Abstract
BackgroundThe purpose of this study was to identify potential concealed variables associated with the difficulty of lower third molar (M3) extractions.Material and MethodsTo address the research purpose, we implemented a prospective study and enrolled a sample of subjects presenting for M3 removal. Predictor variables were categorized into Group-I and Group-II, based on predetermined criteria. The primary outcome variable was the difficulty of extraction, measured as extraction time. Appropriate univariate and multivariate statistics were computed using ordinal logistic regression.ResultsThe sample comprised of 1235 subjects with a mean age of 29.49 +/- 8.92 years in Group-I and 26.20 +/- 11.55 years in Group-II subjects. The mean operating time per M3 extraction was 21.24 +/- 12.80 and 20.24 +/- 12.50 minutes for Group-I and Group-II subjects respectively. Three linear parameters including B-M2 height (distance between imaginary point B on the inferior border of mandibular body, and M2), lingual cortical thickness, bone density and one angular parameter including Rc-Cs angle (angle between ramus curvature and curve of spee), in addition to patient’s age, profile type, facial type, cant of occlusal plane, and decreased overbite, were found to be statistically associated (P < or = 0.05) with extraction difficulty under regression models.ConclusionsIn conclusion, our study indicates that the difficulty of lower M3 extractions is possibly governed by morphological and biomechanical factors with substantial influence of myofunctional factors. Practical Implications: Preoperative evaluation of dynamic concealed factors may not only help in envisaging the difficulty and planning of surgical approach but might also help in better time management in clinical practice. Key words:Third molar, impacted, extraction, mandibular, facial type.
Highlights
The surgical removal of third molars has been, and continues to be, the most frequently performed operation by oral and maxillofacial surgeons, both in private practice and in hospital settings
Previous studies have reported a variety of factors that have been associated with the difficulty of impacted mandibular M3 removal including depth, ramus relationship/space available, and width of the root [5]
Further descriptive statistics for each measurement in Group-I and GroupII are summarized in table 2. - Group-I Table 3 summarizes the results of analysis of variance (ANOVA) and post hoc test
Summary
The surgical removal of third molars has been, and continues to be, the most frequently performed operation by oral and maxillofacial surgeons, both in private practice and in hospital settings. Previous studies have reported a variety of factors that have been associated with the difficulty of impacted mandibular M3 removal including depth, ramus relationship/space available, and width of the root [5]. We hypothesize that, apart from the pre-investigated predictive factors, certain dynamic concealed factors might contribute to the difficulty of mandibular M3 extraction With this intent, the present study was aimed to explore and evaluate the role of potential dynamic concealed factors and their association with intra-operative complexity of mandibular M3 removal. A number of studies have investigated this association before, but, to the best of our knowledge this is the first study of its kind, comparing different profile types and facial types for exploration of potential dynamic concealed factors in the difficulty of lower M3 removal. Practical Implications: Preoperative evaluation of dynamic concealed factors may help in envisaging the difficulty and planning of surgical approach but might help in better time management in clinical practice
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