Retrospective analysis of complications in 630 impacted third molar avulsion

OBJECTIVES This work aims to analyze whether the careful analysis of all parameters following the surgical extraction of the lower third molars can reduce the risk of both intra- and post-operative complications. MATERIALS AND METHODS A sample of 380 patients aged between 14 and 30 years had indications for the extraction of at least one impacted or partially impacted lower third molar due to different diagnoses, for a total of 630 extractions. All surgeries were performed by the same surgeon using the same surgical technique between January 2015 and January 2020. The following data was collected: date of surgery; age of the patient; extracted tooth; remote and upcoming pathological history; indication for extraction; possible prescription of antibiotic prophylaxis; duration of the surgery; type of anesthesia; radiographic examinations before surgery; inclination of the impacted tooth; relationship to the inferior alveolar nerve; position of the wisdom teeth according to the Pell and Gregory Classification; flap design; whether or not the ostectomy and odontotomy procedures were performed and the instruments used to perform them; placement of lingual nerve protection; type of suture; any intra-operative complications; any post-operative complications; prescription of any supportive post-operative drug therapy; any administration of cortisone. RESULTS AND CONCLUSIONS The application of this standardized surgical protocol has shown significant results in reducing intra- and post-operative complications. As for significant intra-operative complications, there was only one case of major bleeding during surgery. As far as post-operative complications are concerned, three different clinical scenarios were observed: late abscess (0.63%), dehiscence of the flap (0.48%) and infection (0.16%). No permanent sensory changes to the nerve structures (inferior alveolar nerve and lingual nerve) were reported. CLINICAL SIGNIFICANCE This type of surgery shows many individual variables, especially anatomical ones, leading to a very heterogeneous pattern of patient to be treated. This study seems to confirm that the young age of the patient (range 14-30 years) is a very important parameter in this type of surgery: the incomplete formation of the root system and the type of linkage between the impacted tooth and the mandibular bone, allow to reduce both the operating time and the post-operative morbidity, with a considerably reduced risk of injury to neuro-vascular structures. The second level three-dimensional radiographic examination (CBCT) for the most complex cases, seems to be an effective tool in the reduction of complications and in the planning of surgery.