Experience versus complication rate in third molar surgery

Waseem Jerjes, Mohammed El-Maaytah, Brian Swinson, Bilquis Banu, Tahwinder Upile, Sapna D'Sa, Mohammed Al-Khawalde, Boussad Chaib, Colin Hopper, Waseem Jerjes, Mohammed El-Maaytah, Brian Swinson, Bilquis Banu, Tahwinder Upile, Sapna D'Sa, Mohammed Al-Khawalde, Boussad Chaib, Colin Hopper

Abstract

Objectives: The records of 1087 patients who underwent surgical removal of third molar teeth were prospectively examined to analyse the possible relationship between postoperative complications and the surgeon's experience parameter.

Method and materials: Seven surgeons (three specialists in surgical dentistry [specialists SD] and four oral and maxillofacial Senior House Officers [OMFS residents]) carried out the surgical procedures. For each patient, several variables were recorded including age, gender, radiographic position of extracted teeth, treating surgeon, duration of surgery and postoperative complications.

Results: Analysis of the data revealed some differences in the incidence of complications produced by the specialists SD and OMFS residents. The main statistically relevant differences were increase the incidences of trismus, nerve paraesthesia, alveolar osteitis and infection in the resident-treated group, while the specialist-treated group showed higher rates of post-operative bleeding.

Conclusion: The higher rate of postoperative complications in the resident-treated group suggests that at least some of the complications might be related to surgical experience. Further work needs to compare specialists of training programmes with different years of experience, using large cross - sectional studies.

References

    1. Benediktsdottir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:438–446.
    1. Berge TI, Boe OE. Predictor evaluation of postoperative morbidity after surgical removal of mandibular third molars. Acta Odontol Scand. 1994;52:162–169.
    1. Bruce RA, Frederickson GC, Small GS. Age of patients and morbidity associated with mandibular third molar surgery. J Am Dent Assoc. 1980;101:240–245.
    1. Capuzzi P, Montebugnoli L, Vaccaro MA. Extraction of impacted third molars. A longitudinal prospective study on factors that affect postoperative recovery. Oral Surg Oral Med Oral Pathol. 1994;77:341–343. doi: 10.1016/0030-4220(94)90194-5.
    1. Shepherd JP, Brickley M. Activity analysis: measurement of the effectiveness of surgical training and operative technique. Ann R Coll Surg Engl. 1992;74:417–420. discussion 421.
    1. Sisk AL, Hammer WB, Shelton DW, Joy ED., Jr Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg. 1986;44:855–859.
    1. Olech E. Value of implantation of certain chemotherapeutic agents in sockets of impacted lower third molars. J Am Dent Assoc. 1953;46:154–159.
    1. Verbic RL. Local implantation of aureomycin in extraction wounds: a preliminary study. J Am Dent Assoc. 1953;46:160–163.
    1. Ragno JR, Jr, Szkutnik AJ. Evaluation of 0.12% chlorhexidine rinse on the prevention of alveolar osteitis. Oral Surg Oral Med Oral Pathol. 1991;72:524–526.
    1. Penarrocha M, Sanchis JM, Saez U, Gay C, Bagan JV. Oral hygiene and postoperative pain after mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:260–264.
    1. Mufson RA. The influence of experience on complication rates. J Oral Maxillofac Surg. 1987;45:906.
    1. Handelman SL, Black PM, Desjardins P, Gatlin L, Simmons L. Removal of impacted third molars by oral/maxillofacial surgery and general dentistry residents. Spec Care Dentist. 1993;13:122–126.
    1. Berge TI, Gilhuus-Moe OT. Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon. Acta Odontol Scand. 1993;51:389–397.
    1. de Boer MP, Raghoebar GM, Stegenga B, Schoen PJ, Boering G. Complications after mandibular third molar extraction. Quintessence Int. 1995;26:779–784.
    1. Breytenbach HS. Objective measurement of post-operative swelling. Int J Oral Surg. 1978;7:386–392.
    1. Norholt SE, Aagaard E, Svensson P, Sindet-Pedersen S. Evaluation of trismus, bite force, and pressure algometry after third molar surgery: a placebo-controlled study of ibuprofen. J Oral Maxillofac Surg. 1998;56:420–7. doi: 10.1016/S0278-2391(98)90705-4.
    1. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48:961–964.
    1. Chiapasco M, De Cicco L, Marrone G. Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol. 1993;76:412–420.
    1. Middlehurst RJ, Barker GR, Rood JP. Postoperative morbidity with mandibular third molar surgery: a comparison of two techniques. J Oral Maxillofac Surg. 1988;46:474–476.
    1. Lopes V, Mumenya R, Feinmann C, Harris M. Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction. Br J Oral Maxillofac Surg. 1995;33:33–35. doi: 10.1016/0266-4356(95)90083-7.
    1. Mason DA. Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg. 1988;17:290–294. doi: 10.1016/S0901-5027(88)80005-5.
    1. Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg. 2001;59:1012–1017. doi: 10.1053/joms.2001.25827. discussion 1017.
    1. Mozsary PG, Middleton RA. Microsurgical reconstruction of the lingual nerve. J Oral Maxillofac Surg. 1984;42:415–420.
    1. Field EA, Speechley JA, Rotter E, Scott J. Dry socket incidence compared after a 12 year interval. Br J Oral Maxillofac Surg. 1985;23:419–427. doi: 10.1016/0266-4356(85)90026-9.
    1. Muhonen A, Venta I, Ylipaavalniemi P. Factors predisposing to postoperative complications related to wisdom tooth surgery among university students. J Am Coll Health. 1997;46:39–42.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren