Evaluation of Third Molars According to the Operative Difficulty Score

Abstract

Aim: Third molars (M3) are the most common type of impacted tooth, and the prevalence of impaction varies between 27% and 68.8%. The aim of this study was to evaluate M3 according to their operative difficulty score and angulation. Material and Method: A total of 1000 patients who returned to our clinic for M3 extraction were included in the study. Preoperative clinical and radiological operative difficulty scores (ODS) and angulations were evaluated from 0 to 6. Descriptive statistics were performed. Results: When M3 were evaluated according to ODS, 343 (34.3%) were ODS 1, 106 (10.6%) were ODS 3, 327 (32.7%) were ODS 4, 188 (18.8%) were ODS 5 and 36 (3.6%) were ODS 6. When evaluated according to their angulations, 621 (62.1%) M3 were found in the vertical position, 184 (18.4%) in the mesioangular position, 70 (7%) in the horizontal position, 104 (10.4%) in the distoangular position, and 21 (2.1%) in the buccolingual-palatal position. Conclusion: This study will allow the evaluation of the level of difficulty before the operation in the surgery of the M3 and the creation of a better treatment plan. Thus, perioperative and postoperative complications can be minimized.

Keywords

• Classification
• oral surgery
• third molar

Kaynakça

1. Peñarrocha-Diago M, Camps-Font O, Sánchez-Torres A, et al. Indications of the extraction of symptomatic impacted third molars. A systematic review. J Clin Exp Dent. 2021;13:278-86.
2. Dicus-Brookes C, Partrick M, Blakey GH, et al. Removal of symptomatic third molars may improve periodontal status of remaining dentition. J Oral Maxillofac Surg. 2013;71:1639-46.
3. Jeyashree T, Kumar MPS. Evaluation of difficulty index of impacted mandibular third molar extractions. J Adv Pharm Technol Res. 2022;13:98-101.
4. Kandasamy S, Rinchuse DJ, Rinchuse DJ. The wisdom behind third molar extractions. Aust Dent J. 2009;54:284-92.
5. Hermida-Cabrera P, Lima-Sánchez B, Montoya-Salazar V, et al. Proposal and validation of a new index to assess the difficulty of lower third molar extraction. Dent J. 2024;12:138.
6. Gay-Escoda C, Sánchez-Torres A, Borrás-Ferreres J, Valmaseda-Castellón E. Third molar surgical difficulty scales: systematic review and preoperative assessment form. Med Oral Patol Oral Cir Bucal. 2022;27:e68-76.
7. Al-Dajani M, Abouonq AO, Almohammadi TA, et al. A cohort study of the patterns of third molar impaction in panoramic radiographs in Saudi population. Open Dent J. 2017;11:648-60.
8. Sánchez-Jorge MI, Cortés-Bretón-Brinkmann J, Acevedo-Ocaña R, et al. Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualification in oral surgery and maxillofacial surgeons in a Spanish subpopulation. Med Oral Patol Oral Cir Bucal. 2024;29:263-72.

9. Lang MS, Gonzalez ML, Dodson TB. Do antibiotics decrease the risk of inflammatory complications after third molar removal in community practices?. J Oral Maxillofac Surg. 2017;75:249-55.
10. Saruhan N. Gömülü 3. molar dişlerin operatif zorluk skoruna ve komplikasyonlara göre değerlendirilmesi. Med J SDU. 2018;25:282-6.
11. Mercier P, Precious D. Risks and benefits of removal of impacted third molars. A critical review of the literature. Int J Oral Maxillofac Surg. 1992;21:17-27.
12. van der Linden W, Cleaton-Jones P, Lownie M. Diseases and lesions associated with third molars. Review of 1001 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:142-5.
13. Brasileiro BF, de Bragança RM, Van Sickels JE. An evaluation of patients' knowledge about perioperative information for third molar removal. J Oral Maxillofac Surg. 2012;70:12-8.
14. Contar CM, de Oliveira P, Kanegusuku K, et al.Complications in third molar removal: a retrospective study of 588 patients. Med Oral Patol Oral Cir Bucal. 2010;15:e74-8.
15. Chaparro-Avendaño AV, Pérez-García S, Valmaseda-Castellón E, et al.Morbidity of third molar extraction in patients between 12 and 18 years of age. Med Oral Patol Oral Cir Bucal. 2005;10:422-31.
16. Bali A, Bali D, Sharma A, Verma G. Is pederson index a true predictive difficulty index for impacted mandibular third molar surgery? A meta-analysis. J Maxillofac Oral Surg. 2013;12:359-64.
17. Carvalho RW, do Egito Vasconcelos BC. Assessment of factors associated with surgical difficulty during removal of impacted lower third molars. J Oral Maxillofac Surg. 2011;69:2714-21.
18. Park KL. Which factors are associated with difficult surgical extraction of impacted lower third molars?. J Korean Assoc Oral Maxillofac Surg. 2016;42:251-8.
19. Gümrükçü Z, Balaban E, Karabağ M. Is there a relationship between third-molar impaction types and the dimensional/angular measurement values of posterior mandible according to Pell & Gregory/Winter Classification?. Oral Radiol. 2021;37:29-35.
20. Mahdey HM, Arora S, Wei M. Prevalence and difficulty index associated with the 3(rd) mandibular molar impaction among Malaysian Ethnicities: a clinico-radiographic study. J Clin Diagn Res. 2015;9:ZC65-8.
21. Habets LL, Bezuur JN, Naeiji M, Hansson TL. The Orthopantomogram, an aid in diagnosis of temporomandibular joint problems. II. The vertical symmetry. J Oral Rehabil. 1988;15:465-71.