Radiological Predictors of Surgical Duration and Postoperative Pain After Mandibular Third Molar Extraction: Secondary Exploratory Analysis of a RCT

Radiological classification systems are widely used to estimate the difficulty of mandibular third molar extraction, yet their ability to predict patient-centered outcomes remains uncertain. This study investigated whether radiological predictors of surgical difficulty are associated with prolonged operative time and increased postoperative pain, and whether the association between radiological parameters and postoperative pain changes after adjustment for operative time. In this exploratory secondary analysis of a randomized clinical trial, 122 patients undergoing mandibular third molar extraction were evaluated using the Winter and Pell–Gregory classifications and the Pederson difficulty index. Surgical duration was recorded, and postoperative pain was assessed during the early postoperative period using a numeric rating scale. Multivariable regression analyses were applied to identify independent predictors of operative time and postoperative pain. Horizontal and mesioangular impactions were associated with significantly longer operative times. Surgical duration was independently associated with higher postoperative pain (β = 0.03 per minute; R2 = 0.22). Importantly, radiological parameters were no longer significant after adjustment for operative time. These findings indicate that the association between radiological complexity and postoperative pain is not independent of operative time and should be interpreted as reflecting shared variance between these factors rather than a direct relationship.