الفهرس 
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Abstract
Summary
In summary, this study aimed to evaluate the accuracy of the preoperative
difficulty index for removal of impacted mandibular third molar using: Sammartio et
al difficulty index.
Fifty four healthy patients were selected classified as ASA class I. The selected
patients have impacted mandibular third molars require surgical extraction. The
patients were randomly selected from the outpatient clinic of Oral and Maxillofacial
Surgery Department, Faculty of Dentistry, Suez Canal University.
Impacted mandibular third molars still a public health concern among youth and
young adults. Individuals between the age of 18 and 29 should be examined to weight
the risk or benefits for extracting impacted mandibular third molars, because
extracting IMTMS often causes discomfort and various complications to the patients,
affecting their quality of life after surgery.
So an analysis of the surgical difficulty of impacted lower third molar
extraction is essential for treatment planning and help asses professional surgical
skill, reduces complications ( most researchers agree that postoperative complication
are more commonly associated with more difficult extraction), minimizes
postoperative pain and inflammation, and optimizes patient preparation.
Furthermore, a more precise surgical time prediction could help to manage more
efficient daily planning both in dental offices and hospital departments.
In case needing in particular general anesthesia or conscious sedation reliable
time prediction could help in minimizing the use of sedative drugs and related
complications, together with human and economic resources.
The difficulty index scale proposed here based on anatomical and radiological
impacted mandibular third molar features is promising to be a helpful tool assessment
as well as for planning for surgical operation.
The educational role of this difficulty scale could be exploited mainly in
university hospitals; it could be possible to balance the difficulty of operation with
the skills of the surgeon in training, by grading the surgical procedure.
Our scale is effective, since the lower third molars with the highest scores were
significantly correlated to longer ostectomy time and total surgical time.
Summary
08
The strongest predictors of ostectomy time were Winter’s distance, the
distance from the ramus of the mandible to the second molar, root shape and
the proximity of the mandibular third molar roots to the inferior canal, while
the strongest predictor of tooth sectioning was coronal width, mesial and distal
or horizontal inclination of the mandibular third molar separate and
dysmorphic or anomalous roots, and the distance between ramus of the
mandible and the second molar.
Finally, future scientific works on impacted mandibular tooth extraction
could benefit from this difficulty index scale to stratify surgical difficulty in
order to standardize the recorded data, analyzing them in a more consistent and
predictable way