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Risk factor analysis for perioperative complications in impacted third molar surgery – a single center experience

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Abstract

Background

The surgical removal of impacted third molars is usually carried out by an oral/maxillofacial surgeon. Two specific risks of surgical removal of impacted third molars are oroantral communication (OAC) when extracting ​​upper third molars and hypesthesia of the inferior alveolar nerve (IAN) ​​when extracting lower third molars. The aim of this study is to determine the distribution of complications in deeply impacted third molar surgery, to identify specific risk factors influencing the most common perioperative (OAC, IAN hypesthesia) and to compare these results with other studies.

Materials and methods

The clinical findings, digital panoramic radiographs, intra- and postoperative data of 80 patients with a total of 232 impacted third molars that had been subjected for tooth extraction, from December 2022 and August 2023, were collected and analyzed. Perioperative complications (IAN hypesthesia, OAC, hypesthesia lingual nerve, postoperative bleeding, postoperative infection) were identified. A risk analysis for OAC and IAN hypesthesia was performed regarding perioperative data.

Results

Overall, the rate of OAC for the right upper third molar was 12.8% and for the left upper third molar 15.6%. The complication rates regarding transient hypesthesia were 8.1% for the left IAN and 7.3% for the right IAN. The distance to maxillary sinus, the depth score according to Pell and Gregory, the bone coverage score, the operation time, the tooth's angulation and the type of surgeon (oral surgeon, DMD) were identified as significant risk factors for the occurrence of OAC. The minimum distance to IAN, the bone coverage score, the total operation time and the operation by an oral surgeon (DMD) were identified as significant risk factors for hypesthesia of the IAN.

Conclusion

Next to the risk factors from above, the present study is one of the first showing that patients who were primarily operated on by an oral surgeon (DMD) and not a maxillofacial surgeon (MD, DMD) showed higher rates of OAC and IAN hypesthesia in impacted third molar extraction. The results of this study can serve as a baseline for further studies to investigate complication patterns in impacted third molar surgery.

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Data availability

No datasets were generated or analysed during the current study.

References

  1. Shaari RB, AwangNawi MA, Khaleel AK, AlRifai AS (2023) Prevalence and pattern of third molars impaction: a retrospective radiographic study. J Adv Pharm Technol Res 14(1):46–50. https://doi.org/10.4103/japtr.japtr_489_22

    Article  PubMed  PubMed Central  Google Scholar 

  2. Al-Anqudi SM, Al-Sudairy S, Al-Hosni A, Al-Maniri A (2014) Prevalence and pattern of third molar impaction: a retrospective study of radiographs in Oman. Sultan Qaboos Univ Med J 14(3):388–392

    Google Scholar 

  3. Ercal P, Taysi AE (2020) Third molar agenesis: prevalence and association with agenesis of other teeth in a Turkish population. Niger J Clin Pract 23(3):392–397. https://doi.org/10.4103/njcp.njcp_520_19

    Article  CAS  PubMed  Google Scholar 

  4. Santosh P (2015) Impacted mandibular third molars: review of literature and a proposal of a combined clinical and radiological classification. Ann Med Health Sci Res 5(4):229–234. https://doi.org/10.4103/2141-9248.160177

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. German Society of Cranio-, Maxillofacial Surgery, S2k-Leitlinie (Langversion), Operative Entfernung von Weisheitszaḧ nen, AWMF-No. 007–003, 2019. https://register.awmf.org/assets/guidelines/007003l_S2k_Weisheitszahnentfernung_2019-08.pdf, Date: 09.11.2023

  6. Passi D, Singh G, Dutta S, Srivastava D, Chandra L, Mishra S, Srivastava A, Dubey M (2019) Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: a retrospective study. Natl J Maxillofac Surg 10(1):59–67. https://doi.org/10.4103/njms.NJMS_70_17

    Article  PubMed  PubMed Central  Google Scholar 

  7. Scherstén E, Lysell L, Rohlin M (1989) Prevalence of impacted third molars in dental students. Swed Dent J 13(1–2):7–13

    PubMed  Google Scholar 

  8. Candotto V, Oberti L, Gabrione F, Scarano A, Rossi D, Romano M (2019) Complication in third molar extractions. J Biol Regul Homeost Agents 33(3 Suppl. 1):169–172 (DENTAL SUPPLEMENT)

    CAS  PubMed  Google Scholar 

  9. Rothamel D, Wahl G, d’Hoedt B, Nentwig GH, Schwarz F, Becker J (2007) Incidence and predictive factors for perforation of the maxillary antrum in operations to remove upper wisdom teeth: prospective multicentre study. Br J Oral Maxillofac Surg 45(5):387–391. https://doi.org/10.1016/j.bjoms.2006.10.013

    Article  PubMed  Google Scholar 

  10. del Rey-Santamaría M, ValmasedaCastellón E, BeriniAytés L, Gay EC (2006) Incidence of oral sinus communications in 389 upper thirmolar extraction. Med Oral Patol Oral Cir Bucal 11(4):E334–E338

    PubMed  Google Scholar 

  11. Sarikov R, Juodzbalys G (2014) Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. J Oral Maxillofac Res 5(4):e1. https://doi.org/10.5037/jomr.2014.5401

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bataineh AB (2001) Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg 59(9):1012–1017. https://doi.org/10.1053/joms.2001.25827

    Article  CAS  PubMed  Google Scholar 

  13. AlSheef M, Gray J, AlShammari A (2021) Risk of postoperative bleeding following dental extractions in patients on antithrombotic treatment. Saudi Dent J 33(7):511–517. https://doi.org/10.1016/j.sdentj.2020.09.005

    Article  PubMed  Google Scholar 

  14. Al-Asfour A (2009) Postoperative infection after surgical removal of impacted mandibular third molars: an analysis of 110 consecutive procedures. Med Princ Pract 18(1):48–52. https://doi.org/10.1159/000163046

    Article  PubMed  Google Scholar 

  15. Farhadi F, Emamverdizadeh P, Hadilou M, Jalali P (2022) Evaluation of infection and effective factors in impacted mandibular third molar surgeries: a cross-sectional study. Int J Dent 2022:8934184. https://doi.org/10.1155/2022/8934184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Akadiri OA, Fasola AO, Arotiba JT (2009) Evaluation of Pederson index as an instrument for predicting difficulty of third molar surgical extraction. Niger Postgrad Med J 16(2):105–108

    Article  CAS  PubMed  Google Scholar 

  17. KalaiSelvan S, Ganesh SKN, Natesh P, Moorthy MS, Niazi TM, Babu SS (2020) Prevalence and pattern of impacted mandibular third molar: an institution-based retrospective study. J Pharm Bioallied Sci 12(Suppl 1):S462–S467. https://doi.org/10.4103/jpbs.JPBS_140_20

    Article  PubMed  PubMed Central  Google Scholar 

  18. Akashi M, Hiraoka Y, Hasegawa T, Komori T (2016) Temporal evaluation of neurosensory complications after mandibular third molar extraction: current problems for diagnosis and treatment. Open Dent J 10:728–732. https://doi.org/10.2174/1874210601610010728

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sukegawa S, Yokota K, Kanno T, Manabe Y, Sukegawa-Takahashi Y, Masui M, Furuki Y (2019) What are the risk factors for postoperative infections of third molar extraction surgery: a retrospective clinical study? Med Oral Patol Oral Cir Bucal 24(1):e123–e129. https://doi.org/10.4317/medoral.22556

    Article  CAS  PubMed  Google Scholar 

  20. Miclotte I, Agbaje JO, Spaey Y, Legrand P, Politis C (2018) Incidence and treatment of complications in patients who had third molars or other teeth extracted. Br J Oral Maxillofac Surg 56(5):388–393. https://doi.org/10.1016/j.bjoms.2018.02.001

    Article  CAS  PubMed  Google Scholar 

  21. Handelman SL, Black PM, Desjardins P, Gatlin L, Simmons L (1993) Removal of impacted third molars by oral/maxillofacial surgery and general dentistry residents. Spec Care Dentist 13(3):122–126. https://doi.org/10.1111/j.1754-4505.1993.tb01633.x

    Article  CAS  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Lesserstraße 180, 22049, Hamburg, Germany

    Florian Dudde, Filip Barbarewicz & Kai-Olaf Henkel

Authors
  1. Florian Dudde
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  2. Filip Barbarewicz
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  3. Kai-Olaf Henkel
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Contributions

KOH, FB and FD treated the patients and revised the article. FD and FB researched the scientific literature, provided statistical findings/analysis and wrote the article. All Authors gave final approval for publication.

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Correspondence to Florian Dudde.

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Ethics approval and consent to participate

This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was waived by the clinical Ethics Committee of the Army Hospital/ German army research committee (IRB). All the procedures/diagnostics being performed were part of the routine care. Informed consent was waived by the clinical ethical board due to the retrospective nature of the study.

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All authors gave final approval for publication.

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Dudde, F., Barbarewicz, F. & Henkel, KO. Risk factor analysis for perioperative complications in impacted third molar surgery – a single center experience. Oral Maxillofac Surg (2024). https://doi.org/10.1007/s10006-024-01232-3

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