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Review of Difficulty Indices for Removal of Impacted Third Molars and a New Classification of Difficulty Indices

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Abstract

Background

A number of efforts have been made to establish a reliable assessment model for the surgical removal of impacted third molars. Although many such models have been proposed, none is considered universally applicable, and controversy remains. The earlier attempts were based exclusively on radiographic variables, whereas recent evidence is associated with nonradiographic and demographic variables.

Purpose

This article aimed to prepare review of the relevant literature to summarize the important indices given till date, tabulating only new indices as old indices are mentioned in almost all text books, their merits and demerits and their specificity and sensitivity (if assessed in the literature). In addition to it, authors also aimed to introduce a new descriptive classification of all indices based on pre- and postoperative assessment and further classify based on clinical, radiographic and demographic factors, surgical technique and time. This article will be of academic and practical help for residents and clinicians.

Method

A literature search was conducted in Medline, PubMed, Google Scholar, Science Direct and Cochrane electronic database with keywords—impacted mandibular third molar, difficulty indices, validity of, sensitivity, specificity. No publication year limit was used. The abstracts of the articles were retrieved, reviewed and sorted based on the following inclusion and exclusion criteria. Articles which include a new index, validate difficulty index, compare two or more difficulty indices, specificity and sensitivity of particular index are included. Duplicate articles, articles on complication, flap design, drug study, radiographic relation of inferior alveolar nerve, suturing, classification, only assessing factor affecting difficulty of third molar surgery are not included.

Results

Total 39 (36 articles + 3 books) are included. A total of 20 individual indices were found in the literature; each has been described in brief in this review. These indices are also listed in chronological order with their specificity and sensitivity if accessed in the literature.

Conclusion

There is a definite need to derive and validate an user-friendly index that could be used for preoperative prediction of difficulty. To the best of our knowledge, this review including all indices till date and classification proposed is the first on this subject.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Govt. Dental College or RUHS College of Dental Sciences, H-1, Manak-Vallabh, Vinay Path, Kanti Chand Road, Banipark, Jaipur, 302016, India

    Sonal Priya Bhansali

  2. Department of Prosthodontics, Govt. Dental College, Jaipur, India

    Sumit Bhansali

  3. Jaipur Dental College, Jaipur, India

    Archit Tiwari

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  1. Sonal Priya Bhansali
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  2. Sumit Bhansali
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Correspondence to Sonal Priya Bhansali.

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Bhansali, S.P., Bhansali, S. & Tiwari, A. Review of Difficulty Indices for Removal of Impacted Third Molars and a New Classification of Difficulty Indices. J. Maxillofac. Oral Surg. 20, 167–179 (2021). https://doi.org/10.1007/s12663-020-01452-6

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  • DOI: https://doi.org/10.1007/s12663-020-01452-6

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