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Background <p>Impacted third-molar extraction is among the most frequently performedoral surgical procedures and remains commonly associated with postoperativecomplications such as pain, alveolar osteitis, neurosensory injury, trismus, and delayedhealing. Emerging evidence suggests that preoperative pain characteristics—intensity,chronicity, and referral patterns—may influence these outcomes throughneuroinflammatory and sensitisation mechanisms, yet findings across studies remaininconsistent.</p> Objective <p>To systematically review and meta-analyse the predictive value ofpreoperative pain intensity, chronicity, and referral patterns for postoperativecomplications following impacted third-molar surgery.</p> Methods <p>This review adhered to PRISMA 2020 guidelines and was prospectivelyregistered on PROSPERO (CRD420251123273). Comprehensive searches ofPubMed, Embase, Scopus, Cochrane CENTRAL, Web of Science, and grey literaturewere conducted up to June 2025. Eligible studies included prospective cohorts orrandomised controlled trials assessing preoperative pain using validated scales (VAS/NRS) in patients aged ≥16 years with a minimum follow-up of 7 days. Randomeffects meta-analyses calculated standardised mean differences (SMDs) and riskratios (RRs) with 95% confidence intervals (CIs).</p> Results <p>From 3,456 records, 28 studies (n = 10,832 patients) met inclusion criteria.Severe preoperative pain (VAS &gt; 60 mm) was associated with significantly higherpostoperative pain at 7 days (SMD 0.78, 95% CI 0.62–0.94; I² = 65%). Chronic pain(≥3 months) increased the risk of alveolar osteitis (RR 1.68, 95% CI 1.35–2.09; I² =50%) and delayed mucosal healing (mean difference 3.8 days, 95% CI 2.5–5.1; I² =70%). Referred preoperative pain doubled the risk of nerve injury (RR 2.05, 95% CI1.28–3.27; I² = 45%). Younger patients (16–19 years) demonstrated strongerassociations.</p> Conclusion <p>Preoperative pain characteristics are strong and independent predictors ofpostoperative complications after impacted third-molar surgery. Standardised painassessment should be incorporated into preoperative evaluation, and patients withsevere, chronic, or referred pain warrant multimodal analgesia, nerve-sparingtechniques, and extended postoperative monitoring.</p>

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Preoperative Pain Intensity, Chronicity, and Referral as Predictors of Postoperative Complications in Impacted Third Molar Surgery: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年1月3日

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  • Chandrashekhar Chattopadhyay,
  • Vikas Deo,
  • Charu Chouhan,
  • Mamta Patel,
  • Ayush Garg,
  • Sugandha Jain,
  • Priti Airun

摘要

Background

Impacted third-molar extraction is among the most frequently performedoral surgical procedures and remains commonly associated with postoperativecomplications such as pain, alveolar osteitis, neurosensory injury, trismus, and delayedhealing. Emerging evidence suggests that preoperative pain characteristics—intensity,chronicity, and referral patterns—may influence these outcomes throughneuroinflammatory and sensitisation mechanisms, yet findings across studies remaininconsistent.

Objective

To systematically review and meta-analyse the predictive value ofpreoperative pain intensity, chronicity, and referral patterns for postoperativecomplications following impacted third-molar surgery.

Methods

This review adhered to PRISMA 2020 guidelines and was prospectivelyregistered on PROSPERO (CRD420251123273). Comprehensive searches ofPubMed, Embase, Scopus, Cochrane CENTRAL, Web of Science, and grey literaturewere conducted up to June 2025. Eligible studies included prospective cohorts orrandomised controlled trials assessing preoperative pain using validated scales (VAS/NRS) in patients aged ≥16 years with a minimum follow-up of 7 days. Randomeffects meta-analyses calculated standardised mean differences (SMDs) and riskratios (RRs) with 95% confidence intervals (CIs).

Results

From 3,456 records, 28 studies (n = 10,832 patients) met inclusion criteria.Severe preoperative pain (VAS > 60 mm) was associated with significantly higherpostoperative pain at 7 days (SMD 0.78, 95% CI 0.62–0.94; I² = 65%). Chronic pain(≥3 months) increased the risk of alveolar osteitis (RR 1.68, 95% CI 1.35–2.09; I² =50%) and delayed mucosal healing (mean difference 3.8 days, 95% CI 2.5–5.1; I² =70%). Referred preoperative pain doubled the risk of nerve injury (RR 2.05, 95% CI1.28–3.27; I² = 45%). Younger patients (16–19 years) demonstrated strongerassociations.

Conclusion

Preoperative pain characteristics are strong and independent predictors ofpostoperative complications after impacted third-molar surgery. Standardised painassessment should be incorporated into preoperative evaluation, and patients withsevere, chronic, or referred pain warrant multimodal analgesia, nerve-sparingtechniques, and extended postoperative monitoring.