Difficulty of impacted mandibular third molar tooth removal: predictive ability of senior surgeons and residents

Abstract

Purpose: 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 (κ = 0.24) was found between the senior surgeons' preoperative estimations and actual difficulty, and the agreement was 52% (κ = 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.