter-rater agreement, especially in intermediate healing stages, indicates that scoring categories need refinement and examiners need enhanced calibration. Future studies could validate a revised scale in larger and more diverse patient populations to improve reliability, reproducibility, and clinical applicability.

The scale was highly accepted and could standardize mucosal-healing assessments, but only fair agreement shows that intermediate scores still need clearer descriptions and better examiner calibration.