Development and Validation of a Novel Radiographic Difficulty Scale for Assessing Extraction Complexity of Distoangular and Vertical Mandibular Third Molars
Dr. Deborah Sybil1 , Dr. Nancy Mathew2 , Dr. Aditi Sharma3
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi
DOI: 10.54936/haoms262105112
SUMMARY: : Background: Accurate preoperative assessment of mandibular third molar extraction difficulty is essential for optimizing surgical outcomes, particularly for distoangular and vertical impactions. This study validates a novel five-class radiographic difficulty scale centered on retromolar bone (RMB) positioning. Methods: In a prospective study, 58 distoangular and vertical mandibular third molar extractions were performed by a single clinician at the Faculty of Dentistry, Jamia Millia Islamia uses panoramic radiographs to assign difficulty scores. Extraction type (non-surgical vs. surgical), procedure time, and complications were recorded. Spearman’s correlation, ANOVA, and chi-square tests analyzed scale performance. Results: Cases were evenly distributed across five classes (Class 1–5, n=11–14). A strong correlation existed between difficulty scores and extraction type (Spearman’s rho = 0.833, p< 0.001), with Classes 1–2 exclusively non-surgical and Classes 4–5 entirely surgical. Procedure times increased from 7.27 ± 1.79 minutes (Class 1) to 38.27 ± 6.48 minutes (Class 5) (p < 0.001). Complications occurred in 12.1% of cases, with no significant class variation (p = 0.593). Conclusion: This RMB-based difficulty scale reliably predicts extraction complexity for distoangular and vertical mandibular third molars, enhancing preoperative planning.
KEY WORDS: Mandibular third molar, distoangular impaction, vertical impaction, retromolar bone, difficulty scale, oral surgery
REFERENCES
1. Renton T, Yilmaz Z, Ghaeminia H. Impacted third molars: assessment and surgical management. Br J Oral Maxillofac Surg. 2020;58(2):113-22. doi: 10.1016/j.bjoms.2019.10.317
2. Yilmaz Z, Renton T, Ghaeminia H. The influence of radiographic classification on surgical outcomes. Clin Oral Investig. 2019;23(9):3901-10. doi: 10.1007/s00784-019-02901-6
3. Winter GB. Principles of exodontia as applied to the impacted mandibular third molar. St Louis: American Dental Publishing Co.; 1926.
4. Pell GJ, Gregory BT. Impacted mandibular third molars: classification and modified technique for removal. Dent Dig. 1933;39:330-8.
5. Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res. 2013;4(2):e1. doi: 10.5037/jomr.2013.4201
6. Koerner KR, Johns ME. Radiographic evaluation of the impacted third molar. Oral Maxillofac Surg Clin North Am. 1994;6(3):369-81.
7. Susarla SM, Dodson TB. Risk factors for third molar extraction difficulty. J Oral Maxillofac Surg. 2004;62(11):1363-71. doi: 10.1016/j.joms.2004.05.214
8. Benediktsdóttir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(4):438-46. doi: 10.1016/j.tripleo.2003.10.018
9. Santamaria J, Arteagoitia I. Radiologic variables of clinical significance in the extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(5):469-73. doi: 10.1016/S1079-2104(97) 90259-6
10. Gbotolorun OM, Olojede AC, Arotiba GT, Ladeinde AL, Akinwande JA, Bamgbose BO. Impacted mandibular third molars: presentation and postoperative complications at the Lagos University Teaching Hospital. Niger Q J Hosp Med. 2008;18(4):211-4.
11. Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg. 2018;76(3):427-33. doi: 10.1016/j. joms.2017.07.160
12. Ghaeminia H, Perry J, Renton T. The role of preoperative assessment in predicting surgical complexity. Br Dent J. 2021;230(7):447-52. doi: 10.1038/s41415-021-2795-9
13. Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007;19(1):117-28. doi: 10.1016/j.coms.2006.11.004
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi
DOI: 10.54936/haoms262105112
SUMMARY: : Background: Accurate preoperative assessment of mandibular third molar extraction difficulty is essential for optimizing surgical outcomes, particularly for distoangular and vertical impactions. This study validates a novel five-class radiographic difficulty scale centered on retromolar bone (RMB) positioning. Methods: In a prospective study, 58 distoangular and vertical mandibular third molar extractions were performed by a single clinician at the Faculty of Dentistry, Jamia Millia Islamia uses panoramic radiographs to assign difficulty scores. Extraction type (non-surgical vs. surgical), procedure time, and complications were recorded. Spearman’s correlation, ANOVA, and chi-square tests analyzed scale performance. Results: Cases were evenly distributed across five classes (Class 1–5, n=11–14). A strong correlation existed between difficulty scores and extraction type (Spearman’s rho = 0.833, p< 0.001), with Classes 1–2 exclusively non-surgical and Classes 4–5 entirely surgical. Procedure times increased from 7.27 ± 1.79 minutes (Class 1) to 38.27 ± 6.48 minutes (Class 5) (p < 0.001). Complications occurred in 12.1% of cases, with no significant class variation (p = 0.593). Conclusion: This RMB-based difficulty scale reliably predicts extraction complexity for distoangular and vertical mandibular third molars, enhancing preoperative planning.
KEY WORDS: Mandibular third molar, distoangular impaction, vertical impaction, retromolar bone, difficulty scale, oral surgery
REFERENCES
1. Renton T, Yilmaz Z, Ghaeminia H. Impacted third molars: assessment and surgical management. Br J Oral Maxillofac Surg. 2020;58(2):113-22. doi: 10.1016/j.bjoms.2019.10.317
2. Yilmaz Z, Renton T, Ghaeminia H. The influence of radiographic classification on surgical outcomes. Clin Oral Investig. 2019;23(9):3901-10. doi: 10.1007/s00784-019-02901-6
3. Winter GB. Principles of exodontia as applied to the impacted mandibular third molar. St Louis: American Dental Publishing Co.; 1926.
4. Pell GJ, Gregory BT. Impacted mandibular third molars: classification and modified technique for removal. Dent Dig. 1933;39:330-8.
5. Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res. 2013;4(2):e1. doi: 10.5037/jomr.2013.4201
6. Koerner KR, Johns ME. Radiographic evaluation of the impacted third molar. Oral Maxillofac Surg Clin North Am. 1994;6(3):369-81.
7. Susarla SM, Dodson TB. Risk factors for third molar extraction difficulty. J Oral Maxillofac Surg. 2004;62(11):1363-71. doi: 10.1016/j.joms.2004.05.214
8. Benediktsdóttir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(4):438-46. doi: 10.1016/j.tripleo.2003.10.018
9. Santamaria J, Arteagoitia I. Radiologic variables of clinical significance in the extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(5):469-73. doi: 10.1016/S1079-2104(97) 90259-6
10. Gbotolorun OM, Olojede AC, Arotiba GT, Ladeinde AL, Akinwande JA, Bamgbose BO. Impacted mandibular third molars: presentation and postoperative complications at the Lagos University Teaching Hospital. Niger Q J Hosp Med. 2008;18(4):211-4.
11. Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg. 2018;76(3):427-33. doi: 10.1016/j. joms.2017.07.160
12. Ghaeminia H, Perry J, Renton T. The role of preoperative assessment in predicting surgical complexity. Br Dent J. 2021;230(7):447-52. doi: 10.1038/s41415-021-2795-9
13. Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007;19(1):117-28. doi: 10.1016/j.coms.2006.11.004
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