An Assessment of Factors Influencing the Difficulty in Third Molar Surgery

Abstract

Background and objectives: Surgical removal of a mandibular impacted third molar is one among the most common oral surgical procedures. The objective of this study was to assess and identify risk indicators influencing extended operation time in relation to the surgical removal of mesioangular impacted mandibular third molar, position A, Class I and to evaluate the incidence of postoperative swelling, trismus, and pain.

Materials and methods: A prospective cohort was implemented and the patients who presented for mandibular third molar removal which were impacted in position A, Class I were enlisted for the study. During 1 year between July 2014 and June 2015, a total of 40 patients were enrolled in the study. The evaluation of patient variables and radiographic variables was done preoperatively. Depending on the duration of time taken for an operation, patients were divided into three groups: Group I, Group II, and Group III. Postoperative complications such as swelling, trismus, and pain were assessed in each of the patients.

Statistical analysis: The statistical analysis was done among the groups using Chi-square test, and ANOVA.

Results: Among the six variables studied in this study including patient variables and radiographic variables, maximum interincisal opening, external oblique ridge, and root morphology were found to be dependent factors which influence the operating time. Moreover, other variables such as the crown root width ratio and the number of roots were independent factors. Swelling, trismus, and pain were statistically significant among groups and were directly related to operating time.

Conclusion: We consider that the outcome of surgical removal of mandibular impacted third molar, position A, Class I depends significantly on relevant patients characteristics and radiographic variables which should be evaluated preoperatively as they are predetermined factors to avoid postoperative morbidity.

Keywords: Indicators of difficulty; mesioangular impaction; pain; swelling.

Figure 1

Measurement of cheek flexibility

Figure 2

Measurement of interincisal opening

Figure 3

Preoperative assessment of intraoral periapical radiograph 1

Figure 4

Preoperative assessment of intraoral periapical radiograph 2

Figure 5

Reflection of mucoperiosteal flap after terrance ward incision

Figure 6

Bone trough prepared

Figure 7

Measurement of cheek swelling

Figure 8

Measurement of cheek swelling markings

Figure 9

Markings for cheek swelling

Graph 1

Preoperative interincisal distance

Graph 2

Preoperative cheek flexibility

Graph 3

Effect of operating time on trismus

Graph 4

Postoperative swelling in different groups of patients

Graph 5

The mean pain intensity in different groups