WHARFE Assessment

The six factors chosen for scoring are:

Winters classification
Height of the mandible
Angulation of the 2nd molar
Root shape & morphology
Follicle development
Path of Exit of the tooth during removal

The scoring by this system helps the beginners to anticipate problems and to avoid
difficult impactions. Unfortunately, the disadvantage of this method is that it is
related only to radiological features alone; the details of the surgical procedures
are not considered. The total scoring is directly related corresponding difficulties in
removing that impacted teeth.
Assessment of difficulty of third molar surgery is fundamental to forming an optimal
treatment plan in order to minimise complications. A compilation of both clinical
and radiological information is necessary to make an intelligent estimate of the time
required to remove a tooth and whether it would be better done just under LA or
under LA Sedation or GA.

There are a number of classifications / scales that try to be predictive of the
extraction however each has its good and bad points.

There has been an attempt to computerise the assessment of impacted 3rd
molars. However good this is though, there is still the problem of whether the
scale used is of any use or widely understood.

The acid test for any of these classifications / scales is whether they are actually
used in OMFS Departments or dental surgeries. From personal experience, they
are not.

Factors that Make Surgery Less Difficult:

Mesio-angular impaction
Class 1 ramus
Class A depth
Roots 1/3 – 2/3 formed (present in the younger patient)
Fused conical roots
Wide periodontal ligament (present in the younger patient)
Large follicle (present in the younger patient)
Elastic bone (present in the younger patient)
Separated from 2nd molar
Separated from IDN
Soft tissue impaction

Factors that Make Surgery More Difficult:

Disto-angular impaction
Class 3 ramus
Class C depth
Long thin roots (present in the older patient)
Divergent curved roots
Narrow periodontal ligament (present in the older patient)
Thin follicle (present in the older patient)
Dense, inelastic bone (present in the older patient)
Contact with 2nd molar
Close to IDN
Complete bony impaction.