Analysis of potential dynamic concealed factors in the difficulty of lower third molar extraction

BACKGROUND: The purpose of this study was to identify potential concealed variables associated with the difficulty of lower third molar (M3) extractions. MATERIAL AND METHODS: To address the research purpose, we implemented a prospective study and enrolled a sample of subjects presenting for M3 removal. Predictor variables were categorized into Group-I and Group-II, based on predetermined criteria. The primary outcome variable was the difficulty of extraction, measured as extraction time. Appropriate univariate and multivariate statistics were computed using ordinal logistic regression. RESULTS: The sample comprised of 1235 subjects with a mean age of 29.49 +/- 8.92 years in Group-I and 26.20 +/- 11.55 years in Group-II subjects. The mean operating time per M3 extraction was 21.24 +/- 12.80 and 20.24 +/- 12.50 minutes for Group-I and Group-II subjects respectively. Three linear parameters including B-M2 height (distance between imaginary point B on the inferior border of mandibular body, and M2), lingual cortical thickness, bone density and one angular parameter including Rc-Cs angle (angle between ramus curvature and curve of spee), in addition to patient’s age, profile type, facial type, cant of occlusal plane, and decreased overbite, were found to be statistically associated (P < or = 0.05) with extraction difficulty under regression models. CONCLUSIONS: In conclusion, our study indicates that the difficulty of lower M3 extractions is possibly governed by morphological and biomechanical factors with substantial influence of myofunctional factors. Practical Implications: Preoperative evaluation of dynamic concealed factors may not only help in envisaging the difficulty and planning of surgical approach but might also help in better time management in clinical practice. Key words:Third molar, impacted, extraction, mandibular, facial type.