Extraction of mandibular third molars: proposal of a new scale of difficulty (original) (raw)
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Annali di Stomatologia, 2014
Introduction. The first aim of the present study was to analyze if any correlation exists between the post-graduate's and the tutor's difficulty evaluation of the same tooth to be extracted. Secondly, the study aimed to verify whether, and possibly which, anatomical/topographic characteristics of the impacted lower third molar influence the postgraduate's difficulty evaluation. Thirdly, patient's age and gender were studied for any influence either on the post-graduate's and tutor's extraction difficulty evaluation or on surgical time. Lastly, the possible effect of the post-graduate's difficulty evaluation on the incidence of surgical accidents was also studied. Materials and methods. Eighty-four impacted mandibular third molars have been retrospectively reviewed. For each molar, pre-and operative information have been collected. The Pearson's Product Moment Correlation, the general linear model with backward stepwise procedure, the variance analysis and the logistic regression were used for inferential statistics. Main results. Correlation between the post-graduate's and tutor's difficulty evaluation of each lower third molar to be extracted as well as between difficulty evaluation and operative time were statistically significant. Tooth position, impaction depth and relationship with the inferior alveolar nerve influenced operative times. Pre-surgical difficult degree had a positive significant effect on accident occurrence. Conclusions. The pre-operative post-graduates' difficulty evaluation did not differ from their post-operative evaluation although their judgement differed from that given by the tutor and did not correlate with the operative time. Lower third molar extraction difficulty seems to be influenced by some topographic factors such as tooth position, impaction depth and relationship between inferior alveolar nerve and impacted tooth.
Journal of Oral and …, 2007
The aim of this prospective study was to investigate radiologic and clinical factors associated with increased difficulty in the removal of impacted mandibular third molars. We also aimed to form an index to measure the difficulty of removal of the impacted molars preoperatively. Patients and Methods: A total of 87 patients who required 90 surgical extractions of impacted mandibular third molars from November 2003 to May 2004 were involved in the study. Radiologic and clinical data were taken preoperatively. All extractions were performed under local anesthesia by a single operator. Surgical difficulty was measured by the total intervention time. Results: Increased surgical difficulty was associated with increasing age and body mass index. It was also associated with the curvature of roots of the impacted tooth and the depth from point of elevation (P Ͻ .05). Conclusion: Both clinical and radiologic variables are important in predicting surgical difficulty in impacted mandibular third molar extractions.
The journal of contemporary dental practice, 2008
The aim of this study was to assess the relative contributions of patient characteristics and radiographic variables to the difficulty of extraction of impacted mandibular third molars in a Nigerian population. Seventy-nine consecutive patients undergoing mandibular third molar extractions were recruited for this prospective cohort study. Specific patient characteristics and radiographic variables were recorded. All extractions were performed under local anesthesia by the same oral surgeon, and the surgical difficulty was assessed based on the duration of surgery. Body weight (BW) (P=0.009) and body surface area (BSA) (P=0.004) were the significant patient characteristics while tooth impaction depth (P=0.002), number of roots (P=0.035), and tooth angulation (P=0.003) were the significant radiographic variables associated with surgical difficulty using a univariate analysis. A multiple linear regression model was constructed with these variables using surgical difficulty as the depen...
2019
The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, especially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complications in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon’s experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for ‘right side’ was higher w...
Evaluation of Recently Proposed Scales as Predictors of Mandibular Third Molar Extraction Difficulty
Journal of Dentistry and Oral Sciences, 2022
Background: The Prediction of extraction difficulty of impacted mandibular third molar (M3M) is extremely important for both patients and clinicians. Recently, many new difficulty-estimating indices had been proposed, among them are, Zhang et al., Kim et al., Pernambuco, Lainez et al., and Roy et al. indices. This study aimed to evaluate the validity of these new scales as preoperative predictors of the difficulty of surgical removal of impacted M3M. Material and Methods: The five scales under study predicted extraction difficulty of a series of 50-impacted M3M preoperatively, and postoperative difficulty was assessed with Parant scale (PS) and by the time required for surgery (TS). Results: The proposed indices had low to moderate sensitivity (21%-45%, 41%-67%) and variable in their specificity (21%-86%, 36%-85%). Only three out of five evaluated indices have shown a statistically significant correlation with both, the operation time and the surgical technique; namely, Zhang et al., Pernambuco, Lainez et al. indices. Conclusions: Zhang et al., Pernambuco, Lainez et al. indices can be used as preoperative predictors of the impacted M3M extraction difficulty.
International Journal of Medical and Surgical Sciences, 2019
The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. Both the patient and dentist must therefore have scientific evidence-based information concerning the estimated level of surgical difficulty of every case to consider in referring cases of impacted third molars for specialists’ handling. We have undertaken a study in which demographic and radiological variables were considered together to evaluate the risk factors for surgical difficulty in a cohort of 100 impacted mandibular third molars. There were 13 variables evaluated for surgical difficulty. Total surgical time intervention was noted at the end of each surgery. Each variable was analysed with total surgical time intervention with univariate and multiple linear regression. Out of 13 variables, 9 were found statistically significant. The most significant predictors for surgical difficulty were Body Mass Index, Depth of impacted tooth an...
Journal of Oral and Maxillofacial Surgery, 2014
The present study investigated whether residents are able to estimate the degree of difficulty of mandibular third molar removal to the same extent as senior surgeons. Materials and Methods: The study included 2 residents and 2 senior surgeons, each of whom extracted 50 mandibular third molars of similar complexity. The clinical variables evaluated included patient age, gender, body size, maximal mouth opening, and tongue interference. The radiographic variables related to the third molars examined on the panoramic radiographs included spatial positioning, tooth-bone interface, root morphology, and proximity of the tooth to the inferior alveolar canal. Before each extraction, the operating surgeon estimated the level of difficulty of the surgery after considering all the variables. The predicted length of time per operation was regarded as representative of operative difficulty. At the end of each operation, its actual duration was also recorded. Results: The residents and senior surgeons both accurately predicted the difficulty of surgery in just more than one half of the cases. A 57% agreement (k = 0.24) was found between the senior surgeons' preoperative estimations and actual difficulty, and the agreement was 52% (k = 0.19) for the residents' estimations. No significant difference was found between the senior surgeons and residents in the accuracy of their estimations of operation length. Conclusions: The preoperative prediction of the surgical difficulty of mandibular third molar tooth removal was unreliable, not only for the residents, but also for the senior surgeons.
Assessment of Difficulty in Third Molar Surgery—A Systematic Review
Journal of Oral and Maxillofacial Surgery, 2009
Purpose: The aim of this review was to identify the most important variables that determine surgical difficulty of impacted third molar extractions by their consistent showing in previous studies. Materials and Methods: Electronic library search for current evidence in the world literature was conducted, and relevant articles were selected, scrutinized, and the findings were compared. Results: Seven articles were most relevant, and the results of the comparison of the selected articles showed that demographic variable, age; operative variables: surgeon procedure type and number of teeth extracted; and ratiographic variable, depth angulation; and root morphology, are the most consistent determinants of difficulty. Conclusion: Current evidence is in support of 3 categoreis of variables strongly associated with surgical diffulty of impacted third molars. The most important variables in each of these categories have been identified.
Evaluation of the surgical difficulty in lower third molar extraction
Medicina Oral Patología Oral y Cirugia Bucal, 2010
The ability to predict the surgical difficulty of lower third molar extraction facilitates the design of treatment plans by minimizing complications and improving the preparation of patients and assistants in terms of the postoperative management of inflammation and pain. The aims of this study were to evaluate the value of panoramic radiographs in predicting lower third molar extraction difficulty and technique and to determine if the experience of the practitioner had any influence on this predictive ability. Fourteen dental practitioners with varying levels of experience evaluate the difficulty of lower third molar extraction in a group of patients using a 100-mm visual analog scale (VAS) and a modified version of a surgical difficulty scale. The results were then compared to postoperative scores calculated using the same scale. A tendency to underestimate the difficulty of procedures that was more pronounced in observers with greater levels of experience was observed. A low level of agreement between preoperative and postoperative evaluations using the surgical difficulty scale as well as an association between difficulty assessed preoperatively using the VAS and difficulty assessed postoperatively using the surgical difficulty scale was also found. The use of panoramic radiographs does not allow practitioners to accurately predict lower third molar extraction difficulty and technique, regardless of their level of experience.