Transalveolar extraction of impacted mandibular third molars frequently presents formidable clinical challenges that may significantly impede postoperative convalescence. This investigation aimed to assess whether clinical diagnostic complexities influence the trajectory of patient recovery. In this prospective study, 135 healthy adults (68 females, 67 males; mean age 27.3 ± 6.4 years) underwent mandibular third molar surgery under local anesthesia. Clinical diagnostic complexity was quantified using the Pederson Difficulty Index (PDI) derived from panoramic radiographs. Surgical duration (mean 9.4 ± 4.0 min) and complications - bleeding, swelling, trismus, pain, nerve paresthesia, infection, dry socket, TMJ disorders, and mandibular fracture—were systematically evaluated at postoperative days 3 and 7. Postoperative morbidity was most notable in pain (119 cases) and trismus (65 cases), with mild to moderate swelling in approximately 94% of patients; transient lingual nerve paresthesia occurred in two cases, with no other serious sequelae. This study demonstrated that cases with severe clinical complexity were associated with marginally higher complication rates and slightly longer extraction times compared with cases classified as moderate or mild by the difficulty index.
Chaudhary et al. (2026) studied this question.