Original Article

Evaluation of the complications after mandibular third

molar surgical extraction
Navvab Azam, AR. * Ezoddini, F. ** Khalesi, M. *** Gholami, L. **** Momtaz,
A. *****
*Assistant professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yazd University of
Medical Sciences.
** Assistant professor, Department of Oral Radiology, Faculty of Dentistry, Yazd University of Medical Sciences.
***Post graduate student of Prosthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences.
**** Post graduate student of Prosthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences.
*****Dentist

Abstract
Statement of the problem: This study was designed to investigate the complications after surgical
removal of mandibular third molars.
Patients and Methods: Six Hundreds and ninety eight lower third molars among 450 patients
surgically extracted by general dentists from April 2005 to April 2006 were selected for this study.
Data were recorded by completing questionnaires regarding post surgical complications based on the
documents of patients. Data were coded and statistically analyzed by Chi-Square and T-student
tests.
Results: Pain was the most common complication (28.5%) and mandibular fracture was a rare
complication (0.04%). In relation to the angulation of the teeth, this study showed that horizontally
angled molars posed the most complications.
Conclusions: Results showed that pain was the most common complication and mandibular fracture
was the rarest. Prediction of operative difficulty before the extraction of the lower third molars
allows a design of treatment that minimizes the risk of complications.

Keywords: Mandibular third molar, surgical complication, pain, mandibular fractures

bleeding and temporary or permanent

INTRODUCTION
There
following

are

several

surgical

complications

removal

of

the

damage to the cranial nerves.

(1)

The age

and gender of the patients in combination

mandibular third molars which include

with

pain, secondary infection of the head and

proximity of the teeth play important roles

neck

fracture,

in the severity and prevalence of the

molars, excessive

complications. De Boer MP et al reported

Corresponding Author: M, Khalesi Address:

that older patients tend to suffer more often

Department of Prosthodontics, Hamadan University

from complications after mandibular third

region,

mandibular

dislocation of third

of Medical Sciences.

Tel: 09126778160 Fax:

the

angulation

molar surgical extraction.

and

(2)

anatomical

On the other

+98(351)6250344,Email:meisamkhalesi@yahoo.com

DJH 2010; Vol.2, No.1

29

Khalesi et al.

Evaluation of the complications

hand, Osborn TP et al reported that removal

Anatomical proximity of mandibular third

of mandibular third molar teeth during

molar to the cranial nerves can result in

teenage

nerve damage following their surgical

years

resulted

in

decreased

operative and postoperative morbidity.

(3)

In

removal. Carmichael FA and McGowan

terms of the gender of the patients, Angine

DA reported that removal of lower third

Virginia CA reported that post extraction

molars can result in sensorial disturbances

complications of third molars were more

with the percent of nerve damage to the

frequent in females (18%) than in males

lingual

(9.3%).

(4)

Regarding anatomical location,

nerves

following

third

molar

surgery ranging from 0.6 % to 22%.

(7)

since the lower third molar is located near

Furthermore, ValmasedaCastelon et al

the angle of the mandible, it presence

reported that although only 1.3% of the

increases the risk of fracture in the

lower

mandibular angle. Krimmel M and Reinert

temporary inferior alveolar nerve damage,

S reported that mandibular fracture during

25% of the lesions were permanent 8. The

lower third molar removal is a rare, but

aim of this study was to evaluate the

major, complication and major risk factors

complications occurring after mandibular

for this complication seem to be advanced

third molar surgical extraction and the

age in combination with a full dentition.

(5)

third

prevalence

molar

and

extractions

severity

caused

of

the

The danger of an immediate jaw fracture

complications with regard to the age and

can be avoided by means of proper

gender of the patients in combination with

instrumentation and by refraining from

angulation and anatomical proximity of the

excessive force on the bone. The tooth

mandibular third molars.

should be sectioned in such a way as to

PATIENTS AND METHODS

minimize the extent of bone removal and

We studied the complications of 698

force caused by instrumentation. The

lower third molars after surgical removal

danger of a late jaw fracture can be avoided

from a total of 450 patients .The extractions

by precise diagnosis in cases of patients

were done between April 2005 and April

over 25 years of age, particularly men,

2006 by general dentists .The documents of

whose tooth roots are superimposed on or

patients were reviewed and data in relation

adjacent to the inferior alveolar canal on a

to study variables were obtained. Study

panoramic image, any local pathology and

variables were categorized as demographic

systemic disease or medication which may

and anatomical variables. The demographic

impair bone strength, and patients who

variables were gender and age, and

present bruxism and are active athletes are

anatomical variables were tooth descriptors

to be taken into consideration.

(6)

(position, location in the arch, angulation).

Surgical

30

complications

in

this

study

DJH 2010; Vol.2, No.1

Khalesi et al.
included

Evaluation of the complications

mandibular

lip

statistically by chi-square and t-student

paresthesia, tongue paresthesia, pain lasting

tests. The chi-square test was used to assess

more than 3 days and bleeding. We

the

designed a questionnaire in which all

variables and appearance of post-extraction

variables

complications and the relation between

were

fracture,

listed,

and

then

association

patient

persons who reviewed the documents of the

complications was in turn evaluated by the

patients.

T-student test.

data

were

analyzed

and

qualitative

questionnaires were completed by the

The

age

between

appearance

of

.It was seen that pain and bleeding were

RESULTS
The post surgical removal complications

more prevalent in older patient (over 40

of 698 mandibular third molars from a total

year-old)

of 450 patients are researched in this study.

statistically significant difference in the

Based on statistical results, pain was the

prevalence of the complications between

most

genders.

common

complication

(28.5%)

(Table

2).

There

was

no

followed by lip paresthesia (4.5%), tongue

In relation to angulation, there were

paresthesia (2.5%), bleeding (1.6%) and

statistically significant results with respect

mandibular fracture (2%) (Table 1).

to

Regarding the age of patients, there were

paresthesia (P <0.05). They were more

statistically significant relations between

prevalent

age and the prevalence of pain and bleeding

horizontally not vertically (Table 3).

pain,

lip

paresthesia

where

tooth

and

tongue

was

posed

Table1: Frequency of complications after mandibular third molars surgical extraction

Complication
Mandibular fracture
Tongue paresthesia
Lip paresthesia
Pain
Bleeding

DJH 2010; Vol.2, No.1

Frequency
2
11
20
127
7

Percent
0.4
2.5
4.5
28
1.3

31

Khalesi et al.

Evaluation of the complications

Table2: Frequency of complications in different age groups

Under 20
Complication

20-40

Frequency Percent

Mandibular fracture
Tongue paresthesia
Lip paresthesia
Pain
Bleeding

0
1
1
22
0

0ver40

Frequency Percent Frequency Percent P-value

0
1.6
1.6
39.4
0

2
9
16
86
5

0.6
2.6
4.6
24.8
1.4

0
1
3
19
2

0
2.8
8.3
52.8
5.6

0.75
0.88
0.28
0.001
0.033

*Significant
Table3: Frequency of complications in combination with the angulation of the mandibular third
molar

Horizontal
Complication
Mandibular fracture
Tongue paresthesia
Lip paresthesia
Pain
Bleeding

frequency

percent

2
10
17
88
4

1.1
5.5
9.3
48.4
2.2

vertical
frequency percent
0
1
3
39
3

0
0.4
1.1
14.
1.1

p-value
0.08
0.001
0.000
0.000
0.37

*Significant

reported that the extraction of lower third

DISCUSSION

molars is one of the most common activities

In this study we wanted to evaluate the

in oral surgical practice and is generally

complications after mandibular third molar

followed by side effects in the form of pain,

surgical extraction. Overall complication

inflammation and trismus.(9) Furthermore,

rates of about 10 % after third molar

Avendano, et al. reported that the post-

surgery have been reported. (8) ChiaPasco M

extraction complication rate of the third

et al. Reported that the incidence of intra

molars was 15.62% and pain was the most

operative complications and side effects of

prevalent

complication in their study

(4)

This study also showed that

mandibular third molar surgery was 1.1%

(8.9%).

whereas postoperative complication was

mandibular fracture is a rare complication

4.3%. Our results showed that the pain was

(0.4%).In another study, Krimmel M, et al.

the most prevalent complication after

reported that mandibular fracture after

surgical removal of the mandibular third

lower third molar removal is a rare, but

molar. In another study, Capuzzi P et al

major, complication and the major risk

32

DJH 2010; Vol.2, No.1

Khalesi et al.

Evaluation of the complications

factor for this complications seems to be

complications were more prevalent in older

advanced age in combination with a full

patients in regard to the effect of the age of

dentition.

(3)

This present study showed that

patient

on

the

prevalence

one of the complications after lower third

complications Osborn TP et al.

molar removal was the damage to cranial

(5)

, Perry PA

(3)

(11)

of

Krimmel

, De Boer MP
(7)

the

(2)

and

nerves which result in tongue and lip

Valmaseda-Castellon E

paresthesia

4.5%

analogue to ours. In conclusion, our study

respectively).Valmaseda-Castellon, et al.

suggested that the Prediction of the

reported that 1.3% of extraction caused

operative difficulty before the extraction of

temporary nerve damage to inferior alveolar

lower third molars allows a design of

.Ana Claudia Amorim Gomes, et al.

treatment that minimizes the risk of the

showed that lingual nerve damage occurred

complications

in 9.1% in the mandibular third molar

surgeons are naturally expected to have

surgery in which lingual flap retraction was

higher incidence of complications.

performed.

(2.5%

(10)

and

and

reported findings

less

experienced

Our study showed that the

DJH 2010; Vol.2, No.1

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Khalesi et al.

Evaluation of the complications

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