How Many Wisdom Teeth Does It Take to Learn?
Tracking the learning curve of young dentists during lower wisdom tooth surgery
Removing impacted wisdom teeth is one of the most common surgical procedures in dentistry. Yet, for young dentists in training, this seemingly routine operation is anything but simple. A recent study published in the European Journal of Dental Education takes a closer look at an important question in dental education: how many cases does it take before surgical performance starts to improve?
Why the learning curve matters
In surgery, experience matters—not only for efficiency, but also for patient safety. The concept of a learning curve refers to the number of procedures a clinician needs to perform before reaching a stable and competent level of performance. In dental surgery, understanding this curve can help training programs set realistic expectations and improve supervision strategies.
Lower third molar (wisdom tooth) extraction is particularly relevant because it varies widely in difficulty and carries a risk of complications such as infection, nerve injury, or prolonged pain. Knowing when trainees begin to operate more efficiently could benefit both educators and patients.
What the researchers did
The research team conducted a prospective cohort study involving 174 patients who required removal of an impacted lower wisdom tooth. All surgeries were performed by six second-year postgraduate residents enrolled in an oral surgery and implantology master’s program at the University of Barcelona.
The researchers followed each procedure closely, recording:
Operative time (from first incision to final suture),
Surgeon-reported difficulty, and
The occurrence of incidents—minor intraoperative events that did not qualify as complications but could still affect surgical performance (such as root fractures or flap tears).
By grouping surgeries into blocks of ten cases, the team was able to observe how performance changed with experience.
When improvement begins
The findings revealed a clear pattern. After approximately 10 procedures, residents showed a significant reduction in operative time. In other words, once trainees had performed around ten impacted lower wisdom tooth extractions, they began working faster.
Interestingly, while the number of incidents tended to decrease as experience increased, this trend did not reach statistical significance. This suggests that speed improves earlier than overall surgical smoothness, which may require more prolonged practice.
Importantly, performance was similar across all six residents, indicating that the observed improvement was consistent and not driven by a single high-performing individual.
What makes a case more difficult
Beyond experience, the study also identified factors that made surgery more challenging. Procedures that required crown or root sectioning were consistently associated with longer operative times and higher perceived difficulty. Likewise, wisdom teeth that were deeply impacted against the second molar proved more demanding.
These findings highlight that not all wisdom tooth extractions are equal—and that surgical difficulty depends as much on anatomy as on operator experience.
Why this study is important
This research provides practical insights for dental education. It suggests that around ten supervised cases may be a meaningful milestone for postgraduate trainees to begin gaining efficiency in impacted lower wisdom tooth surgery. While this does not imply full mastery, it offers a data-driven reference point for training programs.
The study also emphasizes the value of tracking incidents, not just complications. Minor intraoperative events can serve as early indicators of where skills still need refinement, supporting reflective learning and continuous improvement.
Take-home message
For young dentists in surgical training, improvement does not happen overnight—but it does happen sooner than many might expect. According to this study, the first ten impacted lower wisdom tooth extractions mark a turning point, where operative efficiency begins to improve. Surgical difficulty, however, remains closely tied to anatomical complexity and technique requirements.
As dental education continues to evolve, studies like this help align training standards with real-world performance—benefiting both clinicians and the patients they serve.
Original Article Reference
Sánchez-Torres A, Sabreen E, Arias-Huerta X, et al.
Learning Curve in the Extraction of Impacted Lower Third Molars: A Prospective Cohort Study.
European Journal of Dental Education. 2025;29:266–276.
DOI: 10.1111/eje.13066