Comparative assessment of difficulty scales for removal of the third molar of the lower jaw depending on its position
DOI:
https://doi.org/10.26641/2307-0404.2024.2.307467Keywords:
impacted third molar, impaction, atypical removal, complicationsAbstract
Retention (delayed eruption) of the third molar is one of the most common pathologies in the outpatient practice of a dentist-surgeon. Such a pathology can very often be complicated by inflammatory diseases, such as pericoronitis, periostitis and other more serious diseases. Therefore, early warning and most gentle removal of the causative tooth determines the professionalism of the dental surgeon. A large number of indexes of difficulty of removal of the third molar have been proposed by different authors, but none of them is considered universal and optimal for different clinical cases. The level of complexity is most clearly characterized by a scale that takes into account not only radiological but also clinical and demographic indicators. Such scales exist in modification or in more recent literary sources. Having chosen the most clear and correct scale, it is possible for the surgeon to clearly assess the entire level of complexity and responsibility for surgical intervention on removing the third molar, thereby obtaining the most effective result, minimizing complications both during the operation and after a while. The purpose of the study: justification of the selection of the difficulty rating scale for the removal of the third molar of the lower jaw, depending on its position. The study analyzed and compared 18 basic scales of complexity that are most often used by surgeons before removing the impacted third molar of the lower jaw. Data sources that were used for the search were taken from Medline, PubMed, Google Scholar, Minerva library databases. Each of the difficulty scales was presented and translated into Ukrainian for convenient use in the practice of a dental surgeon. A general table was provided where a comparative analysis of the difficulty scales was made according to thirty parameters. It is shown that the Cosme Gay-Escoda C. scale has the most indicators for preoperative assessment of complexity. There are many difficulty scales for preoperative assessment for the removal of impacted third molars of the lower jaw. Some of them have radiological evaluation criteria, some have clinical criteria, and only the Pernumbuco index (2017), Zhang X. (2019), and Cosme Gay-Escoda C. (2022) scales also have demographic indicators. However, the latter has the largest number of criteria, according to which the difficulty of removing the third molar of the lower jaw is calculated.
References
Ahmed HA, López-López J, Egido-Moreno S, Llabrés XR, Hameed M, Estrugo-Devesa A. Mandibular Third Molar Impaction and Bone Change Distal to the Second Molar: A Panoramic Radiographic Study. J Clin Med. 2024 Feb 4;13(3):906. doi: https://doi.org/10.3390/jcm13030906
Al-Haj Husain A, Stadlinger B, Winklhofer S, Müller M, Piccirelli M, Valdec S. Mandibular Third Molar Surgery: Intraosseous Localization of the Inferior Alveolar Nerve Using 3D Double-Echo Steady-State MRI (3D-DESS). Diagnostics (Basel). 2021;11(7):1245. doi: https://doi.org/10.3390/diagnostics11071245
Tkachenko PI, Pankevych AI, Kolisnyk IA, Hohol AM, Rezvina KIu. [Atypical removal of lower third molars in the complex treatment of tooth crowding]. Aktualni problemy suchasnoi medytsyny: Visnyk ukrainskoi medychnoi stomatolohichnoi akademii. 2020;3(71):81-86. doi: https://doi.org/10.31718/2077-1096.20.3.81
Nekhanevych Zh. Osteogenesis characteristics in the bone loss zone after the impacted mandibular third molar abnormal extraction. Journal of Education, Health and Sport. Online. 2021;11(4):37-44. doi: https://doi.org/10.12775/JEHS.2021.11.04.004
Dudde F, Barbarewicz F, Henkel KO. Risk factor analysis for perioperative complications in impacted third molar surgery – a single center experience. Oral Maxil-lofac Surg. 2024 Mar 1. Epub ahead of print. Ukrainian. doi: https://doi.org/10.1007/s10006-024-01232-3
Valls-Ontañón A, Kesmez Ö, Starch-Jensen T, Triginer-Roig S, Neagu-Vladut D, Hernández-Alfaro F. Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing. Oral Maxillofac Surg. 2024 Mar;28(1):345-53. doi: https://doi.org/10.1007/s10006-023-01148-4
Albanese M, Zangani A, Manfrin F, Bertossi D, De Manzoni R, Tomizioli N, et al. Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study. Dent J (Basel). 2023 Oct 17;11(10):238. doi: https://doi.org/10.3390/dj11100238
Karpe T, Sanober A, Nasyam FA, Soumya S, Seethamsetty S, Sarepally G. To Study the Impact of Tooth Sectioning on Postoperative Pain, Swelling and Trismus After Surgical Extraction of Impacted Mandi-bular Third Molars. Cureus. 2023 Dec 28;15(12):e51207. doi: https://doi.org/10.7759/cureus.51207
Gay-Escoda C, Sánchez-Torres A, Borrás-Fer-reres J, Valmaseda-Castellón E. Third molar surgical difficulty scales: systematic review and preoperative assessment form. Med Oral Patol Oral Cir Bucal. 2022;27(1):e68-e76. doi: https://doi.org/10.4317/medoral.24951
Bhansali SP, 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. 2021;20(2):167-79. doi: https://doi.org/10.1007/s12663-020-01452-6
MacGregor AJ. The impacted lower wisdom tooth. Oxford University Press. New York; 1985. 206 р.
Winter GB. Principles of exodontia as applied to the impacted third molar. American Medical books. St Louis; 1926. 835 р.
Pell GJ, Gregory GT. Impacted third molars: clas-sification and modified technique for removal. Dent Digest. 1933;39:330-8.
Pederson GW. The removal of impacted third molars – principles and procedures. Oral surgery. Dent Clin North Am. 1994;38:255-78. doi: https://doi.org/10.1016/S0011-8532(22)00199-9
Sánchez-Torres A, Soler-Capdevila J, Ustrell-Barral M, Gay-Escoda C. Patient, radiological, and operative factors associated with surgical difficulty in the extraction of third molars: a systematic review. Int J Oral Maxillofac Surg. 2020 May;49(5):655-65. doi: https://doi.org/10.1016/j.ijom.2019.10.009
Al-Haj Husain A, Valdec S, Stadlinger B, Rüc-ker M, Piccirelli M, Winklhofer S. Preoperative visuali-zation of the lingual nerve by 3D double-echo steady-state MRI in surgical third molar extraction treatment. Clin Oral Investig. 2022 Feb;26(2):2043-53. doi: https://doi.org/10.1007/s00784-021-04185-z
Adamska P, Adamski ŁJ, Musiał D, Tylek K. Panoramic radiograph – a useful tool to assess the difficulty in extraction of third molars. Eur J Transl Clin Med. 2020;3:44-52. doi: https://doi.org/10.31373/ejtcm/126928
Alvira-González J, Figueiredo R, Valmaseda-Castellón E, Quesada-Gómez C, Gay-Escoda C. Predic-tive factors of difficulty in lower third molar extraction: A prospective cohort study. Med Oral Patol Oral Cir Bucal. 2017 Jan 1;22(1):e108-e114. doi: https://doi.org/10.4317/medoral.21348
Khojastepour L, Khaghaninejad M, Hasansha-hi R, Forghani M, Ahrari F. Does the Winter or Pell and Gregory Classification System Indicate the Apical Position of Impacted Mandibular Third Molars? J Oral Maxillofac Surg. 2019;77(11):2222.e1-2222.e9. doi: https://doi.org/10.1016/j.joms.2019.06.004
Al-Samman AA, Sami GM, Abdullah RM, Majid OW. Evaluation of Recently Proposed Scales as Predictors of Mandibular Third Molar Extraction Dif-ficulty. J Dent Oral Sci. 2022;4(3):1-11. doi: https://doi.org/10.37191/Mapsci-2582-3736-4(3)-134
Yuasa H, Kawai T, Sugiura M. Classification of surgical difficulty in extracting impacted third molars. Br J Oral Maxillofac Surg. 2002 Feb;40(1):26-31. doi: https://doi.org/10.1054/bjom.2001.0684
Sánchez Jorge MI, Ocaña RA, Valle Rodríguez C, Peyró Fernández-Montes B, Rico-Romano C, Bazal-Bonelli S, et al. Mandibular third molar extraction: perceived surgical difficulty in relation to professional training. J BMC Oral Health. 2023 Jul 14;23(1):485. doi: https://doi.org/10.1186/s12903-023-03131-7
Jaroń A, Trybek G. The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difculty: A Retrospective Study of Radiographs in East Baltic Population. Int J Environ Res Public Health. 2021;18(11):6016. doi: https://doi.org/10.3390/ijerph18116016
Al-Haj Husain A, Stadlinger B, Winklhofer S, Bosshard FA, Schmidt V, Valdec S. Imaging in Third Molar Surgery: A Clinical Update. J Clin Med. 2023 Dec 14;12(24):7688. doi: https://doi.org/10.3390/jcm12247688
Gbotolorun OM, Arotiba GT, Ladeinde AL. Assessment of factors associated with surgical difficulty in impacted mandibular third molar extraction. J Oral Maxillofac Surg. 2007 Oct;65(10):1977-83. doi: https://doi.org/10.1016/j.joms.2006.11.030
Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res. 2013 Jul 1;4(2):e1. doi: https://doi.org/10.5037/jomr.2013.4201
Olczyk A, Malicka B, Skośkiewicz-Malinowska K. Retrospective study of the morphology of third maxillary molars among the population of Lower Silesia based on analysis of cone beam computed tomography. PloS One. 2024 Feb 23;19(2):e0299123. doi: https://doi.org/10.1371/journal.pone.0299123
Chen Z, Gu BX, Tang YF, Yan ZY, Ni FD, Cui NH. [Constructions of the scale of difficulty in the extraction of impacted mandibular third molars by using Delphi method]. Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Feb 18;54(1):100-4. Chinese. doi: https://doi.org/10.19723/j.issn.1671-167X.2022.01.016
Sekhar MR, Singh S, Valluri R. Correlation of Variables for WHARFE Assessment and Pederson Dif-ficulty Index for Impacted Mandibular Third Molar Surgery-A Prospective Clinical Study. J Maxillofac Oral Surg. 2021 Sep;20(3):502-6. doi: https://doi.org/10.1007/s12663-020-01362-7
Conti M, Valente A, Catelani M, Bertolai R. Assessment of difficulty in third impacted mandibular molar surgery: the Conti Scale. Minerva Stomatol. 2015 Aug;64(4):177-88. PMID: 25937579.
Pang SL, Yeung WKA, Hung KF, et al. Third Molar Coronectomy vs Total Removal in Second Molar Periodontal Healing. Int Dent J. 2024;74(2):246-52. doi: https://doi.org/10.1016/j.identj.2023.08.006
Ribes LainezN, Sanchis Gonza´lez JC, Pen˜arrocha Oltra D, Sanchis Bielsa JM. Importance of a preoperative radiographic scale for evaluating surgical difficulty of impacted mandibular third molar extraction. J Oral Science Rehabilitation. 2017;3(1):52-59.
Lejnieks M, Akota I, Jākobsone G, Neimane L, Radzins O, Uribe SE. Effect of 3D printed replicas on the duration of third molar autotransplantation surgery: A controlled clinical trial. Dent Traumatol. 2024;40(2):221-8. doi: https://doi.org/10.1111/edt.12905
Sammartino G, Gasparro R, Marenzi G, Tro-sino O, Mariniello M, Riccitiello F. Extraction of mandi-bular third molars: proposal of a new scale of difficulty. Br J Oral Maxillofac Surg. 2017;55(9):952-7. doi: https://doi.org/10.1016/j.bjoms.2017.09.012
Lindahl O, Ventä I. Level of difficulty of tooth extractions among roughly 100,000 procedures in primary care. Clin Oral Investig. 2023 Aug;27(8):4513-20. doi: https://doi.org/10.1007/s00784-023-05073-4
Di Lauro AE, Boariu M, Sammartino P, Scotto F, Gasparro R, et al. Lower third molar inclusion associated with paraesthesia: A case report. Exp Ther Med. 2021;22(2):826. doi: https://doi.org/10.3892/etm.2021.10258
de Carvalho RWF, Vasconcelos BC. Pernambuco index: predictability of the complexity of surgery for impacted lower third molars. Int J Oral Maxillofac Surg. 2018 Feb;47(2):234-40. doi: https://doi.org/10.1016/j.ijom.2017.07.013
Jing Q, Song H, Huang H, Shi Y, Cheng J, Wang D. Characterizations of three-dimensional root morphology and topological location of mandibular third molars by cone-beam computed tomography. Surg Radiol Anat. 2023 May;45(5):527-36. doi: https://doi.org/10.1007/s00276-023-03111-0
Kim JY, Yong HS, Park KH, Huh JK. Modified difficult index adding extremely difficult for fully impacted mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg. 2019 Dec;45(6):309-15. doi: https://doi.org/10.5125/jkaoms.2019.45.6.309
Zhao J, Zhang Y, Cheng Y, Xie S, Li DD, Zhang PF, et al. Effects of modified triangular flap for third molar extraction on distal periodontal health of second molar: A randomized controlled study. Heliyon. 2023 May 16;9(5):e16161. doi: https://doi.org/10.1016/j.heliyon.2023.e16161
Ku JK, Baik SH, Kim JY, Huh JK. Effect of a vertical incision on postoperative swelling after an impacted mandibular third molar extraction: two cases with split-mouth designed magnetic resonance imaging analysis. J Korean Assoc Oral Maxillofac Surg. 2023 Apr 30;49(2):91-5. doi: https://doi.org/10.5125/jkaoms.2023.49.2.91
Zhang X, Wang L, Gao Z, Li J, Shan Z. Develop-ment of a new index to assess the difficulty level of surgical removal of impacted mandibular third molars in an Asian population. J Oral Maxillofac Surg. 2019;77(7):1358.e1-1358.e8.
Miron MI, Florea CT, Lungeanu D, Todea CD. Diagnostic Aspects of an Included Third Molar in an 88-Year-Old Patient: A Case Report and Literature Review. Diagnostics (Basel). 2022;12(9):2082. doi: https://doi.org/10.3390/diagnostics12092082
44.Penarrocha M, Sanchis J, Saez U, Gay E, Bagan J. Escala numerica de valoracion de la dificultad quirurgica en la extraccion de 190 terceros molars mandibulares incluidos. Arch Odontoestomatol. 2000Jan.1;16(2):96-100.
Penarrocha M, Boronat A, Carrillo C, Albalat S. Computer-guided implant placement in a patient with severe atrophy. J Oral Implantol. 2008;34(4):203-7. doi: https://doi.org/10.1563/1548-1336(2008)34[203:CIPIAP].2.0.CO;2
Gay-Escoda C, Sánchez-Torres A, Borrás-Fer-reres J, Valmaseda-Castellón E. Third molar surgical difculty scales: systematic review and preopera tive assessment form. Med Oral Patol Oral Cir Bucal. 2022;27(1):e68-76.
AAE Endodontic Case Difficulty Assessment Form and Guidelineshttps [Internet]. [cited 2024 Apr 07]. Available from: http//www.aae.org/specialty/wp-content/uploads/sites/2/2022/01/CaseDifficultyAssessmentFormFINAL2022.pdf
Sánchez-Jorge MI, Cortés-Bretón-Brinkmann J, Acevedo-Ocaña R, Quispe-López N, Falahat F, Martín-Granizo R. Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualification in oral surgery and maxillofacial surgeons in a Spanish subpopulation. Med Oral Patol Oral Cir Bucal. 2024 Mar 1;29(2):e263-e272. doi: https://doi.org/10.4317/medoral.26243
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Medicni perspektivi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.
