Evaluation of Postoperative Complications after Surgical Removal of Impacted Lower Wisdom Teeth: a Prospective Study

Labeed Sami Hasan

Abstract


The removal of third molars is the most common procedure in oral surgery. It may be associated
with minor complications such as pain, dry socket, infection, and major complications such as sensory
disturbances and iatrogenic damage to the 2nd molar or mandibular fractures.
Aim: The aim of this study was to evaluate the incidence of various complications, including pain, alveolitis,
infection and damage to the inferior alveolar and lingual nerve that may occur during or after surgical removal
of impacted mandibular third molars.
Materials and methods: This prospective study took place between March 1st, 2013 and January 29th, 2014 and it was done by the
author. The sample consisted of 152 patients (90 males and 62 females with an age range of 20 – 45 years). The patients underwent
surgical removal of a completely or partially impacted lower wisdom tooth. All impacted third molars in the study were asymptomatic
at the time of surgery. A standardized case sheet was filled for each patient and the patients were informed to register the pain
and any other complications in these sheets.
Results: The overall complication rate was 35 patients (23.02%). Twenty-three (15%) patients developed moderate to severe pain,
immediately after the operation lasting till the 3rd or 4th day postoperatively. Five patients (3.42%) developed localized osteitis, four
patients (2.73%) developed postoperative oozing that lasted for 5 days, and three cases (1.97%) developed postoperative infection.
None of the patients developed postoperative lingual nerve or inferior alveolar nerve dysfunction.
Conclusion: Postoperative pain is the main complication after surgical removal of impacted lower wisdom teeth and alveolar osteitis
is the second most important complication. Inferior alveolar nerve, lingual nerve damage and bleeding are very rare complications.
The complications can be minimized by careful surgical extraction, postoperative medication and following postoperative
instructions.


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References


Dimitroulis G . A Synopsis of Minor Oral Surgery. Oxford

university press: 1997. Chapter 6, pp 48-57.

Obimakinde OS. Impacted mandibular third molar surgery;

an overview. Dentiscope, 2009; volume 16, January.

Ma’aita J and Alwrikat A . Is the mandibular third molar a

risk factor for mandibular angle fracture? Oral Surg Oral

Med Oral Pathol Oral Radiol Endod, 2000;89(2): 143-146.

Fuselier JC, Ellis EE 3rd and Dodson TB .Do mandibular

third molars alter the risk of anglefracture? J Oral

Maxillofac Surg, 2002; 60(5): 514-518.

Sağlam AA, Tüzüm MS. Clinical and radiologic investigation

of the incidence, complications, and suitable removal

times for fully impacted teeth in the Turkish population.

Quintessence Int, 2003 ;34(1): 53-59.

Pell GJ, Gregory BT. Impacted mandibular third molars:

Classification and modified techniques for removal. Dent

Digest. 1933;39:330–8.

Sham Kishor Kanneppady, Balamanikandasrinivasan,Ramesh

Kumaresan,and Santosh B. SakriA . comparative study on

radiographic analysis of impacted third molars among

three ethnic groups of patients attending AIMST Dental

Institute, Malaysia .Dent Res J (Isfahan). 2013 May-Jun;

(3): 353–358. PMCID: PMC3760359)

Yitzhak Woldenberg et al , Iatrogenic mandibular fracture

associated with third molar removal. Can it be prevented ?

Med Oral Patol Oral Cir Bucal 2007;12:E70-2.

Sisk AL, Hammer WB, Shelton DW, Joy ED Jr. Complications

following removal of impacted third molars: the role of the

experience of the surgeon. J Oral Maxillofac Surg 1986;

(11):855–9.

Lopes V, Mumenya R, Feinmann C, Harris M. Third molar

surgery: an audit of the indications for surgery, postoperative

complaints and patient satisfaction.

Br J Oral

Maxillofac Surg 1995; 33(1):33–5.

Jose Rodrigues Laureano Filho, Emanuel Dias de Oliveira

e Silva, Igor Batista Camargo, and Fabiana MV Gouveia.

The influence of cryotherapy on reduction of swelling, pain

and trismus after third molar extraction. J Am Dent Assoc,

Vol 136, No 6,774-778.

AB Barroso, V Lima, GC Guzzo, RA Moraes, MC

Vasconcellos, MM Bezerra, FAL Viana, RCR Bezerra,

GSM Santana, FA Frota-Bezerra, MO Moraes and MEA

Moraes. Efficacy and safety of combined piroxicam,

dexamethasone, orphenadrine, and cyanocobalamin

treatment in mandibular molar surgery. Braz J Med Biol

Res, September 2006,Volume 39(9) 1241-1247.

Blum IR. Contemporary views on dry socket (alveolar

osteitis): a clinical appraisal of standardization,

aetiopathogenesis and management: a critical review. Int

J Oral Maxillofac Surg 2002;31:309-17

Bello S. A., Adeyemo W., Bamgbose B., Obi E., Adeyinka

A. A . Effect of age, impaction types and operative time on

inflammatory tissue reactions following lower third molar

surgery . Head & Face Medicine 2011, 7:8;3.

Baqain Z. H., , Abu Karaky A., Sawair F., , Khaisat A. ,

Rajab L., Frequency Estimates and Risk Factors for

Postoperative Morbidity After Third RemovalMolar

Removal: A Prospective Cohort Study J Oral MaxillofacSurg

;66:2276-2283.

Yuasa H, Kawai T, Sugiua M. Classification of surgical

difficulty in extracting impacted third molars. Br J Oral

Maxillofac Surg 2002; 40:26–31.

Chi H et al . Types, Frequencies, and Risk Factors for

complications After Third Molar Extraction . J Oral

Maxillofac Surg, 2003 ;61:1379-1389.

Benediktsdottir IS, Wenzel A, Petersen JK, et al: Mandibular

third molar removal: Risk indicators for extended operation

time, postoperative pain, and complications. Oral Surg

Oral Med Oral Pathol Oral Radiol Endod ,2004; 97:438.

Jerjes W, El-Maaytah M, Swinson B, et al: Experience

versus complication rate in third molar surgery.2006 ;

Head Face Med 25:14.

Renton T, Smeeton N, McGurk M: Factors predictive of

difficulty of mandibular third molar surgery. 2001; Br Dent

J 190:607.

Nusair YM, Younis MH: Prevalence, clinical picture,

and risk factors of alveolar osteitis in a Jordanian dental

teaching center.2007 ;J Contemp Dent Pract 8:53.

Rubio-Palau J, et al , Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of

alveolar osteitis following the extraction of mandibular

third molars. A double-blind randomized clinical trial. Med

Oral Patol Oral Cir Bucal. 2015 Jan 1;20(1):e117-22.

Monaco G, Staffolani C, Gatto MR, et al: Antibiotic

therapy in impacted third molar surgery. Eur J Oral Sci

,1999;107:437.

Victoria AM. Relation of patient and surgical variables to

postoperative pain and inflammation in the extraction of

third molars. Medicina Oral ,2002; 7: 360-369.

Birn H: Etiology and pathogenesis of fibrinolytic alveolitis

(“alveolar osteitis”). Int Oral Surg ,1973; 2:215.

De Boer MP, Raghoebar GM, Stegenga B, et al:

Complications after mandibular third molar extraction.

Quintessence Int , 1995; 26:779.

David D, Marvin P, Chinnis RJ. Comparison of primary

and secondary closure techniques after removal of

impacted mandibular third molars. J Oral Maxillofac Surg.

;11:631–634. [PubMed].

Berge TI. Visual analogue scale assessment of postoperative

swelling: a study of clinical inflammatory variables

subsequent to third-molar surgery. Acta Odontol Scand.

;46:233–240. doi: 10.3109/00016358809004772.

[PubMed] [Cross Ref].

Bui CH, Seldin EB, DodsonTB .Type ,frequencies

and risk factors doe complications after third molar

extraction .journal of oral and maxillofacial surgery,

;61(12):1379-8.

Bouloux GF,Steed MB,Periaccante VJ .Complications of

third molar surgery .oral and maxillofacial surgery clinics

of north America 2007;19(1):117.

Rosfaima Othman@Jaffar, Mon Mon Tin-Oo. Impacted

mandibular third molars among patients attending Hospital

Universiti Sains Malaysia, Archives of Orofacial Sciences

(2009); 4(1): 7-12.

Chuang SK, Perrott DH, Susarla SM, er al: Age as a

risk factor for third molar surgery complications. J Oral

Maxillofac Surg ,2007;65:1685.

Turner PS: A clinical study of “alveolar osteitis.” ,1982; Int

J Oral Surg 11:226.

White RP et al : Recovery after third molar surgery: clinical

and healthrelated quality of life outcomes. J Oral Maxillofac

Surg 2003, 61:535-544.

Babatunde O. B.et al . Effects of co-administered

dexamethasone and diclofenacpotassium on pain, swelling

and trismus following third molarsurgery Head & Face

Medicine 2005, 1:11

Larsen PE. Alveolar osteitis after surgical removal of

impacted mandibular third molars: identification of the

patient at risk. Oral Surg Oral Med Oral Pathol, 1992;

:393–7.

Blondeau F and Daniel NG. Extraction of impacted

mandibular third molars: postoperative complications and

their risk factors. J Can Dent Assoc, may 2007; 73(4): 325-

A. E. Swanson, “Prevention of dry socket: an overview,”

Oral Surgery Oral Medicine and Oral Pathology, 1990 ;vol.

, no. 2, pp.131–136.

Caso A,Hung L-K, Beirne OR . Prevention of alveolar

osteitis with chlorhexidine :A meta analytic review . Oral

surgery oral Med Oral radiol Endod 2005;99:155-159.

Chiapasco M, De Cicco L, Marrone G: Side effects and

complications associated with third molar surgery. Oral

Surg Oral Med Oral Pathol1993 ; 76:412.

Muhonen A, Iventa¨ I, Ylipaavalniemi P: Factors

predisposing to postoperative complications related to

wisdom tooth surgery among university students.1997; J

Am Coll Health 46:39.

Hochwald DA, Davies WH, Martinoff J. Modified

distolingual splitting technique for removal of impacted

mandibular third molars: incidence of postoperative

sequelae. Oral Surg Oral Med Oral Pathol 1983; 56: 9–11.

Nordenram A, Sydnes G, Odegaard J. Neomycin-bacitracin

cones in impacted third molar sockets. Int J Oral Surg 1973;

: 279. | PubMed

Bataineh AB: Sensory nerve impairment following

mandibular third molar surgery. J Oral Maxillofac Surg

,2001;59:1012.

Chye EP, Young IG, Osborne GA, et al: Outcomes after

same day oral surgery: A review of 1,180 cases at a major

teaching hospital. J Oral Maxillofac Surg,1993; 51:846.




DOI: http://dx.doi.org/10.26477/idj.v37i2.45

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