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Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 139-141

Assessment of the Correlation between Gender and Third Molar Surgery Duration

1 Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Al-Anbar, Ramadi, Iraq
2 Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Tikrit, Tikrit, Iraq
3 Al-Anbar Health Directorate, Al-Karma, Iraq

Date of Submission26-Aug-2022
Date of Decision20-Oct-2022
Date of Acceptance22-Oct-2022
Date of Web Publication12-Dec-2022

Correspondence Address:
Elham Hazeim Abdulkareem
College of Dentistry, University of Anbar, Al-Anbar, Ramadi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/denthyp.denthyp_101_22

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Introduction: This study aimed to determine whether there was a difference in the duration it required to extract impacted molars based on the sex of the patient. Methods: In this study, 108 patients with impacted mandibular third molars who attended the Tikrit Dental College (50% of them were men, aged 18–30) were included. The impactions were classified using the Winter’s method. The surgery duration was defined as the time between incision and final suturing. Data were analyzed by point-biserial correlation and chi-squared test using R software. Results: The frequencies of different types of impactions were similar between males and females (P ˃ 0.05). The most common type of impaction was mesioangular, followed by distoangular, straight, and horizontal. Negatively very weak correlation found between gender and third molar surgery duration (r = −0.15, P = 0.11, 95% CI −0.037–0.331). Conclusion: No significant correlation among gender and duration of surgery was found. To validate the findings of this study, further research with a larger sample size is needed.

Keywords: Gender, impacted teeth, surgery, surgical difficulty, third molar, tooth extraction

How to cite this article:
Abdulkareem EH, Ali MR, Rasool Hammoodi SA, Talib RF. Assessment of the Correlation between Gender and Third Molar Surgery Duration. Dent Hypotheses 2022;13:139-41

How to cite this URL:
Abdulkareem EH, Ali MR, Rasool Hammoodi SA, Talib RF. Assessment of the Correlation between Gender and Third Molar Surgery Duration. Dent Hypotheses [serial online] 2022 [cited 2023 May 30];13:139-41. Available from:

  Introduction Top

The most usually impacted tooth is the mandibular third molar, for a variety of reasons, which include: inadequate space in the mandible, trauma, infections, or diseases that affect the eruption process.[1],[2] Impactions are categorized as mesioangular, distoangular, vertical, or horizontal depending on the angle between the impacted third molar and the longitudinal axis of the second molar.[3] Impactions are associated with several complications, such as caries in the adjacent teeth, cyst development, and pericoronitis.[4],[5] Third molar extraction is a commonly performed dentoalveolar surgery that is associated with low morbidity.[6],[7] However, it is a multi-step procedure that involves incision, bone removal, tooth separation, and closure. Therefore, removal of the third molar is linked to a variety of complications, which range from slight discomfort to edema and serious complications, such as infections and potentially permanent nerve damage.[8],[9]

The following factors influence postoperative complications: (1) patients-relevant factors, such as age, sex, oral hygiene status; (2) tooth-relevant factors, such as impaction type, impaction depth, infection, roots morphology, their relationship to the inferior alveolar nerve, and pathology; (3) operation-relevant factors, such as the experience of surgeon, time of surgery, usage of drugs, type of incision and its size, and how to close a wound.[10],[11]

The time taken for extraction of the third molar is considered the gold standard for determining the surgical difficulty because it is usually proportional to postoperative complications.[12],[13] Different surgeons estimate the surgery duration in different ways; some measure it from the onset of bone cutting to completion, whereas others measure it from the start of incision to the final suture.[10] Patient sex, age, physique, and angulation of the impacted teeth influence the length of surgery.[14],[15] Although reports suggest an association between surgical difficulty and radiographic features such as the number of roots and type and depth of impaction,[5],[13],[15],[16] the link between the duration of surgery and patient factors is still debated.[5],[10],[11],[13] Nevertheless, this study attempted to examine the effect of sex on impacted third molar surgery duration.

  Subjects and Methods Top

Ethical approval was provided by the College of Dentistry/University of Tikrit (Reference No. 7/26/434 on 04/04/2022). This study included 108 patients (50% male) with mandibular impacted third molars who visited the College of Dentistry, University of Tikrit for dental care. Patients who were smokers and/or had a history of systemic illness were excluded from the study. All participants signed a written informed consent form.

Panoramic radiograph were obtained at the initial visit from individuals and the Winter’s classification system was used to categorize the third molars. Third molar extraction was performed under local anesthesia by a single blinded surgeon. The duration of surgery was defined as the time between incision and final suturing.

Data were analyzed by point-biserial correlation and chi-squared test using R software (R Foundation for Statistical Computing, Vienna, Austria).

  Results Top

One hundred eight patients (18–30 years old, mean age: 24.2 ± 5.19) participated in this study (50% male). Percentage of different types of angulations among different genders are not statistically significant (P ˃ 0.05) [Figure 1]. Negatively very weak correlation found between gender and third molar surgery duration (r = −0.15, P = 0. 11, 95% C.I −0.037–0.331) [Figure 2].
Figure 1 Bar plot showed distribution of different type of angulations among different genders.

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Figure 2 Violin plot showed results of the third molar surgery duration among different genders.

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  Discussion Top

We found negatively very weak correlation between gender and surgery duration. Several studies have investigated surgical difficulty in terms of duration.[12],[17],[18] Study of radiological findings prior to surgery is crucial and ultimately helps to reduce anxiety and fear and increase patient satisfaction. Although several studies have attempted to evaluate the influence of patient factors on surgical difficulty, the findings remain ambiguous.

Demographic, radiological, and surgical parameters were correlated with surgical difficulty.[17] In previous studies, the gold standard for determining the difficulty of third molar extraction was the duration of the procedure,[13],[15] which has been reported to range between 8 and 45 minutes, with a mean of 17.88 minutes. Other studies have reported longer durations ranging from 7.74 to 105 minutes. [6, 7, 10–15,19–21] In this study, the mean surgical duration was 33.75 ± 15.77 minutes. Such variations in surgical duration can be explained by variables such as the definition of duration of surgery, the experience of the surgeon,[19] micro-motor speed and bur sharpness, anxiety, panic, gag reflex, mouth opening, and general infrastructure.[22]

Some studies showed that sex and the type of impaction were significantly associated with the duration of third molar surgery.[9],[18],[21],[22] However, several studies have shown that there was no significant relationship between surgery duration and patient sex.[7],[12],[13],[14] In line with these findings, we also did not find a statistically significant relationship between sex and the duration of third molar surgery, although it was longer in women than in men. A longer duration of third molar surgery has been associated with frequent complications in women.[7]

Previous studies showed, in decreasing order, the most common forms of tooth impactions are: mesioangular, vertical, horizontal, and distoangular.[4],[21] However, in this study, the most prevalent type of was mesioangular, followed by distoangular, straight, and horizontal. Although the type of impaction is an important factor in third molar extraction, contradictory findings have been reported. In one study, the impaction type was not significantly related to the surgery duration.[21] However, other studies have highlighted that the difficulty of extraction is directly influenced by the position of the impacted tooth.[12],[13],[14],[15] Another study reported that the impacted tooth position was not related to surgical difficulty; rather, it was correlated to bony impaction.[20] The angle and depth of impaction, root development, and root morphology are all critical radiographic considerations.[14],[15]

Another study highlighted that factors such as age, sex, teeth angulation, and depth of impaction were not significantly associated with the duration of surgery.[24] Similarly, we were unable to find a significant relationship between sex and surgery duration.

Nevertheless, despite contradictory reports and the absence of consensus among researchers, factors such as age, gender, surgeon’s experience, side, body mass index, ethnicity, extraction method, impaction depth, ramus relationship, angulation, root development, root morphology, mandibular canal relationship, root width, patient anxiety, fear, gag reflex, and mouth opening have been reported as influential factors regarding difficulty of third molar extraction.[6],[9],[12],[13],[14],[15]

As a suggestion for future research, conduction of systematic reviews with meta-analyses to summarize several contradictory reports regarding relationship between difficulty of third molar surgery and sex is recommended.

This study had several limitations. The first was the minimal sample size. We suggest more studies with larger sample sizes. Second, we did not consider other patient factors such as body mass index, age, medical history, and nutritional status as co-factors for predicting the association with surgical duration. Third, there was no postoperative follow-up. Despite these limits, this study provided useful insights into the association between patient sex and duration of impacted third molar extraction.


The authors appreciate all the support provided by the Universities of Tikrit and Anbar.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Carter K, Worthington S. Predictors of third molar impaction: a systematic review and meta-analysis. J Dent Res 2016;95:267-76.  Back to cited text no. 2
Boeddinghaus R, Whyte A. Dental panoramic tomography: an approach for the general radiologist. Australas Radiol 2006;50:526-33.  Back to cited text no. 3
Latt MM, Chewpreecha P, Wongsirichat N. Prediction of difficulty in impacted lower third molars extraction; review literature. M Dent J 2015;35:281-90.  Back to cited text no. 4
Patel S, Mansuri S, Shaikh F, Shah T. Impacted mandibular third molars: a retrospective study of 1198 cases to assess indications for surgical removal, and correlation with age, sex and type of impaction—a single institutional experience. J Maxillofac Oral Surg 2017;16:79-84.  Back to cited text no. 5
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Park KL. Which factors are associated with difficult surgical extraction of impacted lower third molars? J. Korean Assoc Oral Maxillofac Surg 2016;42:251-8.  Back to cited text no. 9
Bello SA, Adeyemo WL, Bamgbose BO, Obi EV, Adeyinka AA. Effect of age, impaction types and operative time on inflammatory tissue reactions following lower third molar surgery. Head Face Med 2011;7:1-8.  Back to cited text no. 10
Osunde OD, Saheeb BD. Effect of age, sex and level of surgical difficulty on inflammatory complications after third molar surgery. J Maxillofac Oral Surg 2015;14:7-12.  Back to cited text no. 11
Gbotolorun OM, Arotiba GT, Ladeinde AL. Assessment of factors associated with surgical difficulty in impacted mandibular third molar extraction. J Oral Maxillofac Surg 2007;65:1977-83.  Back to cited text no. 12
Obimakinde OS, Okoje VN, Ijarogbe OA, Obimakinde AM. Role of patients’ demographic characteristics and spatial orientation in predicting operative difficulty of impacted mandibular third molar. Ann Med Health Sci Res 2013;3:81-4.  Back to cited text no. 13
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  [Figure 1], [Figure 2]


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