Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery

Göksal Keldal; Sefa Çolak

doi:10.7126/cumudj.1838946

TR EN

Gömülü Mandibular 3. Molar Diş Cerrahisinde Postoperatif Ağrı ve Cerrahi Süresi Arasındaki İlişkinin Değerlendirilmesi

Abstract

Özet Amaç: Bu çalışmanın amacı, gömülü mandibular üçüncü molar dişin pozisyonu ile cerrahi süre ve postoperatif ağrı düzeyi arasındaki ilişkinin değerlendirilmesidir. Gereç ve Yöntem: Bu retrospektif çalışma, 2022–2023 yılları arasında gömülü mandibular üçüncü molar cerrahisi uygulanan 150 hastanın kayıtları üzerinden yürütüldü. Tüm dişler kemik retansiyonlu olup, preoperatif panoramik radyografiler Pell & Gregory sınıflamasına göre vertikal, mezioanguler, horizontal ve distoanguler olarak değerlendirildi. Cerrahi süre, insizyonun başlangıcından son sütürün atılmasına kadar geçen süre (dakika) olarak kaydedildi. Postoperatif 3. gündeki ağrı düzeyi, Görsel Analog Skala (VAS, 0–10) kullanılarak değerlendirildi. İstatistiksel analizlerde betimsel istatistikler ve Pearson korelasyon analizi kullanıldı (p <0,05). Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 23,67 ± 5,47 yıl olup, hastaların %70,7’si kadındı. Ortalama cerrahi süre 15,94 ± 6,63 dakika, ortalama VAS skoru ise 2,84 ± 1,96 olarak bulundu. Vertikal pozisyondaki dişlerde cerrahi süre ve VAS skorları en düşük, distoanguler ve horizontal pozisyonlarda ise en yüksek değerlerde seyretti. Cerrahi süre ile postoperatif 3. gün ağrı skorları arasında istatistiksel olarak anlamlı bir korelasyon saptandı (p <0,05). Sonuç: Gömülü mandibular üçüncü molarların pozisyonu, cerrahi süre ve erken postoperatif ağrı üzerinde belirleyici bir faktördür. Özellikle distoanguler ve horizontal pozisyonlar, artmış cerrahi zorluk, daha uzun operasyon süresi ve daha yüksek postoperatif ağrı ile ilişkilidir. Diş pozisyonunun cerrahi planlama sürecinde dikkate alınması, postoperatif morbiditenin öngörülmesi ve yönetimi açısından klinik olarak önem taşımaktadır.

Keywords

Supporting Institution

Hayır

Project Number

25-MOBAEK-386

Ethical Statement

Bu retrospektif klinik çalışma, Tokat Gaziosmanpaşa Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Anabilim Dalı'nda, Ocak 2022 ile Aralık 2023 tarihleri arasında gömülü mandibular üçüncü moların cerrahi olarak çekimi endikasyonu ile başvuran ve cerrahisi aynı klinikte gerçekleştirilen hastalar üzerinde yürütülmüştür. Çalışma protokolü, Tokat Gaziosmanpaşa Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Onay No: 25-MOBAEK-386; Onay Tarihi: 05.11.2025).

Thanks

hayır

Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery

Abstract

Abstract Objective: The aim of this study was to evaluate the relationship between the position of mandibular impacted third molars, surgical duration, and postoperative pain level. Materials and Methods: This retrospective study was conducted using the clinical records of 150 patients who underwent mandibular impacted third molar surgery between 2022 and 2023. All teeth were fully bone-impacted. Preoperative panoramic radiographs were assessed according to the Pell and Gregory classification and categorized as vertical, mesioangular, horizontal, or distoangular. The surgical duration was recorded as the time elapsed from the initial incision to the placement of the final suture (minutes). Postoperative pain on the third day was assessed using the Visual Analog Scale (VAS, 0–10). Descriptive statistics and Pearson correlation analysis were performed, with a significance level set at p < 0.05. Results: The mean age of the participants was 23.67 ± 5.47 years, and 70.7% were female. The mean surgical duration was 15.94 ± 6.63 minutes, and the mean VAS score was 2.84 ± 1.96. Vertical impactions demonstrated the lowest surgical duration and VAS scores, whereas distoangular and horizontal impactions showed the highest values. A statistically significant positive correlation was found between surgical duration and postoperative pain scores on day three (p < 0.05). Conclusion: The position of impacted mandibular third molars is a determining factor influencing surgical duration and early postoperative pain. Distoangular and horizontal impactions are associated with increased surgical complexity, longer operative time, and higher postoperative pain levels. Considering the impaction type during preoperative planning may contribute to predicting postoperative morbidity and improving patient management.

Keywords

Supporting Institution

None

Project Number

25-MOBAEK-386

Ethical Statement

This retrospective clinical study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpaşa University, involving patients who presented with an indication for surgical removal of impacted mandibular third molars between January 2022 and December 2023 and whose surgery was performed in the same clinical setting. The study protocol was approved by the Tokat Gaziosmanpaşa University Clinical Research Ethics Committee (Approval No: 25-MOBAEK-386; Approval Date: 05.11.2025).

Thanks

none

References

1. Vallecillo C, Vallecillo-Rivas M, Gálvez R, Vallecillo-Capilla M, Olmedo-Gaya MV. Analgesic efficacy of tramadol / dexketoprofen vs ibuprofen after impacted lower third molar extraction: A randomized controlled clinical trial. J Evid Based Dent Pract 2021;21(4):101618.
2. Demirsoy MS, Erdil A, Çolak S, Tümer MK. Evaluation of the impacts of surgical removal of impacted teeth on mood alterations using the Beck Depression Inventory. Cumhuriyet Dental Journal 2022;25(1):20–28.
3. Göksu VC, Ersoy HE, Eberliköse H, Yücel E. Demographic evaluation of impacted mandibular third molar positions: A retrospective study. ADO Klinik Bilimler Dergisi 2021;10(3):165–171.
4. Alvira-González J, Figueiredo R, Valmaseda-Castellón E, Quesada-Gómez C, Gay-Escoda C. Predictive factors of difficulty in lower third molar extraction: A prospective cohort study. Med Oral Patol Oral Cir Bucal 2017;22(1):e108–e114.
5. Nahir CB, Çitir M, Çolak S, Keldal G. Assessment of cone beam computed tomography use in pediatric and adolescent patients: A cross-sectional study. BMC Oral Health 2024;24(1):1068.
6. Garcia-Garcia A, Gude-Sampedro F, Gandara-Rey J, Gallas-Torreira M. Trismus and pain after removal of impacted lower third molars. J Oral Maxillofac Surg 1997;55(11):1223–1226.
7. Diniz-Freitas M, Lago-Méndez L, Gude-Sampedro F, Somoza-Martin JM, Gándara-Rey JM, García-García A. The Pederson scale fails to predict the difficulty of lower third molar extraction. Br J Oral Maxillofac Surg 2007;45(1):23–26.
8. Koerner KR. The removal of impacted third molars: Principles and procedures. Dent Clin North Am 1994;38(2):255–278.

9. Cao Z, Zhao C, Wang R, Du Q, Zhang K, Zhao J, et al. Postoperative pain and influencing factors after prophylactic extraction of impacted mandibular third molars: A multicenter prospective cohort study. BMC Oral Health 2025;25(1):827.
10. Almendros-Marqués N, Berini-Aytés L, Gay-Escoda C. Intra- and inter-examiner agreement in classifying lower third molars according to the Pell and Gregory and Winter systems. J Oral Maxillofac Surg 2008;66(5):893–899.
11. Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J Oral Maxillofac Surg 1995;53(1):2–8.
12. Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg 2003;61(12):1379–1389.
13. Renton T, Smeeton N, McGurk M. Factors predictive of difficulty of mandibular third molar surgery. British Dental Journal 2001;190(11):607–610.
14. Olmedo-Gaya MV, Vallecillo-Capilla M, Galvez-Mateos R. Relation of patient and surgical variables to postoperative pain and inflammation in third molar extraction. Med Oral 2002;7(5):360–369.
15. Jerjes W, El-Maaytah M, Swinson B, Banu B, Upile T, D'Sa S, et al. Experience versus complication rate in third molar surgery. Head & Face Medicine 2006;2:14.
16. Pedersen A. Interrelation of complaints after removal of impacted mandibular third molars. Int J Oral Surg 1985;14(3):241–244.
17. Altan A, Akkoç S, Erdil A, Çolak S, Demir O, Altan H. Effects of pain catastrophizing and anxiety on analgesic use after surgical removal of impacted mandibular third molars. J Dent Anesth Pain Med 2019;19(6):379–388.
18. Farhadi F, Asadi M, Nezafati S, Pourlak T. Effect of preemptive amitriptyline on postoperative pain after impacted mandibular third molar extraction: A randomized clinical trial. Front Dent 2025;22:30.
19. Bello SA, Adeyemo WL, Bamgbose BO, Obi EV, Adeyinka AA. Effect of age, impaction type, and operative time on inflammatory reactions following lower third molar surgery. Head & Face Medicine 2011;7:8.
20. Akinwande JA. Mandibular third molar impaction: A comparison of two methods for predicting surgical difficulty. Nig Dent J 1991;10(1):3–7.
21. Rakprasitkul S, Pairuchvej V. Mandibular third molar surgery with primary closure and tube drain. International J Oral Maxillofac Surg 1997;26(3):187–190.
22. Chandler LP, Laskin DM. Accuracy of radiographs in classification of impacted third molars. J Oral Maxillofac Surg 1988;46(8):656–660.
23. Starch-Jensen T, Gacic B, Konstantinovic VS, Valls Ontañón A, Sapundzhiev A, Pavlov N, et al. Patient perception of recovery following surgical removal of mandibular third molars: A prospective European multicenter study. J Craniomaxillof Surg 2023;51(10):635–643.
24. Isiordia-Espinoza MA, Alonso-Castro ÁJ, Serafín-Higuera N, Castañeda-Santana DI, de la Rosa Coronado M, Bologna-Molina RE. Postoperative ketorolac compared with other drugs for pain control after third molar surgery: A meta-analysis. Br J Clin Pharmacol 2022;88(6):2591–2604.
25. Bortoluzzi MC, Guollo A, Capella DL. Pain levels after third molar surgical removal: An evaluation of predictive variables. J Contemp Dent Pract 2011;12(4):239–244.
26. Aznar-Arasa L, Figueiredo R, Valmaseda-Castellón E, Gay-Escoda C. Patient anxiety and surgical difficulty in impacted lower third molar extraction. Int J Oral Maxillofac Surg 2014;43(9):1131–1136.
27. Gbotolorun OM, Arotiba GT, Ladeinde AL. Assessment of factors associated with surgical difficulty in impacted mandibular third molar extraction. J Oral Maxillofac Surg 2007;65(10):1977–1983.
28. Peterson L, Ellis E, Hupp J, Tucker M. Contemporary Oral and Maxillofacial Surgery. 3rd ed. St. Louis: Mosby; 1993. p. 225–260.
29. Chiapasco M, De Cicco L, Marrone G. Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol 1993;76(4):412–420.
30. Sağlam AA. Effects of tube drain with primary closure on postoperative trismus and swelling after removal of fully impacted mandibular third molars. Quintessence Int 2003;34(2):143–147.
31. López-Carriches C, Gómez-Font R, Martínez-González JM, Donado-Rodríguez M. Influence of smoking on the postoperative course of lower third molar surgery. Med Oral Patol Oral Cir Bucal 2006;11(1):E56–E60.
32. Benediktsdóttir IS, Wenzel A, Petersen JK, Hintze H. Risk indicators for extended operation time, postoperative pain, and complications after mandibular third molar removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97(4):438–446.
33. Ryalat S, AlRyalat SA, Kassob Z, Hassona Y, Al-Shayyab MH, Sawair F. Impaction of lower third molars and association with age: Radiological perspectives. BMC Oral Health 2018;18(1):58.
34. Al-Dajani M, Abouonq AO, Almohammadi TA, Alswilem RO, Alzoubi IA. Patterns of third molar impaction in panoramic radiographs in a Saudi population. Open Dent J 2017;11(1):648-660.
35. Ali FM, Jafar M, Jafar AH, Bai P, Dungrani H, Hassan I. A study of mandibular third molar impaction in an outpatient oral surgery clinic. Journal of International Oral Health 2016;8(7):776-780.

Details

Primary Language

English

Subjects

Oral and Maxillofacial Surgery

Journal Section

Research Article

Authors

Göksal Keldal ^*
0000-0002-7784-9809
Türkiye

Sefa Çolak
0000-0002-0807-9089
Türkiye

Publication Date

July 1, 2026

Submission Date

December 9, 2025

Acceptance Date

March 27, 2026

Published in Issue

Year 2026 Volume: 29 Number: 2

DOI

https://doi.org/10.7126/cumudj.1838946

IZ

https://izlik.org/JA99LG79WT

Cite

RIS / Bibtex

APA

Keldal, G., & Çolak, S. (2026). Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery. Cumhuriyet Dental Journal, 29(2), 301-308. https://doi.org/10.7126/cumudj.1838946

AMA

1.Keldal G, Çolak S. Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery. Cumhuriyet Dent J. 2026;29(2):301-308. doi:10.7126/cumudj.1838946

Chicago

Keldal, Göksal, and Sefa Çolak. 2026. “Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery”. Cumhuriyet Dental Journal 29 (2): 301-8. https://doi.org/10.7126/cumudj.1838946.

EndNote

Keldal G, Çolak S (July 1, 2026) Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery. Cumhuriyet Dental Journal 29 2 301–308.

IEEE

[1]G. Keldal and S. Çolak, “Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery”, Cumhuriyet Dent J, vol. 29, no. 2, pp. 301–308, July 2026, doi: 10.7126/cumudj.1838946.

ISNAD

Keldal, Göksal - Çolak, Sefa. “Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery”. Cumhuriyet Dental Journal 29/2 (July 1, 2026): 301-308. https://doi.org/10.7126/cumudj.1838946.

JAMA

1.Keldal G, Çolak S. Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery. Cumhuriyet Dent J. 2026;29:301–308.

MLA

Keldal, Göksal, and Sefa Çolak. “Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery”. Cumhuriyet Dental Journal, vol. 29, no. 2, July 2026, pp. 301-8, doi:10.7126/cumudj.1838946.

Vancouver

1.Göksal Keldal, Sefa Çolak. Evaluation of the Relationship Between Postoperative Pain and Operating Time in Mandibular Impacted Third Molar Surgery. Cumhuriyet Dent J. 2026 Jul. 1;29(2):301-8. doi:10.7126/cumudj.1838946