Key Points
-
There is a relationship between the surgeon's experience and postoperative complications in third molar surgery.
-
With careful assessment and treatment planning postoperative complications may be minimised.
-
Knowledge of general surgical principles is often learned best through direct observation and/or assisting senior colleagues, building upon information gained from written material.
Abstract
Background The relationship between a surgeon's experience and the incidence of postoperative complications after third molar surgery is assessed in this prospective clinical study. Previous reports have shown this to be one the most influential factors on surgical outcome.
Method In this study, 3,236 patients underwent surgical removal of impacted third molars. All patients included in the study were reviewed and the various postoperative complications were recorded and statistically compared to the surgeon's grade. Patients' demographics and pre-operative radiographic findings were also noted.
Results The surgical procedures were performed by seven specialists and 12 residents. In the group of patients treated by the residents, the incidence of postoperative complications was found to be significant with regards to trismus, infection, alveolar osteitis and paraesthesia of the lingual and inferior alveolar nerves. In the group of patients treated by specialists, the incidence of postoperative bleeding was found to be statistically significant.
Conclusion There is without doubt a relationship between the surgeon's experience and the postoperative complication in third molar surgery. The impact of the findings from this study upon the profession, education and research is as yet unrealised. The ethical and moral implications of our findings are discussed.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Jerjes W, El-Maaytah M, Swinson B, Banu B et al. Experience versus complication rate in third molar surgery. Head Face Med 2006; 2: 1–14.
Kim J C, Chan S S, Wang S G . Minor complications after mandibular third molar surgery: type, incidence and possible prevention. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 4–11.
Blondeau F, Daniel N G . Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc 2007; 73: 325.
Benediktsdottir I S, Wenzel A, Petersen J K, Hintze H . 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: 438–446.
Goldberg M H, Nemarich A N, Marco W P . Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in a private practice. J Am Dent Assoc 1985; 11: 277–279.
de Boer M P, Raghoebar G M, Stegenga B, Schoen P J, Boering G . Complications after mandibular third molar extraction. Quintessence Int 1995; 26: 779–784.
Halpern L R, Dodson T B . Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery? J Oral Maxillofac Surg 2007; 65: 177–185.
Lacasa J M, Jiménez J A, Ferrás V, Bossom M et al. Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5 mg). Int J Oral Maxillofac Surg 2007; 36: 321–327.
Bergdahl M, Hedström L . Metronidazole for the prevention of dry socket after removal of partially impacted mandibular third molar: a randomised controlled trial. Br J Oral Maxillofac Surg 2004; 42: 555–558.
Bonine F L . Effect of chlorhexidine rinse on the incidence of dry socket in impacted mandibular third molar extraction sites. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79: 154–157.
Ragno J R, Jr, Szkutnik A J . Evaluation of 0.12% chlorhexidine rinse on the prevention of alveolar osteitis. Oral Surg Oral Med Oral Pathol 1991; 72: 524–526.
Bruce R A, Frederickson G C, Small G S . Age of patients and morbidity associated with mandibular third molar surgery. J Am Dent Assoc 1980; 101: 240–245.
Capuzzi P, Montebugnoli L, Vaccaro M A . Extraction of impacted third molars. A longitudinal prospective study on factors that affect postoperative recovery. Oral Surg Oral Med Oral Pathol 1994; 77: 341–343.
Berge T I, Gilhuus-Moe O T. Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon. Acta Odontol Scand 1993; 51: 389–397.
Sisk A L, Hammer W B, Shelton D W, Joy E D Jr . Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 1986; 44: 855–859.
Shepherd J . Rinsing with chlorhexidine may reduce incidence of dry socket after third molar surgery. Evid Based Dent 2005; 6: 36.
Handelman S L, Black P M, Desjardins P, Gatlin L, Simmons L . Removal of impacted third molars by oral/maxillofacial surgery and general dentistry residents. Spec Care Dentist 1993; 13: 122–126.
Susarla S M, Dodson T B . How well do clinicians estimate third molar extraction difficulty? J Oral Maxillofac Surg 2005; 63: 191–199.
Sursala S M, Dodson T B . Risk factors for third molar extraction difficulty. J Oral Maxillofac Surg 2004; 62: 1363–1371.
Norholt S E, Aagaard E, Svensson P, Sindet-Pedersen S. Evaluation of trismus, bite force, and pressure algometry after third molar surgery: a placebo-controlled study of ibuprofen. J Oral Maxillofac Surg 1998; 56: 420–427.
Breytenbach H S . Objective measurement of post-operative swelling. Int J Oral Surg 1978; 7: 386–392.
Baxendale B R, Vater M, Lavery K M . Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 1993; 48: 961–964.
Micó-Llorens J M, Satorres-Nieto M, Gargallo-Albiol J, Arnabat-DomÃnguez J et al. Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction. Eur J Clin Pharmacol 2006; 62: 693–698.
Gersema L, Baker K . Use of corticosteroids in oral surgery. J Oral Maxillofac Surg 1992; 50: 270–277.
Field E A, Speechley J A, Rotter E, Scott J . Dry socket incidence compared after a 12 year interval. Br J Oral Maxillofac Surg 1985; 23: 419–427.
Chuang S K, Perott D H, Susarla S M, Dobson T B . Risk factors for inflammatory complications following third molar surgery in adults. J Oral Maxillofac Surg 2008; 66: 2213–2218.
Fridrich K L, Olson R A . Alveolar osteitis following surgical removal of mandibular third molars. Anesth Prog 1990; 37: 32–41.
Penarrocha M, Sanchis J M, Saez U, Gay C, Bagan J V . Oral hygiene and postoperative pain after mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92: 260–264.
Poeschl P W, Eckel D, Poeschl E . Postoperative prophylactic antibiotic treatment in third molar surgery - a necessity? J Oral Maxillofac Surg 2004; 62: 3–8.
Chiapasco M, De Cicco L, Marrone G . Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol 1993; 76: 412–420.
Middlehurst R J, Barker G R, Rood J P . Postoperative morbidity with mandibular third molar surgery: a comparison of two techniques. J Oral Maxillofac Surg 1988; 46: 474–476.
Lopes V, Mumenya R, Feinmann C, Harris M . Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction. Br J Oral Maxillofac Surg 1995; 33: 33–35.
Mason D A . Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 1988; 17: 290–294.
Bataineh A B . Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg 2001; 59: 1012–1017.
Robinson P P . Observations on the recovery of sensation following inferior alveolar nerve injuries. Br J Oral Maxillofac Surg 1988; 26: 177–189.
Mozsary P G, Middleton R A . Microsurgical reconstruction of the lingual nerve. J Oral Maxillofac Surg 1984; 42: 415–420.
Meyer R A . Evaluation and management of neurological complications. In Kaban L B, Pogrel M A, Perrott D H (eds). Complications in oral and maxillofacial surgery. p 69. Philadelphia: Saunders, 1997.
Renton T, McGurk M . Evaluation of factors predictive of lingual nerve injury in third molar surgery. Br J Oral Maxillofac Surg 2001; 39: 423–428.
Author information
Authors and Affiliations
Corresponding author
Additional information
Refereed paper
Rights and permissions
About this article
Cite this article
Jerjes, W., Upile, T., Nhembe, F. et al. Experience in third molar surgery: an update. Br Dent J 209, E1 (2010). https://doi.org/10.1038/sj.bdj.2010.581
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bdj.2010.581
This article is cited by
-
Do anatomical variations of the mandibular canal pose an increased risk of inferior alveolar nerve injury after third molar removal?
Clinical Oral Investigations (2022)
-
Analgesia and Side Effects of Codeine Phosphate Associated with Paracetamol Versus Oxycodone After the Extraction of Mandibular Third Molars: A Randomized Double-Blind Clinical Trial Using the Split-Mouth Model
Journal of Maxillofacial and Oral Surgery (2022)
-
Trigeminal nerve injuries after mandibular oral surgery in a university outpatient setting—a retrospective analysis of 1,559 cases
Clinical Oral Investigations (2015)
-
Evaluation of masseter muscle electromyography after surgical extraction of third molar
Oral and Maxillofacial Surgery (2015)
-
Politically driven
British Dental Journal (2010)


