Extraction of mandibular third molars: proposal of a new scale of difficulty

Sammartino, Gilberto; Gasparro, Roberta; Marenzi, Gaetano; Trosino, Oreste; Mariniello, Mauro; Riccitiello, Francesco

doi:10.1016/j.bjoms.2017.09.012

Cited by 22 publications

(14 citation statements)

References 13 publications

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“…In previous classifications, however, there is also a lack of detailed consideration for teeth that are deeply impacted, such as a description of which part of the crown of the impacted third molar is located underneath the root of the adjacent second molar. Therefore, further studies are necessary to determine how to fully evaluate the difficulty of an impacted third molar extraction [8][9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Modified difficult index adding extremely difficult for fully impacted mandibular third molar extraction

Kim

Yong

Park

et al. 2019

J Korean Assoc Oral Maxillofac Surg

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Objectives: The aim of this study was to evaluate the validity of the existing classification and difficulty index of impacted mandibular third molars in clinical situations and propose a more practical classification system. Materials and Methods: This study included 204 impacted mandibular third molars in 154 patients; panoramic x-ray images were obtained before tooth extraction. Factors including age, sex, and pattern of impaction were investigated. All impacted third molars were classified and scored for spatial relationship (1-5 points), depth (1-4 points), and ramus relationship (1-3 points). All variables were measured twice by the same observer at a minimum interval of one month. Finally, the difficulty index was defined based on the total points scored as slightly difficult (3-4 points), moderately difficult (5-7 points), very difficult (8-10 points), and extremely difficult (11-12 points). Results: The strength of agreement of the total points scored and difficulty index were 0.855 and 0.746, respectively. Most cases were classified as moderately difficult (73.0%). Although only 13 out of 204 cases (6.4%) were classified as extremely difficult, patients classified as extremely difficult were the oldest (P<0.05). Conclusion: For difficulty classification, the authors propose one more difficult category beyond the existing three-step difficulty index: the clinician should consider the patient's age in the difficulty index evaluation.

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Section: Introductionmentioning

confidence: 99%

Modified difficult index adding extremely difficult for fully impacted mandibular third molar extraction

Kim

Yong

Park

et al. 2019

J Korean Assoc Oral Maxillofac Surg

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“…Park 20 observed an increased difficulty due to third molar ankylosis which is more frequent in patients over 25. On the other hand, in young patients the easy surgeries were correlated to a lower bone density 9,21 . In a recent study, Gonzaléz et al 22 observed a significant correlation between age, prolonged surgical duration and post‐operative pain.…”

Section: Discussionmentioning

confidence: 96%

To what extent are surgeons capable of establishing the difficulty degree of lower third molar surgery pre‐operatively?

Pippi

Sallemi

2020

Oral Surgery

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Background Several methods and variables have been proposed to evaluate surgical difficulty in lower third molar extraction. Aims The main aim of the present study is to identify which variable influences most the surgeon’s judgment on technical difficulty and which patient‐ and tooth‐related variables are directly associated with an increase in surgical difficulty. Materials & Methods A prospective observational study was performed. Assessment of the difficulty of surgery was conducted both asking surgeons to subjectively evaluate the difficulty of each procedure, pre‐ and post‐operatively, and using a modified Pederson anatomical variable score. Results Patients with high positive scores for Factor 1 of the principal component analysis underwent third molar surgeries evaluated as difficult by surgeons and were also associated with longer durations of tooth sectioning, ostectomy, flap incision and detachment, luxation/extraction, as well as a greater overall duration of surgery. Teeth with slightly divergent or fused roots were associated with shorter surgeries, which were evaluated as easier by surgeons in comparison to cases of teeth with apical anomalies. When the position of the tooth was vertical, surgery was evaluated as easier by surgeons and lasted less, compared to when the tooth was in a horizontal position. When the roots were slightly divergent or fused, suture and flap incision and detachment lasted longer, and surgery was evaluated as relatively easier compared to when the tooth presented apical anomalies. Conclusion Surgeons evaluated the difficulty of lower third molar surgery in a substantially different manner compared to the anatomic variable score used.

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“…Prediction of surgical extraction difficulty is important for anticipating postoperative issues and planning treatment options such as general anesthesia in a controlled environment to prevent complications 12 , 13 . Extraction difficulties were evaluated based on position of the third molars using panoramic radiography 1 - 5 . The position was associated with postoperative complications such as alveolar nerve injury 6 and dry socket 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical difficulty in mandibular third molar extractions can predict the incidence of postoperative complications. Since the 19th century, several researchers have attempted to classify extraction difficulty using radiographic techniques or estimating the prevalence of complications [1][2][3][4][5] . In December 2019, a difficulty index was proposed based on positional variations in impacted mandibular third molars evaluated by panoramic radiography 5 .…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a difficulty index for mandibular third molars with extraction time

Chang

Jeong

et al. 2020

JKAOMS

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Objectives This study aimed to validate the effectiveness of a recently proposed difficulty index for removal of impacted mandibular third molars based on extraction time and suggest a modified difficulty index including the presence of pathologic conditions associated with third molars. Materials and Methods This retrospective study enrolled 65 male patients younger than 25 years with third molars. Extraction time was calculated from start of the incision to the last suture. The difficulty scores for third molars were based on spatial relationship (1-5 points), depth (1-4 points), and ramus relationship (1-3 points) using cone-beam computed tomography. The difficulty index was defined as follows I (3-4 points), II (5-7 points), III (8-10 points), and IV (11-12 points). The modified difficulty score was calculated by adding one point to the difficulty score if the third molar was associated with a pathologic condition. Two modified difficulty indices, based on the presence of pathologic conditions, were as follows the half-level up difficulty index (HDI) and the one-level up difficulty index (ODI) from the recently proposed difficulty index. Results The correlations between extraction time and difficulty index and or modified difficulty indices were significant ( P <0.001). The correlation coefficient between extraction time and difficulty index was 0.584. The correlation coefficients between extraction time and HDI and ODI were 0.728 and 0.764, respectively. Conclusion Extraction time of impacted third molars exhibited a moderate correlation with difficulty index and was strongly correlated with the modified indices. Considering the clinical implications, the difficulty index of surgical extraction should take into consideration the pathologic conditions associated with third molars.

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Extraction of mandibular third molars: proposal of a new scale of difficulty

Cited by 22 publications

References 13 publications

Modified difficult index adding extremely difficult for fully impacted mandibular third molar extraction

Modified difficult index adding extremely difficult for fully impacted mandibular third molar extraction

To what extent are surgeons capable of establishing the difficulty degree of lower third molar surgery pre‐operatively?

Development and validation of a difficulty index for mandibular third molars with extraction time

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