Relationship between surgical difficulty of third molar extraction under local anesthesia and the postoperative evolution of clinical and blood parameters.

Publication date: Available online 20 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Beatriz Sainz de Baranda, Francisco-Javier Silvestre, Javier Silvestre-Rangil

Abstract

Purpose

To determine whether the Pederson scale is a good predictor of the surgical difficulty of third molar extraction and establish whether such surgical difficulty is directly related to the postoperative course as assessed from clinical (pain, inflammation and trismus) and blood parameters (C-reactive protein, IL-6 and fibrinogen).

Material and methods

A prospective observational study was made of two groups of patients respectively subjected to simple or surgical third molar extraction under local anesthesia. The abovementioned clinical and blood parameters were recorded during one week after extraction, along with the possible complications.

Results

A total of 118 patients were studied. Surgical difficulty as predicted by the Pederson scale revealed significant differences (p<0.001) in terms of osteotomy, sectioning of the crown, root sectioning, duration of the intervention, type of closure and number of sutures. Under conditions of equal surgical difficulty, the evolution of the groups was similar with regard to pain and inflammation, though trismus was greater among the patients subjected to surgical extraction. Following the operation, significant increments were recorded in serum C-reactive protein, IL-6 and fibrinogen, though without differences among the different levels of surgical difficulty. The probability of complications was found to be similar in the simple and surgical extraction groups. The appearance of complications was the principal cause of alterations in the clinical and blood parameters.

Conclusion

The Pederson scale is a good predictor of the surgical difficulty of third molar removal as assessed from different clinical and blood parameters. The C-reactive protein, IL-6 and fibrinogen concentrations varied significantly after the operation, but were not influenced by the degree of surgical difficulty. The presence of postoperative complications was associated to poorer evolution of the clinical and blood parameters.

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