Rotational drift of mandibular third molar teeth is a challenge for clinicians to predict and manage. Evidence on the incidence and degree of rotation is sparse. As the factors influencing rotation are not defined, prediction is impossible. A series of four cases with lower third molar rotation are presented and discussed. Significant rotation can alter the degree of difficulty for an extraction. A lack of well-documented cases has hindered investigation of this phenomenon. Further research is required to identify the aetiology, incidence and increase in risk factors caused by such rotational drift.