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a a Figs. 7a–c Coronal width: (a) < 10.0 mm (1); (b) 10.0–11.5 mm (2); and (c) > 11.5 mm (3). Fig. 8a–c Distance from mandibular ramus to distal surface of the second molar: (a) 10.5–14 mm (1); (b) 8.0–10.5 mm (2); and (c) 2.0–8.0 mm (3). E v a l u a t i o n o f s u r g i c a l d i f f i c u l t y o f e x t r a c t i o n b b c c Figs. 7a–c Figs. 8a–c According to the model, higher scores on the radiographic scale were associated with longer ostectomy time and total surgical time. For each additional point increase on the scale, the ostectomy time was seen to increase by 2.89 s, while the total surgical time increased by 0.56 s. Discussion In order to successfully predict the dificulty of impacted mandibular third molar extraction, consideration is required of the clinical and ra- diographic findings, which not only help to plan surgery, but also to increase patient satisfaction with the treatment received. Barreiro-Torres et al. underscored the importance of operator exper tise in establishing a prior diagnosis of sur- gical dificulty, since an expert dental profes- sional tends to underestimate surgery and only examine the radiographs—and this in turn can lead to a failed estimation of extraction difi- culty.8 The various systems developed for estimat- ing surgical dificulty in extracting impacted mandibular third molars are based on preoper- ative examination of the panoramic radiographs. Although the classifications of Pell and Gregory1 and Winter2 have served as references, some authors, such as García-García et al.,9 have found the classification of Pell and Gregory to ofer low sensitivity: It failed to detect many of those cases that subsequently proved to be very dif- ficult when classified with the scale of Parant.10 This scale,10 in contrast to the presurgical radio- graphic scale used in the present study, was designed to assess the dificulty of extraction from the clinical perspective: It is based on the need for rating from greater to lesser surgical effort, but lacks predictive value. Pedersen3 added a further factor to the classification of Pell and Gregory1—the position of the third molar— and predicted surgical dificulty from the sum of the individual scores of the scale. With the aim of establishing a preoperative diagnosis of surgical dificulty, various investi- gators have proposed scales based on a series of clinical and radiographic parameters. Peñar- rocha et al. added the variables of inclination of the third molar and inclination of the second molar, pericoronal radiolucency, pericoronal space, Winter’s distance, length and type of root, 56 Volume 3 | Issue 1/2017 Journal of Oral Science & Rehabilitation