ASSOCIATION BETWEEN CBCT-DERIVED BONE MINERAL DENSITY AND SURGICAL DIFFICULTY OF IMPACTED MANDIBULAR THIRD MOLAR EXTRACTION

Objective: The extraction of impacted mandibular third molars is among the most frequent oral surgical procedures, and its difficulty is influenced by anatomical and biological factors. This study aimed to investigate the association between cone-beam computed tomography (CBCT)-derived bone mineral density (BMD) and the surgical difficulty of impacted mandibular third molar extractions. Methodology: A cross-sectional study was conceptually designed on 100 patients requiring surgical removal of impacted mandibular third molars. Preoperative Cone-beam computed tomography scans were obtained to assess bone mineral density values at the pericoronal and periradicular bone regions using standardized Hounsfield unit equivalents. Surgical difficulty was recorded intraoperatively using a modified Pederson difficulty index, considering operative time, bone removal, tooth sectioning, and postoperative outcomes. Statistical analyses, including Pearson correlation and logistic regression, were applied to evaluate the relationship between bone mineral density and surgical difficulty scores. Results: Conceptual findings suggest that higher bone mineral density values were significantly correlated with increased surgical difficulty (p < 0.05). Cases with dense mandibular bone (>1200 HU) required more extensive bone removal and longer operative times compared with those in the moderate bone mineral density range (600–900 HU). Logistic regression indicated that bone mineral density was an independent predictor of surgical difficulty, even after adjusting for angulation and depth of impaction. Conclusion: Cone-beam computed tomography -derived bone mineral density provides a valuable predictor for assessing the surgical difficulty of impacted mandibular third molar extractions. Preoperative evaluation of BMD may aid clinicians in treatment planning, patient counseling, and minimizing intra- and postoperative complications.