Surgical Difficulty Assessment in Patients Undergoing Impacted Mandibular Third Molar Extraction. A Single Center Evaluation in Najran, Kingdom of Saudi Arabia

Abstract

Introduction: The evaluation of surgical difficulty preoperatively is important during mandibular third molar (MTM) extraction. This study aimed to evaluate the difficulty index for the removal of impacted MTM using Pederson difficulty index (PDI), Parant Scale (PS), and total operation time (TOT). Materials and Methods: This was a prospective study of patients referred for the extraction of impacted MTM between April, 2019 and July, 2020. Estimated level of difficulty was done before a standardized surgery using the PDI and classified as: Minimally difficult (I), moderately difficult (II), and very difficult (III). Intraoperatively, it was classified as extraction requiring ostectomy only (II); extraction requiring ostectomy and coronal section (III); and complex extraction requiring coronal and root sectioning (IV) using the Modified PS. TOT was recorded by a resident with stopwatch. Results: A total of 502 patients (203 [40.4%] males and 299 [59.6%] females) with an M:F of 1:1.5. The age ranged from 17 to 69 years with a mean age ± standard deviation (SD) (31.6 ± 9.6) years. The majority of the patients were in the age group of 21–40 years. TOT ranged from 10 to 35 min with mean TOT ± SD (15.35 ± 7.02) min. The mean TOT according to PDI was 11.30 ± 2.22, 12.74 ± 4.14, and 26.44 ± 4.39 min in I, II, and III, respectively, while according to PS were 10.91 ± 0.9, 19.60 ± 4.5, 28.82 ± 3.5 min in II, III, and IV, respectively. The observed correlation coefficients® for PDI and PS were 0.716 and 0.870, respectively. Conclusion: Analysis of the surgical difficulty of impacted MTM extraction is essential for treatment planning and patient satisfaction. PS has been found to be significantly associated with TOT.