To what extent are surgeons capable of establishing the difficulty degree of lower third molar surgery pre-operatively?

Background: Several methods and variables have been proposed to evaluate surgical difficulty in lower third molar extraction. Aims: The main aim of the present study is to identify which variable influences most the surgeon’s judgment on technical difficulty and which patient- and tooth-related variables are directly associated with an increase in surgical difficulty. Materials & Methods: A prospective observational study was performed. Assessment of the difficulty of surgery was conducted both asking surgeons to subjectively evaluate the difficulty of each procedure, pre- and post-operatively, and using a modified Pederson anatomical variable score. Results: Patients with high positive scores for Factor 1 of the principal component analysis underwent third molar surgeries evaluated as difficult by surgeons and were also associated with longer durations of tooth sectioning, ostectomy, flap incision and detachment, luxation/extraction, as well as a greater overall duration of surgery. Teeth with slightly divergent or fused roots were associated with shorter surgeries, which were evaluated as easier by surgeons in comparison to cases of teeth with apical anomalies. When the position of the tooth was vertical, surgery was evaluated as easier by surgeons and lasted less, compared to when the tooth was in a horizontal position. When the roots were slightly divergent or fused, suture and flap incision and detachment lasted longer, and surgery was evaluated as relatively easier compared to when the tooth presented apical anomalies. Conclusion: Surgeons evaluated the difficulty of lower third molar surgery in a substantially different manner compared to the anatomic variable score used.