Analysis of potential dynamic concealed factors in the difficulty of lower third molar extraction

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.

Anatomia e considerações clínicas dos Terceiros Molares Inclusos: Uma Revisão de Literatura / Anatomy and clinical considerations of the included third molars: A Literature Review

“…Status de erupção, posição e angulação têm impacto sobre esses sintomas. A decisão de remover ou não um terceiro molar inferior é provavelmente uma das decisões de tratamento mais frequentes na profissão odontológica (CHOU et al, 2017;SINGH et al, 2016). V.13, N. 47 p. 823-835, Outubro/2019 -ISSN 1981-1179 Edição eletrônica em http://idonline.emnuvens.com.br/id Essa diretriz recomendou que a prática de remoção profilática de terceiros molares impactados, sem patologia, fosse descontinuada e sugeriu indicações para a extração cirúrgica da seguinte forma: pericoronite recorrente, celulite, abscesso, osteomielite, doença de folículos, incluindo cistos e tumores, cárie não restaurável, patologia pulpar e/ou periapical intratável, reabsorção interna/externa de dentes adjacentes, fratura de dente, uma cirurgia de impedimento de dente ou cirurgia reconstrutiva da mandíbula e um dente envolvido no ou dentro do campo do tumor ressecção (FAN et al, 2015;KARASAWA et al, 2013;SIDLAUSKAS;TRAKINIENE, 2006;ZAWAWI;MELIS, 2014).…”

“…Os terceiros molares inclusos estão associados a apinhamentos, pericoronarite, cárie dentária, reabsorção radicular e periodontites. Além disso, complicações mais graves como desenvolvimento de cistos e tumores, osteomielite e celulites também são relatados, podendo gerar hospitalização para tratamento odontológico associado ao médico (SINGH et al, 2016).…”

Spatial Position and Anatomical Characteristics Associated with Impacted Third Molars Using a Map-Reading Strategy on Cone-Beam Computed Tomography Scans: A Retrospective Analysis

“…Impacted teeth can induce changes in adjacent structures, giving rise to the development of pericoronitis, primary and/or secondary dentition crowding, tumors, odontogenic cysts, associated periodontal defects, caries, as well as myofascial and neurogenic pain [3]. The extraction of mandibular third molars is a well-executed dental office procedure, necessitating meticulous planning to minimize the occurrence of severe pain, edema, discomfort, and/or dysfunction, whether temporary or permanent, the latter resulting from potential injury to the inferior alveolar nerve [4][5][6].…”