As the extraction of the mandibular third molars is one of the most common surgical procedures in oral surgery, accurate assessment of its difficulty is helpful for communication between doctors and patients and for controlling intraoperative and postoperative complications. Currently, the most commonly used methods or scales for clinical evaluation of the difficulty of tooth extraction include Winter′s classification, Pell & Gregory classification, and Pederson index, which are not specified and sensitive enough, and no new widely recognized evaluation system has been established. Therefore, this article systematically summarized the possible predictive factors for assessing the difficulty of extracting mandibular third molars, including the anatomical characteristics of the impacted tooth, such as root morphology, impaction angle, depth of impaction, width of the impacted tooth, distance from the second molar to the ramus, periodontal membrane status, and contact with adjacent teeth, as well as the patient information such as age, gender, and body mass index (BMI). The article analyzed the advantages and disadvantages of several current evaluation systems for assessing the difficulty of extracting the mandibular third molars in order to provide useful directions and ideas for establishing a new evaluation system.