Relationships between surgical difficulty and postoperative pain in lower third molar extractions

Purpose: To investigate the influence of surgical difficulty on postoperative pain after extraction of mandibular third molars. Materials and Methods: A prospective study was performed of 139 patients who underwent a total of 157 mandibular third molar extractions. For evaluation of surgical difficulty, a 4-class scale was completed after surgery: I, extraction with forceps only; II, extraction requiring osteotomy; III, extraction requiring osteotomy and coronal section; IV, complex extraction (root section). The duration of surgery was also recorded. Postoperative pain was evaluated using a visual analog scale that each patient completed daily until day 6 postsurgery, at which time the sutures were removed. Results: A statistically significant relationship was observed between surgical difficulty (as rated on the scale) and postoperative pain. Longer interventions generally produced more pain. Conclusions: Pain after extraction of a mandibular third molar increases with increased surgical difficulty and duration of the intervention. (c) 2007 American Association of Oral and Maxillofacial Surgeons.