title: Assessment of factors associated with surgical difficulty during removal of impacted maxillary third molars.
abstract: OBJECTIVE
  Estimating the difficulty of removing third molars is a common dilemma. However, the estimation of the difficulty associated with maxillary third molar surgery has not yet been defined. The aim of the present study was to determine the degree of difficulty and identify predictor variables associated with the occurrence of difficulty in the removal of impacted maxillary third molars.
  
  
  METHODS
  A prospective cohort study was carried out involving patients who underwent at least 1 surgical removal of an impacted maxillary third molar at the Oral and Maxillofacial Surgery Unit, University of Pernambuco (Pernambuco, Brazil). Predictor variables indicative of surgical difficulty were classified by their demographic, clinical, and radiographic aspects. Degree of surgical difficulty was categorized as low, moderate, or high based on the surgical technique used. Descriptive and bivariate statistics were computed.
  
  
  RESULTS
  In total, 106 patients fulfilled the eligibility criteria and 204 surgeries were performed. Patients' mean age was 22.8 ± 2.2 years and the proportion of women to men was 3:1. Approximately 20% of patients were overweight. Surgical difficulty was generally low and 5 variables were significantly associated with the occurrence of a high degree of surgical difficulty.
  
  
  CONCLUSIONS
  Surgical difficulty during the removal of impacted maxillary third molars is generally low. However, for cases with a high degree of difficulty, identification of predictor variables may be useful for students and inexperienced clinicians to consider the decision not to execute the procedure, thus avoiding complications that often require complex management.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Pernambuco, Pernambuco, Brazil.
authors.forename: Ricardo Wathson Feitosa
authors.initials: RW
authors.lastname: de Carvalho
authors.forename: Roberto Carlos Arruda
authors.initials: RC
authors.lastname: de Araújo Filho
authors.forename: Belmiro Cavalcanti
authors.initials: BC
authors.lastname: do Egito Vasconcelos
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003731:Dental Caries / Q000150:complications; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D008443:Maxillary Sinus / Q000000981:diagnostic imaging; D008964:Molar, Third / Q000000981:diagnostic imaging / Q000601:surgery*; D061646:Operative Time; D010497:Pericoronitis / Q000150:complications; D011446:Prospective Studies; D011862:Radiography, Panoramic; D016059:Range of Motion, Articular / Q000502:physiology; D018570:Risk Assessment; D019227:Tooth Apex / Q000000981:diagnostic imaging; D019228:Tooth Crown / Q000000981:diagnostic imaging; D014081:Tooth Extraction / Q000295:instrumentation / Q000379:methods*; D014092:Tooth Root / Q000000981:diagnostic imaging; D014095:Tooth, Impacted / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult