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Susurla SM, Dodson TB J Oral Maxillofac Surg 2005; 63: 427–434

In a US clinic, 14 surgeons first estimated subjectively on a VAS the importance of 21 randomly ordered factors in assessing difficulty. The estimates were averaged as a mean estimate of importance (MEI) for each factor. The surgeons (mean surgical experience 8.7 ± 10.9 yrs) removed 450 M3s from 150 outpatients during a period of 15 months, and one person observed them. Extraction time was used as an outcome to assess objective importance of the individual factors.

Mean extraction time was 6.8 (±7.2) min. MEIs showed that surgeons considered radiographic anatomical and operative variables to be more important for assessing extraction difficulty. Multivariate linear regression showed an association with M3 extraction time for gender, arch location, Winter's classification, tooth morphology, number of teeth extracted, procedure type and surgical experience. This correlated well (r = 0.86; P< 0.01) with surgeons' estimates of importance. However, for mandibular M3s only, MEIs did not correlate significantly, and the authors suggest this indicates a lesser understanding of the relevant factors for these teeth.