Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Development and validation of a difficulty index for mandibular third molars with extraction time

  • Ku, Jeong-Kui (Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Dental Hospital, Armed Forces Medical Command) ;
  • Chang, Na-Hee (Biomedical Research Institute, Seoul National University Bundang Hospital) ;
  • Jeong, Yeong-Kon (Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Dental Hospital, Armed Forces Medical Command) ;
  • Baik, Sung Hyun (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Choi, Sun-Kyu (Department of Biostatistics, Korea University College of Medicine)
  • Received : 2020.02.09
  • Accepted : 2020.03.24
  • Published : 2020.10.31
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Abstract

Objectives: This study aimed to validate the effectiveness of a recently proposed difficulty index for removal of impacted mandibular third molars based on extraction time and suggest a modified difficulty index including the presence of pathologic conditions associated with third molars. Materials and Methods: This retrospective study enrolled 65 male patients younger than 25 years with third molars. Extraction time was calculated from start of the incision to the last suture. The difficulty scores for third molars were based on spatial relationship (1-5 points), depth (1-4 points), and ramus relationship (1-3 points) using cone-beam computed tomography. The difficulty index was defined as follows: I (3-4 points), II (5-7 points), III (8-10 points), and IV (11-12 points). The modified difficulty score was calculated by adding one point to the difficulty score if the third molar was associated with a pathologic condition. Two modified difficulty indices, based on the presence of pathologic conditions, were as follows: the half-level up difficulty index (HDI) and the one-level up difficulty index (ODI) from the recently proposed difficulty index. Results: The correlations between extraction time and difficulty index and or modified difficulty indices were significant (P<0.001). The correlation coefficient between extraction time and difficulty index was 0.584. The correlation coefficients between extraction time and HDI and ODI were 0.728 and 0.764, respectively. Conclusion: Extraction time of impacted third molars exhibited a moderate correlation with difficulty index and was strongly correlated with the modified indices. Considering the clinical implications, the difficulty index of surgical extraction should take into consideration the pathologic conditions associated with third molars.

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