Systematic Risk Assessment Prior to Oral Surgery

Objective Clinical decision-making is based on intuition and experience, patients value, and the biological plausibility supported by literature. Prior to oral surgery the surgeon must consider patient-related, surgical-related and tooth-related factors. It can be limited by human ability, which is why artificial intelligence is suggested to improve clinical decision-making. An assessment tool that predicts complications has not yet been established.

Aim This study aims to evaluate the incidence and predictors of intra- and postoperative complications and assess the surgeon's ability to foresee these events. The study aims to systematize predictable variables to create an artificial intelligence prediction model to assist the oral surgeon in clinical decision-making. The current study will describe the frequencies of complication at a private referral clinic, Specialtandlægerne Sjælland (SPSJ), and clarify the impact of the surgeon and patient as predictive variables. The study contributes to advancing the use of artificial intelligence with the aim of improving clinical outcomes for patients, reducing the occurrence of complications intra- and postoperatively as well as ease the work of the surgeon. The study can potentially provide information regarding optimizing treatment, prognosis, survival and success of oral surgery. In addition, the study will provide valuable information about the surgeon's predictive abilities, and the impact of the patient's anxiety level and personal characteristics on the outcome of successful treatment.

Background The current study will explore the most frequent surgical intervention at a referral dental clinic being third molar removal, apical root surgery and placement of dental implants. Complications can occur intra- and postoperatively and are rarely fatal but often disabling in the short- or longterm. Expected predictive variables will be reported. Sociodemographic factors, patient-related factors and surgeon-related factors will be reported in the same manner independently of the surgical procedure. Additionally, anatomic factors, pathological factors as well as factors related to surgical procedure might affect the risk of complications.

There is a lack of evidence in measuring surgeons' experience and the clinical impact of it as a predictive factor. Studies report a higher incidence of complications occurs for patients operated by less experienced surgeons, hereof an increased risk for alveolar nerve deficiency and postoperative pain. Contradictory, seniority did not impact operation time according to previous studies. Apical surgery requires special knowledge and skills. A study compared the pooled success rate between endodontists and oral and maxillofacial surgeons, with a slightly higher success rate from endodontists, but a greater confidence interval in the group of surgeons. The international team for implantology (ITI) consensus report 2019 states that the clinician constitutes a significant risk factor, however it is not included in the Simple-Advanced-Complex classification guideline due to lack of accuracy in its measure. The investigators will include the surgeon's risk assessment of complications, as well as a self assessment evaluation postoperatively.

Dental anxiety level can affect the postoperative recovery, have serious implications in clinical situations and is reported to impact the intraoperative difficulty. Anxiety can have different expressions, but an objective measure of anxiety is the Spielberger State-Trait Anxiety Inventory (STAI). Measuring the state anxiety prior to the surgery has not yet been examined in a dental referral clinic. This study will ask the patients to fill out the STAI-6 to measure state anxiety prior to the surgery. An association of negative affectivity (NA) and decreased oral health related quality of life has been found. NA is suggested to have influence on human experience and includes fear, anxiety, stress level, anger, guilt, hostility, irritability, being ashamed and jittery. Additionally, lack of compliance can delay implant treatment due to an indirect effect on the outcome. This study will elucidate the connection between NA, state anxiety and oral surgery.