Assessment of Factors Associated With Surgical Difficulty During Removal of Impacted Maxillary Third Molars

Purpose: Estimating the difficulty of removing third molars is a common dilemma. However, the estimation of the difficulty associated with maxillary third molar surgery has not yet been defined. The aim of the present study was to determine the degree of difficulty and identify predictor variables associated with the occurrence of difficulty in the removal of impacted maxillary third molars. Materials and Methods: A prospective cohort study was carried out involving patients who underwent at least 1 surgical removal of an impacted maxillary third molar at the Oral and Maxillofacial Surgery Unit, University of Pernambuco (Pernambuco, Brazil). Predictor variables indicative of surgical difficulty were classified by their demographic, clinical, and radiographic aspects. Degree of surgical difficulty was categorized as low, moderate, or high based on the surgical technique used. Descriptive and bivariate statistics were computed. Results: In total, 106 patients fulfilled the eligibility criteria and 204 surgeries were performed. Patients' mean age was 22.8 +/- 2.2 years and the proportion of women to men was 3: 1. Approximately 20% of patients were overweight. Surgical difficulty was generally low and 5 variables were significantly associated with the occurrence of a high degree of surgical difficulty. Conclusion: Surgical difficulty during the removal of impacted maxillary third molars is generally low. However, for cases with a high degree of difficulty, identification of predictor variables may be useful for students and inexperienced clinicians to consider the decision not to execute the procedure, thus avoiding complications that often require complex management. (C) 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71:839-845, 2013