Predictive Factors to Assess the Difficulty to Extract Retained Lower Third Molars
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Dec 29, 2020
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Abstract
Background: Third molar eruption occurs in a very limited space. Several difficulty scales have been used to determine the complexity when extracting retained molars, which are key for surgical planning and prediction. A scale including indicators such as quality of mucosa and bone, as well as shape and number of roots is introduced. Purpose: Evaluate the difficulty in extracting retained lower third molars, using the scale proposed by Romero-Ruiz, and thus estimate the presence of intraoperative complications and surgical time. Methods: An observational descriptive cross-sectional study was carried out, with a sample of 100 extractions of retained lower third molars in patients between 16 and 40 years of age. The following variables were evaluated: spatial relationship, depth, relationship with mandible ramus/space, integrity of bone and mucosa, roots, dental follicle, and surgical time. The data were summarized in absolute frequency tables and analyzed with Pearson's Chi2 test (p < 0.05). Results: 71 % of third molars were classified as “difficult” on the scale. There were significant differences in terms of surgical time-age (p = 0.002), presence of complications-location of the third molar (p = 0.015), presence of complications-follicle size (p = 0.022), difficulty-sex (p = 0.011 ), difficulty-age (p = 0.068). Conclusions: This scale can be used to plan extraction treatments for retained lower third molars to reduce surgical times and anticipate complications.
Keywords
cirugía bucal, cirugía oral, complicaciones intraoperatorias, diagnóstico bucal, diente retenido, escala de valoración de riesgo, folículo dental, odontología, planeación del tratamiento, tercer molar, tiempo quirúrgicocirurgia oral, complicações intraoperatórias, dente retido, diagnóstico oral, escala de avaliação de risco, folículo dentário, odontologia, planejamento de tratamento, tempo cirúrgico, terceiro molardental follicle, dentistry, intraoperative complications, impacted tooth, oral diagnostics, oral surgery, retained tooth, risk assessment scale, surgical time, third molar, treatment planning
References
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2. Vergara AD, Llinás HJ, Bustillo JM. Lower anterior third molar impact on dental crowding. A new approach. Int J Odontostomatol. 2017; 11(3): 327-332. http://doi.org/10.4067/S0718-381X2017000300327
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6. Santosh P. Impacted mandibular third molars: review of literature and a proposal of a combined clinical and radiological classification. Ann Med Health Sci Res. 2015 Aug; 5(4): 229-234. http://doi.org/10.4103/2141-9248.160177
7. Bachmann H, Cáceres R, Muñoz C, Uribe S. Complicaciones en cirugías de terceros molares entre los años 2007 y 2010, en un hospital urbano, Chile. Int J Odontostomat. 2014; 8(1): 107-112. http://doi.org/10.4067/S0718-381X2014000100014
8. Buesa JM. Implicaciones electromiográficas en la cirugía del tercer molar inferior (trabajo de grado). Madrid, España. Universidad Complutense de Madrid; 2015.
9. Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res. 2013 Apr-Jun; 4(2): 1-12. http://doi.org/10.5037/jomr.2013.4201
10. Yuasa H, Kawai T, Sugiura M. Classification of surgical difficulty in extracting impacted third molars. Br J Oral Maxillofac Surg. 2002; 40(1): 26-31. http://doi.org/10.1054/bjom.2001.0684
11. Burgos G, Morales E, Rodríguez O, Aragón J, Sánchez M. Evaluación de algunos factores predictivos de dificultad en la extracción de los terceros molares inferiores retenidos. Mediciego. 2017; 23(1): 8-15.
12. González-Barboza S, Simancas-Pereira Y. Clasificaciones Winter y Pell-Gregory predictoras del trismo postexodoncia de terceros molares inferiores incluidos. Rev Venez Invest Odontol IADR. 2017; 5(1): 57-75.
13. Mezzour M, El Harti K, El Wady W. Predicting third molar removal difficulty: radiological assessment. Acta Scientif Dental Sci. 2017 Nov; 1(6): 13-19.
14. Ribes N, Sanchis JC, Peñarrocha D, Sanchis JM. Importance of a preoperative radiographic scale for evaluating surgical difficulty of impacted mandibular third molar extraction. J Oral Sci Rehabil. 2017; 3(1): 52-59.
15. Hyam DM. The contemporary management of third molars. Aust Dent J. 2018; 63(1): 19-26. http://doi.org/10.1111/adj.12587
16. Koerner KR. The removal of impacted third molars-principles and procedures. Dent Clin North Am. 1994; 38(2): 255-278.
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19. Lozano-Coquinche M. Evaluación preoperatoria del grado de dificultad quirúrgica para la exodoncia del tercer molar mandibular incluido en pacientes atendidos en la clínica odontológica de la Facultad de Odontología UNAP (trabajo de grado). Iquitos, Perú: Universidad Nacional de la Amazonia Peruana; 2010.
20. Kautto A, Vehkalahti MM, Ventä I. Age of patient at the extraction of the third molar. Int J Oral Maxillofac Surg. 2018; 47(7): 947-951. http://doi.org/10.1016/j.ijom.2018.03.020
21. Winter GB. Principles of exodontia as applied to the impacted third molar: a complete treatise on the operative technic with clinical diagnoses and radiographic interpretations. St. Louis, MO: American Medical Book; 1926.
22. Ryalat S, Al-Ryalat SA, Kassob Z, Hassona Y, Al-Shayyab M. Impaction of lower third molars and their association with age: radiological perspectives. BMC Oral Health. 2018 Apr; 18(58): 1-5. http://doi.org/10.1186/s12903-018-0519-1
23. Peel GJ, Gregory GT. Impacted mandibular third molars: classification and modified technique for removal. Dental Digest. 1933 Sep; 39(9): 330-338.
24. Olguín-Martínez T, Amarillas-Escobar E. Morfología radicular de los terceros molares. Root canal morphology of third molars. Rev ADM. 2017; 74 (1): 17-24.
25. Villafuerte L. cambios histopatológicos de los folículos dentales en relación a los espacios pericoronarios y posición de los terceros molares no erupcionados, en el centro médico naval “CM ST”, en el año 2014-2015 (trabajo de grado) Lima, Perú. Universidad Mayor de San Marcos; 2015.
26. Yasser-Kharma M, Sakka S, Aws G, Tarakji B, Zakaria-Nassani M. Reliability of Pederson scale in surgical extraction of impacted lower third molars: proposal of new scale. J Oral Dis. 2014; (1): 1-4. http://doi.org/10.1155/2014/157523.
27. Al-Samman A. Evaluation of Kharma scale as a predictor of lower third molar extraction difficulty. Med Oral Patol Oral Cir Bucal. 2017 Nov; 22 (6): 796-799. http://doi.org/10.4317/medoral.22082.
28. Gu L, Zhu C, Chen K, Liu X, Tang Z. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat. 2018 Oct; 40(6): 609-614. http://doi.org/10.1007/s00276-017-1928-6.
29. Haghanifar S, Moudi E, Yaghoobi S, Bijani A, Ghasemi N. Evaluation of the anatomical relationship between the mandibular canal and roots of third molars using cone-beam computed tomography (CBCT). J Babol Univ Med. 2016 Mar; 18(3): 7-13.
30. De Toledo G, Peralta-Mamani M, De Fatima A, Fischer CM, Marques H, Fischer IR. Influence of cone beam computed tomography versus panoramic radiography on the surgical technique of third molar removal: a systematic review. Int J Oral Maxillofac Surg. 2019; 48: 1340-1347. http://doi.org/10.1016/j.ijom.2019.04.003
31. Alvira-González J, Figueiredo R, Valmaseda-Castellón E, Quesada-Gómez C, Gay-Escoda C. Predictive factors of difficulty in lower third molar extraction: A prospective cohort study. Med Oral Patol Oral Cir Bucal. 2017 Jan; 22 (1): 108-114. http://doi.org/10.4317/medoral.21348
32. Freire BB, Nascimento EHL, Vasconcelos KF, Freitas DQ, Haiter-Neto F. Radiologic assessment of mandibular third molars: an ex vivo comparative study of panoramic radiography, extraoral bitewing radiography, and cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 128(2): 166-175. http://doi.org/10.1016/j.oooo.2018.11.002
33. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009; 38: 964-971. http://doi.org/10.1016/j.ijom.2009.06.007
34. Neves FS, Souza TC, Almeida SM, Haiter-Neto F, Freitas DQ, Bóscolo FN. Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal. Dentomaxillofac Radiol. 2012 Oct; 41(7): 553-557.
35. Artola- Tapia M, Gutiérrez- Artola K, Reyes- Bellorín E. Efectividad del kin gingival como alternativa al uso de antimicrobianos en pacientes sometidos a cirugía de terceros molares en las clínicas UNAN-Managua, durante el segundo semestre 2015 (trabajo de grado). Managua, Nicaragua. Universidad Nacional Autónoma de Nicaragua; 2016.
36. Fernández- Sainz B. Estudio de la relación entre la dificultad quirúrgica en la exodoncia del tercer molar y las variables clínicas y séricas (trabajo de grado) Valencia, España. Universitat de Valencia; 2017.
37. Santhosh- Kumar MP, Aysha S. Angulations Of Impacted Mandibular Third Molar: A Radiographic Study in Saveetha Dental College. J. Pharm. Sci. & Res. 2015; 7(11): 981-983.
38. Ishwarkumar S, Pillay P, Degama BZ, Satyapal KS. An osteometric evaluation of the mandibular condyle in a black KwaZulu-Natal population. Int J Morphol. 2016; 34(3): 848-853.
39. Guzmán-Castillo G, Paltas-Miranda M, Benenaula- Bojorque J. Núñez-Barragán K, Simbaña-García D. Cicatrización de tejido óseo y gingival en cirugías de terceros molares inferiores. Estudio comparativo entre el uso de FIbrina rica en plaquetas versus cicatrización Fisiológica. Rev Odontol Mex. 2017; 21 (2): 114-120. http://doi.org/10.1016/j.rodmex.2017.05.007
40. Quinatoa C. Accidentes y complicaciones transquirúrgicos de terceros dermatológico Gonzalo González durante el período 2014 (trabajo de grado).Quito, Ecuador. Universidad Central del Ecuador; 2015.
2. Vergara AD, Llinás HJ, Bustillo JM. Lower anterior third molar impact on dental crowding. A new approach. Int J Odontostomatol. 2017; 11(3): 327-332. http://doi.org/10.4067/S0718-381X2017000300327
3. Vázquez DJ, Subiran BT, Osende NH, Estévez A, Vautier ME, Hecht P. Estudio comparativo de la relación de los terceros molares inferiores retenidos con el conducto dentario inferior en radiografías panorámicas. Rev Cient Odontol. 2016 Jul; 12(2): 14-18.
4. Shital P, Saloni M, Farzan S, Taksh S; Impacted mandibular third molars: a retrospective study of 1198 cases to assess indications for surgical removal, and correlation with age, sex and type of impaction—a single institutional experience. J Maxillofac Oral Surg. 2017 Jan-Mar; 16(1): 79-84. http://doi.org/10.1007/s12663-016-0929-z
5. Gay Escoda C, Peñarrocha M, Sanchéz MA, Figueiredo R, Romero-Ruíz M Sanchéz- Torres A, Camps- Font O. Diagnóstico e indicaciones para la extracción de los terceros molares: extracción de los terceros molares. 1ª ed. España: Sociedad Española de Cirugía Bucal; 2018.
6. Santosh P. Impacted mandibular third molars: review of literature and a proposal of a combined clinical and radiological classification. Ann Med Health Sci Res. 2015 Aug; 5(4): 229-234. http://doi.org/10.4103/2141-9248.160177
7. Bachmann H, Cáceres R, Muñoz C, Uribe S. Complicaciones en cirugías de terceros molares entre los años 2007 y 2010, en un hospital urbano, Chile. Int J Odontostomat. 2014; 8(1): 107-112. http://doi.org/10.4067/S0718-381X2014000100014
8. Buesa JM. Implicaciones electromiográficas en la cirugía del tercer molar inferior (trabajo de grado). Madrid, España. Universidad Complutense de Madrid; 2015.
9. Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res. 2013 Apr-Jun; 4(2): 1-12. http://doi.org/10.5037/jomr.2013.4201
10. Yuasa H, Kawai T, Sugiura M. Classification of surgical difficulty in extracting impacted third molars. Br J Oral Maxillofac Surg. 2002; 40(1): 26-31. http://doi.org/10.1054/bjom.2001.0684
11. Burgos G, Morales E, Rodríguez O, Aragón J, Sánchez M. Evaluación de algunos factores predictivos de dificultad en la extracción de los terceros molares inferiores retenidos. Mediciego. 2017; 23(1): 8-15.
12. González-Barboza S, Simancas-Pereira Y. Clasificaciones Winter y Pell-Gregory predictoras del trismo postexodoncia de terceros molares inferiores incluidos. Rev Venez Invest Odontol IADR. 2017; 5(1): 57-75.
13. Mezzour M, El Harti K, El Wady W. Predicting third molar removal difficulty: radiological assessment. Acta Scientif Dental Sci. 2017 Nov; 1(6): 13-19.
14. Ribes N, Sanchis JC, Peñarrocha D, Sanchis JM. Importance of a preoperative radiographic scale for evaluating surgical difficulty of impacted mandibular third molar extraction. J Oral Sci Rehabil. 2017; 3(1): 52-59.
15. Hyam DM. The contemporary management of third molars. Aust Dent J. 2018; 63(1): 19-26. http://doi.org/10.1111/adj.12587
16. Koerner KR. The removal of impacted third molars-principles and procedures. Dent Clin North Am. 1994; 38(2): 255-278.
17. Romero M, Gutiérrez J, Torres D. El tercer Molar Incluido. 1ª. ed. Madrid, España: GSK; 2012.
18. Díaz-Encomendero C. Relación entre el grado de dificultad y el tiempo efectivo en la exodoncia de terceros molares inferiores (trabajo de grado). Trujillo, Perú: Universidad Privada Antenor Orrego; 2015.
19. Lozano-Coquinche M. Evaluación preoperatoria del grado de dificultad quirúrgica para la exodoncia del tercer molar mandibular incluido en pacientes atendidos en la clínica odontológica de la Facultad de Odontología UNAP (trabajo de grado). Iquitos, Perú: Universidad Nacional de la Amazonia Peruana; 2010.
20. Kautto A, Vehkalahti MM, Ventä I. Age of patient at the extraction of the third molar. Int J Oral Maxillofac Surg. 2018; 47(7): 947-951. http://doi.org/10.1016/j.ijom.2018.03.020
21. Winter GB. Principles of exodontia as applied to the impacted third molar: a complete treatise on the operative technic with clinical diagnoses and radiographic interpretations. St. Louis, MO: American Medical Book; 1926.
22. Ryalat S, Al-Ryalat SA, Kassob Z, Hassona Y, Al-Shayyab M. Impaction of lower third molars and their association with age: radiological perspectives. BMC Oral Health. 2018 Apr; 18(58): 1-5. http://doi.org/10.1186/s12903-018-0519-1
23. Peel GJ, Gregory GT. Impacted mandibular third molars: classification and modified technique for removal. Dental Digest. 1933 Sep; 39(9): 330-338.
24. Olguín-Martínez T, Amarillas-Escobar E. Morfología radicular de los terceros molares. Root canal morphology of third molars. Rev ADM. 2017; 74 (1): 17-24.
25. Villafuerte L. cambios histopatológicos de los folículos dentales en relación a los espacios pericoronarios y posición de los terceros molares no erupcionados, en el centro médico naval “CM ST”, en el año 2014-2015 (trabajo de grado) Lima, Perú. Universidad Mayor de San Marcos; 2015.
26. Yasser-Kharma M, Sakka S, Aws G, Tarakji B, Zakaria-Nassani M. Reliability of Pederson scale in surgical extraction of impacted lower third molars: proposal of new scale. J Oral Dis. 2014; (1): 1-4. http://doi.org/10.1155/2014/157523.
27. Al-Samman A. Evaluation of Kharma scale as a predictor of lower third molar extraction difficulty. Med Oral Patol Oral Cir Bucal. 2017 Nov; 22 (6): 796-799. http://doi.org/10.4317/medoral.22082.
28. Gu L, Zhu C, Chen K, Liu X, Tang Z. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat. 2018 Oct; 40(6): 609-614. http://doi.org/10.1007/s00276-017-1928-6.
29. Haghanifar S, Moudi E, Yaghoobi S, Bijani A, Ghasemi N. Evaluation of the anatomical relationship between the mandibular canal and roots of third molars using cone-beam computed tomography (CBCT). J Babol Univ Med. 2016 Mar; 18(3): 7-13.
30. De Toledo G, Peralta-Mamani M, De Fatima A, Fischer CM, Marques H, Fischer IR. Influence of cone beam computed tomography versus panoramic radiography on the surgical technique of third molar removal: a systematic review. Int J Oral Maxillofac Surg. 2019; 48: 1340-1347. http://doi.org/10.1016/j.ijom.2019.04.003
31. Alvira-González J, Figueiredo R, Valmaseda-Castellón E, Quesada-Gómez C, Gay-Escoda C. Predictive factors of difficulty in lower third molar extraction: A prospective cohort study. Med Oral Patol Oral Cir Bucal. 2017 Jan; 22 (1): 108-114. http://doi.org/10.4317/medoral.21348
32. Freire BB, Nascimento EHL, Vasconcelos KF, Freitas DQ, Haiter-Neto F. Radiologic assessment of mandibular third molars: an ex vivo comparative study of panoramic radiography, extraoral bitewing radiography, and cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 128(2): 166-175. http://doi.org/10.1016/j.oooo.2018.11.002
33. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009; 38: 964-971. http://doi.org/10.1016/j.ijom.2009.06.007
34. Neves FS, Souza TC, Almeida SM, Haiter-Neto F, Freitas DQ, Bóscolo FN. Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal. Dentomaxillofac Radiol. 2012 Oct; 41(7): 553-557.
35. Artola- Tapia M, Gutiérrez- Artola K, Reyes- Bellorín E. Efectividad del kin gingival como alternativa al uso de antimicrobianos en pacientes sometidos a cirugía de terceros molares en las clínicas UNAN-Managua, durante el segundo semestre 2015 (trabajo de grado). Managua, Nicaragua. Universidad Nacional Autónoma de Nicaragua; 2016.
36. Fernández- Sainz B. Estudio de la relación entre la dificultad quirúrgica en la exodoncia del tercer molar y las variables clínicas y séricas (trabajo de grado) Valencia, España. Universitat de Valencia; 2017.
37. Santhosh- Kumar MP, Aysha S. Angulations Of Impacted Mandibular Third Molar: A Radiographic Study in Saveetha Dental College. J. Pharm. Sci. & Res. 2015; 7(11): 981-983.
38. Ishwarkumar S, Pillay P, Degama BZ, Satyapal KS. An osteometric evaluation of the mandibular condyle in a black KwaZulu-Natal population. Int J Morphol. 2016; 34(3): 848-853.
39. Guzmán-Castillo G, Paltas-Miranda M, Benenaula- Bojorque J. Núñez-Barragán K, Simbaña-García D. Cicatrización de tejido óseo y gingival en cirugías de terceros molares inferiores. Estudio comparativo entre el uso de FIbrina rica en plaquetas versus cicatrización Fisiológica. Rev Odontol Mex. 2017; 21 (2): 114-120. http://doi.org/10.1016/j.rodmex.2017.05.007
40. Quinatoa C. Accidentes y complicaciones transquirúrgicos de terceros dermatológico Gonzalo González durante el período 2014 (trabajo de grado).Quito, Ecuador. Universidad Central del Ecuador; 2015.
How to Cite
Vargas Madrid, W. A., González Bustamante, A. M., & Zurita Minango, P. E. (2020). Predictive Factors to Assess the Difficulty to Extract Retained Lower Third Molars. Universitas Odontologica, 39. https://doi.org/10.11144/Javeriana.uo39.pfad
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