Risk factors for complications from challenging lower third molar extractions in tertiary hospital patients

Author(s): Sanna J. Koskela , DDS ^a ^, ^b ^, , Irja Ventä , DDS, PhD ^a , Johanna Snäll , DDS, MD, PhD ^a ^, ^b , Hanna Välimaa , DDS, MD, PhD ^a ^, ^b ^, ^c , Miika Toivari , DDS, MD, PhD ^a ^, ^b

Publication date (Electronic): 18 December 2024

Journal: Acta Odontologica Scandinavica

Publisher: MJS Publishing on behalf of Acta Odontologica Scandinavica Society

Keywords: Complications, tooth extraction, risk factors, third molar, tertiary health care

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Abstract

Objective

Third molar extraction is a common procedure with occasional complications. This study aimed to determine the incidence and types of complications in challenging lower third molar extractions and to identify complication risk factors in tertiary hospital patients.

Material and methods

A retrospective cohort study was conducted on 354 patients who underwent unilateral lower third molar extraction during a 2-year period in 2018–2019 at Helsinki University Hospital. The outcome was the presence of a complication, and patient-related and operation-related variables served as determinants. Statistical analyses included Mann–Whitney U and Chi-squared tests, and binary logistic regression.

Results

Complications occurred in 16.7% of patients. The most common complication was local infection (7.6%), followed by nerve injury (5.6%). The complication risk was 3.7-fold (95% confidence interval (CI) 1.97–6.77, p < 0.001) higher in extractions defined as demanding than in routine operative extraction. If the third molar was acutely infected, the complication risk increased 2.0-fold (95% CI 1.08–3.75, p = 0.027).

Conclusions

Due to the high rate of complications in challenging extractions, scheduling a follow-up visit is important, and risk factors must be considered properly, especially in demanding extractions and in acutely infected third molars.

Related collections

Most cited references 24

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Types, frequencies, and risk factors for complications after third molar extraction.

Chi H Bui, Edward B Seldin, Thomas B Dodson (2003)

The study objective was to identify the types, frequency, and risk factors for complications after third molar (M3) extractions. This retrospective cohort study consisted of patients who had 1 or more M3s removed between 1996 and 2001. Risk factors were grouped into demographic, general health, anatomic, and operative. Outcome variables were operative or inflammatory complications. Data were analyzed using descriptive, bivariate, and multivariate statistics. The study sample was composed of 583 patients (57.0% male) with a mean age of 26.4 +/- 8.4 years. The overall complication rate was 4.6%. Increasing age, a positive medical history, and the position of the M3 relative to the inferior alveolar nerve were associated with an increased risk for complications. While age, medical history, and M3 anatomy cannot be altered directly, these factors may be modified indirectly, resulting in a potential decrease for postoperative complications.

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Age as a risk factor for third molar surgery complications.

Sung-Kiang Chuang, David H Perrott, Srinivas M Susarla … (2007)

The purpose of this study was to estimate the frequency of complications after third molar (M3) surgery, with age as the primary risk factor. This was a prospective cohort study of a sample of subjects having at least 1 M3 extracted as part of the American Association of Oral and Maxillofacial Surgeons' Age-Related Third Molar Study. The predictor variables were categorized as demographic, health status, anatomic, and pathological. The outcome variable was overall complications, including both intraoperative and postoperative complications. Appropriate univariate and bivariate statistics were computed. A multiple logistic regression model was used to evaluate the simultaneous effects of multiple covariates. The study sample was comprised of 4,004 subjects having a total of 8,748 M3s removed. The mean age was 39.8 +/- 13.6 years, with 245 subjects (6.1%) age 25 and younger. Approximately half of the subjects were female. The overall complication rate was 19%. In bivariate analyses, age above 25 years, gender, American Society of Anesthesiologists classification, number of preoperatively identified risk factors for complication, impaction level of M3, evidence of periodontal disease, preoperative infection, and evidence of any pathology associated with M3 were associated with complications (P 25 years) appears to be associated with a higher complication rate for M3 extractions.

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Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery-revisited.

Waseem Jerjes, Tahwinder Upile, Priya Shah … (2010)

Earlier reports, including a preliminary study within our unit, have shown that the surgeon's experience is one of the most influential factors in determining the likelihood of both permanent inferior alveolar nerve (IAN) and lingual nerve (LN) paresthesia, following third molar surgery. The effect of this and other factors influencing such prevalence are assessed in this study. This prospective study involved 3236 patients who underwent surgical removal of impacted third molars. Patients' demographics and radiological parameters were recorded along with the grade of the treating surgeon. The prevalence of inferior alveolar and lingual nerves paresthesia at 1 month, 6 months, and 18 to 24 months postoperatively were also traced. At 1 month postoperatively, the incidence of IAN paresthesia was 1.5% and the LN was 1.8%. These figures decreased over time and 18 to 24 months postoperatively, the incidence of permanent dysfunction of the IAN was 0.6% and LN was 1.1%. With regard to inferior alveolar nerve paresthesia, risk factors included the patient's age (26-30 years), horizontally impacted teeth, close radiographic proximity to the inferior alveolar canal (IAC), and treatment by trainee surgeons. With regard to the lingual nerve, risk factors included male patients, distoangular impactions, close radiographic proximity to the IAC, and treatment by trainee surgeons. One of the main risk factors of developing permanent sensory dysfunction in the distribution of these nerves is related to the surgical skills/experience of the operator. Other factors are associated with the type of impaction and the radiographic proximity of the tooth to the inferior alveolar nerve. Such long-term complications can affect the patient's quality of life; the impact on profession, education, and research is unknown. Copyright 2010 Mosby, Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Acta Odontol Scand

Journal ID (iso-abbrev): Acta Odontol Scand

Journal ID (publisher-id): AOS

Title: Acta Odontologica Scandinavica

Publisher: MJS Publishing on behalf of Acta Odontologica Scandinavica Society

ISSN (Print): 0001-6357

ISSN (Electronic): 1502-3850

Publication date (Electronic): 18 December 2024

Publication date Collection: 2024

Volume: 83

Electronic Location Identifier: 42464

Affiliations

[a ]Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland

[b ]Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland

[c ]Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

Author notes

CONTACT Sanna J. Koskela sanna.j.koskela@ 123456helsinki.fi Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 100, FI-00029 Helsinki, Finland

Author information

Sanna J. Koskela https://orcid.org/0000-0002-4284-3458

Irja Ventä https://orcid.org/0000-0003-2753-8444

Johanna Snäll https://orcid.org/0000-0002-8514-5764

Hanna Välimaa https://orcid.org/0000-0002-2187-2399

Miika Toivari https://orcid.org/0000-0002-0614-8423

Article

Publisher ID: AOS-83-42464

DOI: 10.2340/aos.v83.42464

PMC ID: 11707683

PubMed ID: 39692569

SO-VID: a70c681e-2cab-40fe-a248-f8cd064fb809

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.

History

Date received : 12 August 2024

Date accepted : 06 November 2024

Funding

Funding This work was supported by the Finnish Women Dentists’ Association. Open access funded by Helsinki University Library.