Impacted mandibular third molars (wisdom teeth) frequently indicate the need for surgical odontectomy, particularly when they cause symptoms or have the potential to lead to complications. One important aspect of surgical planning is the depth of impaction—that is, how deeply the tooth is embedded in the bone, the amount of bone covering it, and its position relative to anatomical structures such as the inferior alveolar nerve canal. The depth of impaction is commonly assumed to influence the risk of postoperative complications, including pain, edema, infection, paresthesia, trismus, bleeding, or dry socket.
UGM Research Findings
A study conducted by a student of the Faculty of Dentistry, Universitas Gadjah Mada (UGM), Adinda Aaulia Zahra, under the supervision of drg. Cahya Yustisia Hasan, Sp.BM(K); drg. Bramasto Purbo Sejati, Sp.BMM(K); and drg. Pingky Krisna Arindra, Sp.BMM., Subsp.Ped.OM(K), entitled “Hubungan Klasifikasi Gigi Impaksi Molar Ketiga Rahang Bawah dengan Komplikasi Pascaodontektomi”, carried out at RSGM UGM Prof. Soedomo (2021), examined whether the classification of impacted mandibular third molars—particularly the Pell & Gregory classification—was associated with the incidence of complications following odontectomy. The study sample consisted of 64 patient medical records. Observed complications included pain, edema, infection, paresthesia, trismus, bleeding, and dry socket. Impaction classification was determined based on panoramic radiographic evaluation.
The results showed that the classification of impacted mandibular third molars according to the Pell and Gregory system had no significant association with postoperative odontectomy complications (p > 0.05). The conclusion was that there was no significant relationship between mandibular third molar impaction classification and post-odontectomy complications at RSGM UGM Prof. Soedomo, Yogyakarta.
Clinical Analysis
- Although impaction depth is often considered a risk factor, this study indicates that depth classification (and other parameters within the Pell & Gregory system) was not significantly associated with the incidence of postoperative complications in the study sample.
- This suggests that post-odontectomy complications may be influenced not only by impaction depth but also by other factors, such as surgical technique, operator expertise, patient-related factors (age, general health, bone density), oral hygiene, the use of antibiotics or analgesics, and postoperative care.
- Complications such as dry socket, trismus, or paresthesia may be more strongly affected by postoperative management and non-anatomical variables than by impaction depth alone.
Implications for Clinical Practice
Based on this study, several clinical recommendations can be proposed:
- Do Not Focus Solely on Impaction Depth
- Although depth remains relevant in surgical planning as an indicator of procedural difficulty, oral surgeons should consider the patient’s overall profile and the entire surgical process.
- Comprehensive Treatment Planning
- This includes radiographic assessment, evaluation of patient condition, infection control, clear postoperative instructions, and appropriate surgical techniques.
- Patient Education
- Patients should be informed that the risk of complications depends not only on how deeply the tooth is impacted, but also on how the surgery is performed and how postoperative care is managed.
- Further Research
- Additional studies with larger samples or prospective designs are needed, integrating depth, position, type of impaction, as well as patient- and operator-related factors, to better understand their interactions in contributing to complications.
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UGM research indicates that impaction classification (including depth) according to the Pell & Gregory system is not significantly associated with the risk of post-odontectomy complications in the studied sample. Nevertheless, impaction depth remains valuable for procedural planning and should be considered alongside other relevant factors. In clinical practice, a holistic approach is essential for estimating complication risk and for developing appropriate surgical and recovery plans.
References
ADINDA AULIA ZAHRA, drg. Cahya Yustisia Hasan, Sp.BM(K), drg. Bramasto Purbo Sejati, Sp.BMM(K), drg. Pingky Krisna Arindra, Sp.BMMSubsp.Ped.OM(K), Hubungan Klasifikasi Gigi Impaksi Molar Ketiga Rahang Bawah dengan Komplikasi Pascaodontektomi, https://etd.repository.ugm.ac.id/penelitian/detail/200383
Author: Rizky B. Hendrawan | Photo: Freepik
