Abstract
Background The main objective of this systematic review was to collect the pre-existing scales for assessing the difficulty of third molar extraction. The secondary objective was to design a proposal for a preoperative evaluation protocol for the difficulty of third molar extraction.Material and Methods Two independent researchers conducted an electronic search in Pubmed (MEDLINE), Cochrane, and Scopus databases during March 2021. Included studies evaluated the prediction of the difficulty of surgical removal of impacted upper or lower third molars using new indices/scales or pre-existing scales with or without modifications. Articles referring to coronectomies or assessing pre-surgical difficulty using other tools were excluded. Neither language nor publication date restrictions were applied.Results Out of 242 articles, 13 prospective cohort studies were finally selected. Seven developed new indices/scales, and 6 assessed the predictive ability of some pre-existing scales. Most of the indices/scales contained radiological variables and few added any patient-related variables. We proposed a preoperative assessment protocol of the difficulty of third molar extraction to facilitate treatment planning and/or considerate referral in cases of high difficulty. This proposal used patient-related, radiological and surgical variables.Conclusions Using a preoperative protocol to evaluate the surgical difficulty, including different patient-specific, radiological and surgical variables, could facilitate treatment planning, help clinicians prevent complications and assess the possibility of referral. Key words:Wisdom teeth, patient characteristics, radiological variables, surgeon experience, assessment form.
Highlights
Removal of third molars (3M) is one of the most common procedures in oral surgery
Data was recorded in tables to collect the following information: author and year, number of patients and third molars treated, objective of the use of a scale or index, name of the index or scale, type of variables and individual items recorded by the index/scale, objective post-operative variables that help determine the difficulty, evaluator of the index/scale, surgeon(s) experience and main results. Based on this information and the factors that determine an increase in difficulty according to a previous systematic review [7], the authors designed a guide for assessing the surgical difficulty of 3M removal
The results obtained in the present systematic review show that most of the existing indices/scales include radiological variables collected from panoramic radiographs, and only some contain variables or characteristics of the patient himself, such as age or body mass index (BMI), among others
Summary
Removal of third molars (3M) is one of the most common procedures in oral surgery. Pre-operative evaluation of surgical difficulty can help the practitioner plan the surgical technique, estimate the operating time and foresee possible complications [1]. The fact that most 3M difficulty scales are mainly based on radiological criteria constitutes a gap between the impact that patient or surgeon factors can have on actual surgical difficulty [6]. In the field of oral surgery there is no form to determine the difficulty and assess the ability to perform surgery or to refer the case to a specialist according to the different variables involved, such as patient, radiological and operative factors, as determined by a recently published systematic review [6]. Conclusions: Using a preoperative protocol to evaluate the surgical difficulty, including different patient-specific, radiological and surgical variables, could facilitate treatment planning, help clinicians prevent complications and assess the possibility of referral
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