Third molar surgery: the patient's and the clinician's perspective

Area of Science:

• Oral and Maxillofacial Surgery
• Dental Anesthesiology
• Surgical Outcomes Research

Background:

• Review of third molar surgery challenges from patient and clinician viewpoints.
• Analysis of preoperative imaging for surgical planning.
• Investigation into surgical difficulty, patient stress, and postoperative outcomes.

Purpose of the Study:

• To predict surgical difficulty and inferior alveolar nerve injury using orthopantomograms and the Pederson Difficulty Index (PDI).
• To assess patient stress and anxiety using Midazolam versus placebo, with salivary cortisol as a marker.
• To examine postoperative complications in relation to surgeon experience.

Main Methods:

• Radiological analysis of orthopantomograms and application of the Pederson Difficulty Index (PDI).
• Prospective study measuring subjective and objective anxiety parameters, including salivary cortisol levels, with Midazolam administration.
• Comparative analysis of complication rates between junior and senior surgeons.

Main Results:

• A classification tree was developed to predict surgical difficulty and nerve injury risk.
• Midazolam significantly reduced patient anxiety, and salivary cortisol proved to be a reliable anxiety marker.
• Junior surgeons reported higher rates of trismus, alveolar osteitis, infection, and paraesthesia, while senior surgeons reported more bleeding complications.

Conclusions:

• Improved prediction of surgical difficulty and complications can optimize patient management.
• Pharmacological interventions like Midazolam can effectively manage patient anxiety during procedures.
• Surgeon experience is a critical factor influencing the type and frequency of postoperative complications.