Abstract

The records of 350 patients with 379 extractions were examined to analyze possible relationships between postoperative complications following third molar extraction and parameters such as age, sex, position of the molar, surgical technique and postoperative care. Younger patients tend to suffer more often from complications. Surgery performed in female patients was also resulted in more complications after third molar extractions. There were more complications when the position of the third molar was more aberrant. (SMDJ, 1999;6:27-28.)

Introduction

A single impacted tooth is more common in the permanent dentition and the teeth usually involved are the mandible third molar and the maxillary cuspids. Impacted teeth are caused by an abnormal position of the tooth insufficient eruption force, abnormal tooth form, lack of arch space during eruption, and hereditary factor (1).

A discrepancy between tooth size and jaw size is probably the result of a combination of both genetic and environmental factors. The inheritance of large teeth in small jaws appears to be aggravated by a lack of maximal jaw growth due to a softened sophisticated diet, which requires minimal chewing (2). The dental arches must undergo considerable anteroposterior growth to accommodate all permanent molars because the mandible third molar tends to erupt relatively late and slowly, disturbances associated with its eruption and position, pericoronitis and impaction, easily arise in the second and third decades of life.

These disturbances and their prevention are the major reasons for early removal of the mandible third molar. The surgical removal of mandible third molar is generally followed by complaints from the patient about pain, trismus, and swelling. The duration of surgery and the incision, and the reflection of a mucoperiosted flat have been shown to affect the intensity and frequency of postoperative complains (3).

The first aim of this study was to determine the relation between age, sex and postoperative complications after third molar extractions. The second aim was to determine which complications were most frequent.

Methods

The records of all patients referred on March of 1996 to August of 1997 to the Department of Oral and Maxillofacial Surgery of Victoria Hospital, Seychelles, for surgical extraction of third molar were collected and studied. For each patients, the following variables were recorded for this study: age, sex, position of the molar (vertical, horizontal, mesioangular, distoangular or other), surgical technique (describe below), and postoperative complications (pain, swelling, trismus, bleeding,, disturbed wound healing, dry socket, abscess and paresthesia).

Prior to surgery, the patients was informed about the procedure and possible risks, such as nerve damage if a close relationship between the root of the mandible third molar and the mandible canal was detected on the radiograph.

Subsequently, local anaesthesia was applied. If the third molar could not be extracted with an elevator or forceps alone, on incision was made. The mucoperiosteal flap was reflected, and bone was removed with a fissure bur in a hand piece. If necessary, sectioning of crown and roots was performed with a fissure bur.

Bone removal and sectioning were performed under continuous irrigation with sterile saline solution at room temperature. The wound was carefully rinsed. The flap was repositioned and sutured with silk 3.0. All patients were given oral instructions about possible complications and advised to return if any occurred.

Results

A total of 379 third molar extractions on 350 patients were included in this study. There were 202 women (57.8%) and 148 men (42.2%) who had respectively 224 (59.1%) and 155 (40.9%). Distribution of extractions and rate of complications are shown in Tables 2 and Table 3. Highest complication rate was found in the younger age group with 82 complications on 223 extractions (53.9%).

Table 1. Extractions by sex and age
 

Age	Female  (N - %)	Male  (N - %)	Total  (N - %)	% of all extractions
15-24	131 (58.7)	92 (41.2)	233 (100)	58.8
25-34	78 (64.4)	43 (35.5)	121 (100)	31.9
35-44	11 (40.7)	16 (59.2)	27 (100)	7.1
44+	4 (50.0)	4 (50.0)	8 (100)	2.1
Total	224 (59.1)	155 (40.9)	379 (100)	100

 

Table 2. Complications by sex and age
 

Age	Female (N - %)	Male (N - %)	Total (N - %)	% of all complications
15-24	65 (79.2)	17 (20.7)	82 (100)	53.9
25-34	34 (64.2)	19 (35.8)	53 (100)	34.9
35-44	5 (38.4)	8 (61.5)	13 (100)	8.6
44+	1 (25.0)	3 (75.0)	4 (100)	2.6
Total	105 (68.1)	47 (30.9)	152 (100)	100

 

Position of extracted third molars were vertical in 200 (complications in 32.5%), mesioangular in 104 with (43.2%), distoangular in 15 (73.3%), horizontal in 48 (52%), and other in 12 (50%).

Pain and swelling accompanied almost all complications, and were reported on 139 patients out of the 152 patients who had complications. Other complications were found pain only in 4, swelling only in 9, trismus in 5 patients, delayed wound healing with opening of the socket in 3, excessive bleeding in 4, paresthesia in the lower lip occurred temporarily in 1.

Discussion

There was difference in post-operative complication between females 105, 69.1% and males 47, 30.9%. However Martin at. el (4) reported no significant differences between the sex. In our study younger patients appeared with more post-operative symptoms after removal of their molar than older patients. The same results was reported by Estrada Sarmientos (5). However in the analysis complication according to sex, male were the most affected in groups of age 35 to 44 years and 45 and more, I agree with Martin at..el (4) because they found in his study that older patients were more affected, this might be due to the different technique of tooth removal use on the patients on higher density of bone.

There was more complications when the positions of the third molar was more aberrant, because more bone had to be removed and in several extractions, sectioning of the crown or roots was also necessary. I agree with Van Gool and, Pedersen reported by Clauser (3) Who said that when tooth sectioning is necessary for difficult extraction, we need bigger incision and the reflection of a mucoperiosted flap, more time for duration of the procedure, that almost were associated with more pain and swelling.

Thee results suggest that younger patients have a higher risks of postoperative complications after removal of third molar. Female patients have more postoperative complications than male patients. Postoperative complications increase with the extent in abnormally positioned third molars.

References

1. Ishikawa’s Color Atlas of oral pathology. Ishiyaku Euroamerica, INC. St Louis - Tokyo, 1987.
2. Seward GR. An outline of oral surgery. Part one 2^nd Edition Oxford: Wright, 1996: 52 – 92.
3. Clauser C, Barone R. Effect of incision and flap reflection on post-operative pain after the removal of partially impacted mandibular third molars. Quintessence international 1994;12:845-849.
4. Martin PJ, de Boer MP. Complications after mandibular third molar extraction. Quintessence international 1995;11:779-784.
5. Estrada S M. Evaluacion postoperatoria de los terceros molares inferiores retenidos. Rev Cub Cir 1984;23:4.