Observational studyBMC oral health2026
Development and validation of a comprehensive clinical-radiographic difficulty scale for impacted mandibular third molar extractions: a prospective study.
Observational study in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMost existing difficulty indices for impacted mandibular third molar (IMTM) surgery rely predominantly on radiographic criteria and often underrepresent clinical and systemic contributors to surgical difficulty. We aimed to develop and internally assess a multidimensional clinical–radiographic difficulty score and to examine its association with operation time as a pragmatic criterion measure.
methodsThis prospective observational study was conducted in a single oral and maxillofacial surgery unit using consecutive sampling. The difficulty instrument comprised systemic (3 binary items), radiographic (9 ordinal/binary items), and clinical (6 ordinal/binary items) components, summed to yield a total difficulty score. The primary outcome was operation time (minutes). Continuous variables are reported as mean ± SD and median (IQR). Operation time was compared across predefined difficulty groups using Kruskal–Wallis testing with Bonferroni-adjusted Mann–Whitney U post-hoc comparisons. Criterion-related validity was examined using Spearman correlations with bootstrap confidence intervals. Multivariable linear regression with heteroskedasticity-robust standard errors was used to adjust for age, sex, tooth side, and surgeon experience. Discrimination for prolonged surgery (≥ 75th percentile of operation time) was assessed with ROC analysis.
resultsA total of 215 cases were analyzed. Mean operation time was 13.08 ± 6.64 min, and mean total difficulty score was 16.16 ± 2.24. Operation time differed across difficulty categories (Kruskal–Wallis H = 14.29, p < 0.001). Total score showed a low but significant association with operation time (Spearman ρ = 0.266, p < 0.001). In multivariable regression, total score remained independently associated with operation time (β = 0.811 min per 1-point increase, p < 0.001), while surgeon experience was associated with shorter operation time (β=−0.450 min per year, p < 0.001). ROC analysis showed modest discrimination for prolonged surgery (AUC = 0.661).
conclusionsIn this single-center cohort, the proposed multidomain score showed preliminary internal evidence of criterion-related and known-groups validity and may support preoperative risk stratification and planning. External validation and objective reliability testing (inter-rater/test–retest) are warranted.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.