Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(5) > 1032487

Hong, Lim, Kim, Kim, Oh, Lee, and Min: Effect on complications associated with its position and angulation following mandibular third molar extraction

Abstract

Introduction

Mandibular third molar extraction is one of the most common procedures performed in oral and maxillofacial surgery units. Although the overall complication rate is low with most complications being minor, mandibular third molar removal is so common that the population morbidity of complications might be significant1,2. Therefore, efforts to limit intraoperative or postoperative complications might have a significant impact in terms of enhancing the patient outcome. The aims of this study were to identify the position and angulation associated complications after mandibular third molar extractions.

Materials and Methods

This study surveyed 568 patients who had a mandibular third molar extracted, showed clinical complications and underwent a radiographic measurement of the available space, depth and spatial relationship.

Results

The results obtained were as follows: 1. The complications were a dry socket, nerve injury, root rest, infection, bleeding, hamatoma, and adjacent teeth injury. 2. There were no significant differences between the complication and ramus relationship (available space) of the mandibular third molar. 3. There were no significant differences between the complications and depth of the mandibular third molar. 4. There were no significant differences between the complications and spatial relationship of the mandibular third molar.

Conclusion

There were no significant differences in the complication rate, ramus relationship, depth and spatial relationship of the mandibular third molar. This suggests that the position and angulation of the mandibular third molar may not have an impact on the complications. The relationship between the position and angulation of the mandibular third molar, and complications deserves a further study using longitudinal data.

References

1. Lopes V, Mumenya R, Feinmann C, Harris M. Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction. Br J Oral Maxillofac Surg. 1995; 33(1):33–5.
crossref
2. Berge TI, B � e OE. Predictor evaluation of postoperative morbidity after surgical removal of mandibular third molars. Acta Odontol Scand. 1994; 52:162–9.
crossref
3. Calhoun NR. Dry socket and other postoperative complications. Dent Clin North Am. 1971; 15:337–48.
4. Muhonen A, Venta ¨ I, Ylipaavalniemi P. Factors predisposing to postoperative complications related to wisdom tooth surgery among university students. J Am Coll Health. 1997; 46:39–42.
crossref
5. Osborn TP, Frederickson G Jr, Small IA, Torqerson TS. A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg. 1985; 43:767–9.
crossref
6. Capuzzi P, Montebugnoli L, Vaccaro MA. Extraction of impacted third molars. A longitudinal prospective study on facters that affect postoperative recovery. Oral Surg Oral Med Oral Pathol. 1994; 77:341–3.
7. Dodson TB. HIV status and the risk of post-extraction complications. J Dent Res. 1997; 76:1644–52.
crossref
8. Sisk AL, Hammer WB, Shelton DW, Joy ED J. Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg. 1986; 44:855–9.
crossref
9. Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg. 2001; 59:1012–7. discussion 1017.
crossref
10. Chiapasco M, De Cicco L, Marrone G. Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol. 1993; 76:412–20.
crossref
11. Renton T, Smeeton N, McGurk M. Factors predictive of difficulty of mandibular third molar surgery. Br Dent J. 2001; 190:607–10.
crossref
12. Monaco G, Staffolani C, Gatto MR, Checchi L. Antibiotic therapy in impacted third molar surgery. Eur J Oral Sci. 1999; 107:437–41.
crossref
13. Brann CR, Brickley MR, Shepherd JP. Factors influencing nerve damage during lower third molar surgery. Br Dent J. 1999; 186:514–6.
crossref
14. Edwards DJ, Horton J, Shepherd JP, Brickley MR. Impact of third molar removal on demands for postoperative care and job disruption: does anaesthetic choice make a difference? Ann R Coll Surg Engl. 1999; 81:119–23.
15. Pell GJ, Gregory BT. Impacted mandibular third molars: classification and modified techniques for removal. Dent Dig. 1933; 39:330.
16. Winter GB. Principles of Exodontia as Applied to the Impacted Mandibular Third Molar: A Complete Treatise on the Operative Technic With Clinical Diagnoses and Radiographic Interpretations. St. Louis: American Medical Book Co.;1926.
17. Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990; 28:20–5.
crossref
18. Holland IS, Stassen LF. Bilateral block: is it safe and more efficient during removal of third molars? Br J Oral Maxillofac Surg. 1996; 34:243–7.
crossref
19. Heasman PA, Jacobs DJ. A clinical investigation into the incidence of dry socket. Br J Oral Maxillofac Surg. 1984; 22:115–22.
crossref
20. Larsen PE. Alveolar osteitis after surgical removal of impacted mandibular third molars: Identification of the patient at risk. Oral Surg Oral Med Oral Pathol. 1992; 73:393–7.
21. Fridrich KL, Olson RA. Alveolar osteitis following surgical removal of mandibular third molars. Anesth Prog. 1990; 37:32–41.
22. Yuasa H, Kawai T, Sugiura M. Classification of surgical difficulty in extracting impacted third molars. Br J Oral Maxillofac Surg. 2002; 40:26–31.
crossref
23. Chye EP, Young IG, Osborne GA, Rudkin GE. Outcomes after same day oral surgery: A review of 1,180 cases at a major teaching hospital. J Oral Maxillofac Surg. 1993; 51:846–9.
24. Kipp DP, Goldstein BH, Weiss WW jr. Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures. J Am Dent Assoc. 1980; 100:185–92.
crossref
25. de Boer MP, Raghoebar GM, Stegenga B, Schoen PJ, Boering G. Complications after mandibular third molar extraction. Quintessence Int. 1995; 26:779–84.
26. Black CG. Sensory impairment following lower third molar surgery: a prospective study in New Zealand. N Z Dent J. 1997; 93:68–71.
27. Goldberg MH, Nemarich AN, Marco WP 2nd. Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in private practice. J Am Dent Assoc. 1985; 111:277–9.
crossref
28. Alling CC 3rd. Dysesthesia of the lingual and inferior alveolar nerves following third molar surgery. J Oral Maxillofac Surg. 1986; 44:454–7.
crossref
29. Mason DA. Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg. 1988; 17:290–4.
crossref
30. Smith AC, Barry SE, Chiong AY, Hadzakis D, Kha SL, Mok SC, et al. Inferior alveolar nerve damage following removal of mandibular third molar teeth: A prospective study using panoramic radiography. Aust Dent J. 1997; 42:149–52.
31. Blackburn CW, Bramley PA. Lingual nerve damage associated with the removal of lower third molars. Br Dent J. 1989; 167:103–7.
crossref
32. Wofforrd DT, Miller RI. Prospective study of dysesthesia following odontectomy of impacted mandibular third molars. J Oral Maxillofac Surg. 1987; 45:15–9.
33. Sweet JB, Butler DP. The relationship of smoking to localized osteitis. J Oral Surg. 1979; 37:732–5.
34. Bruce RA, Frederickson GC, Small GS. Age of patients and morbidity associated with mandibular third molar surgery. J Am Dent Assoc. 1980; 101:240–5.
35. Raut A, Huryn JM, Hwang FR, Zlotolow IM. Sequelae and complications related to dental extractions in patients with hematologic malignancies and the impact on medical outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92:49–55.
crossref
36. Catellani JE, Harvey S, Erickson SH, Cherkin D. Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis). J Am Dent Assoc. 1980; 101:777–80.
crossref
37. Cohen ME, Simecek JW. Effects of gender-related factors on the incidence of localized alveolar osteitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 79:416–22.
crossref
38. Meechan JG, Macgregor ID, Rogers SN, Hobson RS, Bate JP, Dennison M, et al. The effect of smoking on immediate post-extraction socket filling with blood and on the incidence of painful socket. Br J Oral Maxillofac Surg. 1988; 26:402–9.
crossref
39. Sweet JB, Butler DP. Effect of smoking on the incidence of localized osteitis following mandibular third molar surgery. Quintessence Int Dent Dig. 1978; 9:9–10.
40. MacGregor AJ. Aetiology of dry socket: a clinical investigation. Br J Oral Surg. 1968; 6:49–58.
crossref
41. Edwards DJ, Brickley MR, Horton J, Edwards MJ, Shepherd JP. Choice of anaesthetic and healthcare facility for third molar surgery. Br J Oral Maxillofac Surg. 1998; 36:333–40.
crossref

Fig. 1.
Space available in mandibular third molar between mandibular second molar and mandibular ramus. A: Sufficient space, B: Reduced space, C: No space. Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-349f1.tif
Fig. 2.
Depth in mandibular third molar. A: High occlusal level, B: Medium occlusal level, C: Deep occlusal level. Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-349f2.tif
Fig. 3.
Spatial relationship of mandibular third molar with mandibular second molar axes. Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-349f3.tif
Table 1.
Sex and age distribution
Age Sex Male (%) Female (%) Total (%)
10–19   73 (12.9) 58 (10.2) 131 (23.1)
20–29   136 (23.9) 159 (28.0) 295 (51.9)
30–39   45 (7.9) 34 (6.0) 79 (13.9)
40–49   24 (4.2) 20 (3.5) 44 (7.7)
50<   15 (2.6) 4 (0.7) 19 (3.3)
Total   283 (49.8) 275 (50.2) 568 (100)

Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

Table 2.
Distribution of complications in mandibular third molar extraction
Complication Total (%)
Dry socket 5 (0.84)
Nerve injury 4 (0.67)
Root rest 2 (0.34)
Infection 2 (0.34)
Bleeding 1 (0.17)
Hematoma 1 (0.17)
Adjacent tooth injury 1 (0.17)
Total 16 (2.69)

Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

Table 3.
Distribution of complications rate in ramus and mandibular second molar relationship in mandibular third molar
Space Total (%) Complication (%)
Class I 216 (36.4) 2 (0.3)
Class II 281 (47.4) 10 (1.7)
Class III 96 (16.2) 4 (0.7)
Total 593 (100) 16 (2.7)
*: P<0.05    

Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011a

Table 4.
Depth in mandibular third molar
Depth Total (%) Complication (%)
Level I 270 (45.5) 7 (1.2)
Level II 253 (42.7) 7 (1.2)
Level III 70 (11.8) 2 (0.3)
Total 593 (100) 16 (2.7)

*: P<0.05

Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

Table 5.
Spatial relationship in mandibular third molar
Spatial Total (%) Complication (%)
Inversion 2 (0.3) 0 (0)
Vertical 185 (31.2) 3 (0.5)
Horizontal 231 (39.0) 8 (1.3)
Mesioangular 150 (25.3) 4 (0.7)
Distoangular 25 (4.2) 1 (0.2)
Total 593 (100) 16 (2.7)

*: P<0.05

Sun-Pyo Hong et al: Effect on complications associated with its position and angulation following mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

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