Clinical Indications to Germectomy in Pediatric Dentistry: A Systematic Review

Abstract

Germectomy is a procedure often required in patients at developmental age. It is defined as the surgical removal of the third molar at a very specific stage of development. The aim of this study was to systematically analyze the literature in terms of clinical indications for germectomy in patients at developmental age. Literature searches were performed using PubMed, Google Scholar, Cochrane Library and Scopus from 1952 to 30 June 2021. The study protocol was registered after the screening stage (PROSPERO CRD42021262949). The search strategy identified 3829 articles: 167 from PubMed, 2860 from Google Scholar, 799 from Cochrane Library and 3 from Scopus. Finally, eight full-text papers were included into the qualitative analysis. Based on the included studies, clinical indications for germectomy were mainly related to orthodontic causes, infectious and cariogenic causes and prophylaxis. Based on these results, it is not possible to present evidence-based clinical indications for germectomy in patients at developmental age. Clinical trials on this subject focused specifically on patients at developmental age are awaited.

Factors associated with indication of prophylactic extraction of the lower third molar in orthodontic practice

“…For example, men’s jaws continue to grow during the eruption of third molars, while women’s jaws stop growing when third molars begin to erupt ( 19 ). Even the indications for germectomy of the mandibular third molar in class III patients have been described in cases where predictors of craniofacial growth reveal excessive anteroposterior mandibular growth, a severe dentoalveolar discrepancy or in cases where distalization of the first and second molars is necessary ( 20 ).…”

Surgical removal of third molars in a young adult: review of indications and surgical techniques

“…One study determined impacted M3s to be associated with impacted M2s, while another study found that M3 germectomy did not benefit the M2 uprighting process. Meanwhile, the authors of the systematic review supported the idea of M3 germectomy in cases of impacted M2 since delaying M3 removal would only put the M2 at greater risk of dental caries or periodontitis and/or complicate M2 eruption 13 . Furthermore, germectomy of M3s was justified to gain space in cases requiring molar distalization.…”

“…Most authors defined the tooth in the procedure as having one-third or less of its root 6 , 10 . Recently, a systematic review advocated Demirjian’s classification of types B, C, and D for the definition of germectomy 13 , 15 , 16 . ( Fig.…”

“…Anterior crowding represents a longstanding controversy regarding the presence of M3s. In a recent systematic review and in other literature, the issue is debated 13 , 20 , 21 . Mandibular second molar (M2) impaction is another reported indication.…”

Improvement of the Impacted Level of Lower Third Molars After Orthodontic Treatment

“… 4 , 5 Consequently, the number of asymptomatic M3 removals indicated by orthodontists is increasing. 6 However, their ability to predict the prognosis of M3 eruption was inaccurate in approximately 40% of cases. 7 , 8 …”