Community-Based Assessment of Complications Associated with Surgical Removal of Impacted Mandibular Third Molars

Abstract

Background: Surgical removal of impacted mandibular third molars is frequently associated with postoperative morbidity, ranging from pain and swelling to alveolar osteitis and transient nerve disturbances. Identifying patient- and procedure-related factors associated with these complications may assist clinicians in improving preoperative assessment and postoperative management.

Aim: The present study aimed to assess the frequency and pattern of complications following surgical removal of impacted mandibular third molars and to determine the factors associated with postoperative complications, particularly dry socket.

Materials and Methods: A community-based assessment was conducted among 200 patients undergoing surgical removal of impacted mandibular third molars. Demographic, radiographic, preoperative, and operative characteristics were documented. Impaction patterns were assessed using Winter’s and Pell and Gregory classifications, while surgical difficulty was evaluated using the Pederson Difficulty Index (PDIP. Postoperative complications were recorded clinically, including pain, facial swelling, trismus, dry socket, infection, bleeding, and temporary sensory disturbances. Associations between categorical variables were assessed using the Chi-square or Fisher’s exact test. Multivariable binary logistic regression was subsequently performed to identify independent predictors of dry socket. Statistical significance was established at p < 0.05.

Results: The study population had a mean age of 24.6 ± 4.8 years, with female participants accounting for 59.0% of the sample. Mesioangular impaction was the most commonly observed radiographic orientation (46.0%), while Pell and Gregory Class I and Position A represented the predominant classifications. The average surgical time was 28.4 ± 9.6 minutes. Among postoperative complications, pain was most common (56.0%), followed by facial swelling (48.0%) and trismus (37.0%). Dry socket developed in 14 patients (7.0%). Temporary disturbances involving the inferior alveolar and lingual nerves were reported in 1.5% and 1.0% of patients, respectively, with no permanent sensory impairment observed. A significant relationship was identified between greater impaction depth and the occurrence of postoperative complications (p = 0.012). Similarly, patients presenting with preoperative pericoronitis had a significantly higher frequency of postoperative complications (p < 0.001). The occurrence of dry socket was significantly associated with surgical difficulty, tobacco consumption, and Winter’s classification. Multivariable logistic regression demonstrated that high surgical difficulty (adjusted OR = 2.84; 95% CI: 1.12–7.18; p = 0.027), preoperative pericoronitis (adjusted OR = 2.31; 95% CI: 1.01–5.29; p = 0.047), and distoangular impaction (adjusted OR = 2.34; 95% CI: 1.12–5.56; p = 0.039) were independently associated with an increased risk of developing dry socket.

Conclusion: Postoperative complications following impacted mandibular third-molar removal were relatively common, although most were transient and clinically manageable. Surgical complexity, preoperative pericoronitis, and distoangular impaction were independently associated with an increased likelihood of dry socket. The study underscores the importance of Quality Education Sustainable Development Goals (SDG 4) and continuous professional training in equipping dental professionals with the skills to perform comprehensive preoperative assessment of impaction characteristics, inflammatory status, and surgical difficulty which can enable clinicians to identify patients at increased risk of postoperative complications and to implement appropriate perioperative strategies, thereby promoting safer and more effective patient care.