The aim of this meta-analysis was to find out the clinical reliability of Pederson index in assessing the difficulty of surgery for impacted mandibular 3rd molar. The relevant articles were selected by Hand search and electronic media (Medline, Pubmed, Embase Cochrane library, ISI web of science) from Jan 2000 to Dec 2010. All the relevant articles were properly screened and findings were extracted from the articles. Pederson index had shown low sensitivity and specificity in predicting the difficulty of surgery for impacted mandibular 3rd molar. Positive and negative likelihood ratio had also shown the unreliability of Pederson index. The meta-analysis of the current literature concluded that Pederson index is not a reliable test to predict the surgical difficulty of impacted mandibular 3rd molar.