Third Molar Removal: An Overview of Indications, Imaging, Evaluation, and Assessment of Risk

Is there justification for prophylactic extraction of third molars? A systematic review

“…13,14 Moreover, the risks of surgery and associated complications are justified and uniformly accepted by the majority of dental surgeons, when there is clinical, radiological or laboratorial evidence of acute or chronic periodontitis, caries, pericoronitis, harmful effects on second molars or disease. 15,16 Authors enumerate the main reasons leading to the prophylactic extraction of third molars, but these indications do not have sufficient evidence on which to base such a decision. [3][4][5][6] Partially erupted third molars have the greatest likelihood of developing pericoronitis, and are therefore indicated for prophylactic extraction.…”

Prophylactic Extraction of Third Molars: Evidence-Based Dentistry

“…It is a better strategy, therefore, to implement a watchful monitoring of asymptomatic third molars (2,13). In the same context, Marciani (9) has mentioned that, in the absence of demonstrated pathosis, symptoms or orthodontic considerations, patients may subjected to unnecessary pain, surgical risk, and adverse economic consequences. In summary, these authors in general consider that asymptomatic or diseasefree ITM should be left untouched and screened.…”

“…However, diverse studies have demonstrated considerable intra-and inter-dentist variability -including wrong diagnosis-concerning to decisions to extract or not asymptomatic impacted third molars (9,24). Regarding this, the criteria defining the indications for the surgical extraction of these molars are still the origin of considerable debate among dental practitioners (6,8,9,19). Due to these reasons, diverse clinical practice guidelines have been developed in an attempt to increase the professional performance, and to assist the clinicians, patients and parents in making decisions about the appropriate management of ITM (22).…”

“…Therefore, little controversy exists about their surgical removal when they are properly diagnosed. However, the justification for prophylactic extraction of disease-free ITM has remained less clear for many years (4,6,9,11,12).…”

“…absence of antagonist tooth), infection, cellulitis, non-restorable carious lesions, pericoronitis, periodontal disease, cysts, tumors, and second molar and/or bone destruction (4,5,9,10). Therefore, little controversy exists about their surgical removal when they are properly diagnosed.…”