246 J Maxillofac Oral Surg 8(3):246–248
RETROSPECTIVE STUDY
Indications for removal of impacted mandibular third molars: a single institutional experience in Libya
Krishnan B1 · Mohammad Hossni El Sheikh2 · Rafa El-Gehani3 · Orafi H4
Received: 08 March 2009 / Accepted: 03 August 2009 © Association of Oral and Maxillofacial Surgeons of India 2009
Dept. of Oral and Maxillofacial Surgery, Faculty of dentistry, Al Arab Medical Sciences University Libya
Abstract Aims To investigate the various indications for the removal of impacted lower third molars in a dental school in Libya. Methods The records of all patients who underwent a surgical removal of a lower third molar over a 3 year period were reviewed retrospectively. The indications for removal were classified into 10 groups. Radiographs were also studied to determine angular position as well as pathologies associated with such teeth. Age, gender and chief complaint of all patients were recorded. Results The results were based on the data of 439 patients who had their third molars removed (Male–183; Female–256). 61% of patients were in the age groups 15–24. Recurrent pericoronitis was found to be the most common indication recorded (54%), followed by pulpitis/caries of the 3rd/2nd molar (31%). Orthodontic reasons (2%) and cysts/tumours (5%) were among the other indications recorded. Pain and tenderness was recorded as the most common symptom. The relative absence of prophylactic removal as an indication could be attributed to socioeconomic and logistic reasons. Conclusion Awareness of the indications for removal of impacted lower third molars will help in management of such patients. A fear of dentistry appears to be responsible for patients reporting to the dental surgeon only when symptoms occur. Patients generally do not agree to prophylactic removal of lower third molars. Removal of only symptomatic lower third molars seems to be the logical choice in view of financial and manpower constraints in developing nations. Keywords Indications · Lower third molars · Retrospective Introduction
Material and methods
Removal of wisdom teeth is one of the most common surgical procedures performed by an oral and maxillofacial surgeon. The decision to remove a third molar may often not be a simple and straightforward one. A surgeon must weigh the risks and benefits associated with the surgical removal of third molars. It, thus, becomes necessary to be aware of the specific indications wherein the removal of a lower third molar is justifiable. The aim of this study was to present the indications used for the removal of mandibular third molars in the oldest and largest dental school in Libya.
The records of all patients who underwent a surgical removal of a lower third molar during a 3 year period were retrieved, reviewed and analyzed. All surgical removals were performed under local anesthesia with vasoconstrictor in the Department of Oral and Maxillofacial Surgery, Al Arab Medical Sciences University, Benghazi, Libya. Impacted third molars included in this study were either fully covered with bone or partially erupted, but prevented from reaching the occlusal plane. Mandibular third molars fully erupted to level of occlusal plane and those patients in whom a surgical removal was performed after failure of forceps
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1
Lecturer Professor 3 Associate Professor and Chairman 4 Assistant Professor 2
Address for correspondence: Krishnan B 74, 4th cross, Thanthai Periyar Nagar Ellaipillaichavady Pondicherry 605005 India Email:
[email protected]
extraction were excluded from the study. Each case record was reviewed to determine the reason recorded by the operating surgeon for the removal of the third molar. The indications for the removal are presented in Table 1. When more than 1 indication had been recorded, the particular tooth was included in both categories. Radiographs (Intraoral periapical and Orthopantomogram) were examined to determine the angular position and any associated pathologies.
Results Our results were based on the data of 439 individuals who underwent a surgical
J Maxillofac Oral Surg 8(3):246–248
removal of a mandibular third molar. The sex and age distribution is shown in Table 2. The male-female ratio was 1:1.3. More than half of the patients (61.2%) were in the age groups 15–24. One indication for removal was reported for 361 third molars and 2 indications for 78 third molars resulting in a total of 517 indications. The distribution of these 517 indications can be seen in Table 3. The most frequent indication was recurrent pericoronitis of the third molar (54%). Caries and pulpitis of the third molar accounted for 22% of the indications, while caries of the second molar was mentioned in 9% of the cases. Pathological entities like cysts and tumors made up 6% of the reported indications. The distribution of indications in patients in whom only one indication had been reported is presented in Table 4 and the frequency is similar to that in Table 3. Table 5 presents the distribution of impacted third molars as per the angular position. Mesioangular and vertical impactions accounted for 68% of the cases included in the study. Pain and tenderness was recorded as the most frequent symptom (n=346), followed by swelling (n=74), trismus (n=13) and others (n=6).
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Table 1 Indications for removal 1. 2. 3. 4. 5.
Pericoronitis Pulpitis/caries 3rd molar Caries 2nd molar Periodontitis Orthodontic
6. 7. 8. 9. 10.
Cysts/tumours Prosthetic Root resorption Unexplained facial pain No reason
Table 2 Age and sex distribution Age groups in years
Number of patients
Male
Female
18–24
269
112
157
25–34
115
59
56
35+
55
12
43
Total
439
183
256
Table 3 All indications for removal of third molars (n=439 molars) Indication
Number
Percentage
Pericoronitis
278
54
Pulpitis/caries 3rd molar
115
22
Caries 2nd molar
49
9
Periodontitis
17
3
Orthodontic
14
2
Cysts/Tumours
27
5
Prosthetic
4
