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Risks and benefits of removal of impacted third molars

A critical review of the literature
  • P. Mercier
    Affiliations
    Departments of Oral and Maxillofacial Surgery, St. Mary's Hospital, Montreal, Canada

    Dalhousie University, Halifax, Canada
    Search for articles by this author
  • Author Footnotes
    1 Address: Dr. D. S. Precious Professor, Oral and Maxillo facial Surgery Dalhousie University Halifax, Nova Scotia Canada. B3H 3J5.
    D. Precious
    Footnotes
    1 Address: Dr. D. S. Precious Professor, Oral and Maxillo facial Surgery Dalhousie University Halifax, Nova Scotia Canada. B3H 3J5.
    Affiliations
    Departments of Oral and Maxillofacial Surgery, St. Mary's Hospital, Montreal, Canada

    Dalhousie University, Halifax, Canada
    Search for articles by this author
  • Author Footnotes
    1 Address: Dr. D. S. Precious Professor, Oral and Maxillo facial Surgery Dalhousie University Halifax, Nova Scotia Canada. B3H 3J5.
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      Abstract

      A critical review of the literature about risks and benefits of the removal of impacted 3rd molar teeth is presented in 4 categories: risk of nonintervention, risk of intervention, benefit of non-intervention and benefit of intervention. There are well-defined criteria for removal of impacted 3rd molar teeth. Absolute indications and contra-indications for the removal of asymptomatic 3rd molar teeth cannot be established because no long-term studies exist which validate the benefit to the patient either of early removal or of deliberate retention of these teeth. The prudent course of action for the clinician to follow is based on rational clinical decision-making using traditional methods of evaluation to effect the optimal outcome, keeping the interests of the individual patient above all else.

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      References

        • Ades A
        • Joondeph D
        • Little R
        • Chapko M
        A long-term study of the relationship of third molars to changes in the mandibular dental arch.
        Am J Orthod Dentofac Orthop. 1990; 97: 323-335
        • Al-Khateeb T
        • El-Marsa Fl A
        • Butler N
        The relationship between the indications for the surgical removal of impacted third molars and the incidence of alveolar osteitis.
        J Oral Maxillofac Surg. 1991; 49: 141-145
        • Altonen M
        • Haavikko K
        • Mattila K
        Developmental position of lower third molar in relation to gonial angle and lower second molar.
        Angle Orthod. 1977; 47: 249
        • ASH M
        • Costitch E
        • Hayward J
        A study of the periodontal hazard of third molars.
        J Periodont. 1962; 33: 209-219
        • Azaz B
        • Taicher S
        Indications for the removal of the mandibular impacted third molar.
        JCDA. 1982; 48: 731-734
        • Debrabander E
        • Cattaneo G
        The effect of surgical drain together with a secondary closure technique on postoperative trismus swelling and pain after mandibular third molar surgery.
        Int J Oral Maxillofac Surg. 1988; 17: 119-121
        • Bergstrom K
        • Jensen R
        Responsibility of third molars for secondary crowding.
        Dental Abstracts. 1961; 6: 544-545
        • Berwick J
        • Lessin M
        Effects of chlorhexidine gluconate oral rinse on the incidence of alveolar osteitis in mandibular third molar surgery.
        J Oral Maxillofac Surg. 1990; 48: 444-448
        • Bierne O
        • Ross L
        • Hollander B
        The effect of methylprednisone on pain, trismus and swelling after removal of third molars.
        Oral Surg. 1986; 61: 134-138
        • Birn H
        Kinin and pain in dry socket.
        Int J Oral Surg. 1972; 1: 34-42
        • Birn H
        Etiology and pathogenesis of fibrinolytic alveolitis.
        Int J Oral Surg. 1973; 2: 211-263
        • Bjork A
        • Jensen E
        • Palling M
        Mandibular growth and third molar impaction.
        Acta Odont Scand. 1956; 14: 231-272
        • Bjork A
        • Skieller
        Normal and abnormal growth of the mandible.
        Eur J Orthod. 1983; 5: 1-36
        • Bjornland T
        • Haanaes HR
        • Lind PO
        • Zachrisson B
        Removal of third molar germs. Studies of complications.
        Int J Oral Maxillofac Surg. 1987; 16: 385-390
        • Brekke JH
        • Bresner M
        • Reitman JM
        Polylactic acid surgical dressing material: postoperative therapy for dental extraction wounds.
        JCDA. 1986; 52: 599-602
        • Broadhent BH
        The influence of the third molars on the alignment of teeth.
        Am J Orthod. 1943; 29: 312-330
        • Bruce RA
        • Frederickson GC
        • Small GS
        Age of patients and morbidity associated with mandibular third molar surgery.
        JADA. 1980; 101: 240-245
        • Butler D
        • Sweet J
        The effect of lavage on incidence of localized osteitis in mandibular third molar extraction.
        Oral Surg. 1977; 44: 14-20
        • Bystedt H
        • Nordenram A
        Effect of methylprednisilone on complications after removal of impacted mandibular third molars.
        Swed Dent J. 1985; 9: 65-69
        • Chapman PJ
        Postoperative pain control for outpatient oral surgery.
        Int J Oral Maxillofac Surg. 1987; 16: 319-324
        • Chapman PJ
        A controlled comparison of bupivicaine for postoperative pain control.
        Aust Dent J. 1983; 33: 288-290
        • Chin Que TA
        • Gosselin D
        • Millar EP
        • Stamm JW
        Surgical removal of the fully impacted mandibular third molar: The influence of flap design and alveolar bone height on the periodontal status of the second molar.
        J Periodont. 1985; 56: 625-630
        • Conklin WW
        • Stafne EC
        A study of odontogenic epithelium in the dental follicle.
        JADA. 1949; 39: 143-148
        • Corlo RS
        • Goldblatt SJ
        • Edwards PA
        • Hartman KS
        Ameloblastic carcinoma: a clinico pathologic study and assessment of eight cases.
        Oral Surg. 1987; 64: 570-576
        • Curran JB
        • Kennett S
        • Young AR
        An assessment of the use of prophylactic antibiotics in third molar surgery.
        Int J Oral Surg. 1974; 3: 1-6
        • Dachi SF
        • Howell FV
        A survey of 3,874 routine full mouth radiographs II: a study of impacted teeth.
        Oral Surg. 1961; 14: 1165-1169
        • Dionne R
        • Siska A
        • Fox P
        Suppression of postoperative pain by preoperative administration of flurbiporfen in comparison to acetaminophen and oxycodone and acetaminophen.
        Curr Ther Res. 1983; 34: 15
        • Donoff B
        Manual of oral and maxillofacial surgery. Mosby, Boston1987: 16
        • Dubois D
        • Pizer M
        • Chinnis R
        Comparison of primary and secondary closure techniques after removal of impacted mandibular third molars.
        J Oral Maxillofac Surg. 1982; 40: 631-634
        • Ediby JI
        • Canniff JP
        • Harris M
        A double blind placebo controlled trial of the effects of dexamethasone on postoperative swelling.
        J Dent Res. 1982; 61: 556
        • Eliasson S
        • Heimdahl A
        • Nordenram A
        Pathological changes related to long term impaction of third molars: a radiographic study.
        Int J Oral Maxillofac Surg. 1989; 8: 210-212
        • Eppley B
        • Doucet M
        • Winkelmann T
        • Delfino J
        Effect of different surgical repair modalities on regeneration of rabbit mandibular nerve.
        J Oral Maxillofac Surg. 1989; 47: 257-276
        • Ferdousi AM
        • MacGregor AJ
        The response of the peripheral branches of the trigeminal nerve to trauma.
        Int J Oral Surg. 1985; 14: 41-46
        • Ferreira SH
        Prostaglandins, aspirin-like drugs and analgesia.
        Nature. 1972; 240: 200-203
        • Garcia RI
        • Chauncey HH
        The eruption of third molars in adults: A 10-year longitudinal study.
        Oral Surg. 1989; 68: 9-13
        • Gersel-Pedersen N
        Tranexamic acid in alveolar socket in the prevention of ASD.
        Int J Oral Surg. 1979; 8: 421-429
        • Goldberg MH
        • Nemerich AN
        • Marco WP
        Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in private practice.
        JADA. 1985; III: 277-279
        • Graber T
        • Kaineg T
        The mandibular third molar: its predictive status and role in lower incisor crowding.
        in: Proc Finn Dent Soc. 77. 1991: 37-44
        • Grondahl HG
        • Lekholm M
        Influence of mandibular third molars on related supporting tissues.
        Int J Oral Surg. 1973; 2: 137-142
        • Guernsey L
        • Dechamplain R
        Sequellae and complications of the intraoral sagittal split osteotomy.
        Oral Surg. 1971; 32: 176-192
        • Guralnick W
        • Wilkes JW
        • Aschaffenburg PH
        • Frazier HW
        • House JE
        • Chauncey HH
        Incidence of and progressive pathological changes associated with impacted third molar teeth.
        J Dent Res. 1982; 52 (special issue abstract): 14-28
        • Guralnick W
        Third molar surgery.
        Br Dent J. 1984; 156: 389-394
        • Hall D
        Vestibuloplasty and mucosal grafts.
        J Oral Surg. 1971; 29: 786-791
        • Hall D
        • Bildman B
        • Hand C
        Prevention of dry socket with local application of tetracycline.
        J Oral Surg. 1971; 29: 35-37
        • Happonen R
        • Backstrom A
        • Ylipaavalniemi P
        Prophylactic use of phenoxymethyl penicillin and tinidazole in mandibular third molar surgery: a comparative placebo controlled clinical study.
        Br J Oral Maxillofac Surg. 1990; 28: 12-15
        • Head TW
        • Bentley KC
        • Millar EP
        A comparative study of the effectiveness of Metronidazol and Penicillin V in eliminating anaerobes from post extraction and bacterimias.
        Oral Surg. 1984; 58: 152-155
        • Hellman M
        Our third molar teeth: their eruption, presence and absence.
        Dental Cosmos. 1936; 78: 750-762
        • Hoffman BD
        Mandibular anterior crowding.
        JCDA. 1989; 55: 662
        • Holland CS
        • Hindle MO
        The influence of closure or dressing on third molar sockets on post-operative swelling and pain.
        Br J Oral Maxillofac Surg. 1984; 33: 65-71
        • Holland CS
        The influence of methylprednisolone on postoperative swelling following oral surgery.
        Br J Oral Maxillofac Surg. 1987; 25: 293-299
        • Hooley JR
        • Francis FH
        Dexamethasone in traumatic oral surgery.
        J Oral Surg. 1969; 27: 398-403
        • Hooley JR
        • Hohl TH
        The use of steroid in the prevention of some complications after traumatic oral surgery.
        J Oral Surg. 1974; 32: 864-866
        • Howe GL
        • Poyton HG
        Prevention of damage to the inferior dental nerve during the extraction of mandibular third molars.
        Br Dent J. 1960; 109: 355-363
        • Howe GL
        Minor oral surgery.
        in: 3rd ed. Wright, Toronto1983: 36
        • Huann S
        • Hutton C
        • Kafrawy A
        • Potter R
        Comparison of meclofenamate sodium and hydrocortisone for controlling the postsurgical inflammatory response in rats.
        J Oral Maxillofac Surg. 1988; 46: 777-780
        • Kipp DP
        • Goldstein BH
        • Weiss WW
        Dysesthesia after mandibular third molar surgery: A retrospective analysis of 1,377 surgical procedures.
        JADA. 1980; 100: 185-192
        • Krekmanov L
        Alveolitis after operative removal of third molars in the mandible.
        Int J Oral Surg. 1981; 10: 173-179
        • Krekmanov L
        • Nordenram
        Post-operative complications after surgical removal of mandibular third molar — Effect of penicillin and chlorhexidine.
        Int J Oral Maxillofac Surg. 1986; 15: 25-29
        • Kugelberg CF
        • Ahlstrom V
        • Ericsson S
        • Hugoson A
        Periodontal healing after impacted lower third molar surgery: A retrospective study.
        Int J Oral Surg. 1985; 14: 29-40
        • Kugelberg C
        Periodontal healing two and four years after impacted lower third molar surgery.
        Int J Oral Maxillofac Surg. 1990; 19: 341-345
        • Kugelberg C
        • Ahlstrom U
        • Ericson S
        • Hugoson A
        • Kvint S
        Periodontal healing after impacted lower third molar surgery in adolescents and adults.
        Int J Oral Maxillofac Surg. 1991; 20: 18-24
        • Laskin DM
        Evaluation of the third molar problems.
        JADA. 1971; 82: 824-828
        • Lekholm V
        • Adell R
        • Lindhe J
        • Branemark P
        • Erikson B
        • Lindvall JA
        • Yonehama JT
        Marginal tissue reaction at osseointegrated titanium fixtures.
        Int J Oral Maxillofac Surg. 1986; 15: 53-61
        • Leone SA
        • Edenfield MJ
        • Cohen ME
        Correlation of acute pericoronitis and the position of the mandibular third molar.
        Oral Surg. 1986; 62: 245-250
        • Lilly GE
        • Osborn DB
        • Rael EM
        • Samuel HS
        • Jones JC
        Alveolar osteotis associated with mandibular third molar extractions.
        JADA. 1974; 88: 802-806
        • Lindquist B
        • Thilander B
        Extraction of third molars in cases of anticipated crowding of the lower Jaw.
        Am J Orthod. 1982; 81: 130-139
        • Linenberg WB
        The clinical evaluation of dexamethasone in oral surgery.
        Oral Surg. 1965; 20: 6-28
        • Lysell L
        • Rohlin M
        A study of indications used for removal of the mandibular third molar.
        Int J Oral Maxillofac Surg. 1988; 17: 161-164
        • Lytle JJ
        Indications and contraindications for the removal of the impacted tooth.
        Dent Clin North Am. 1979; 23: 333-346
        • MacGregor AJ
        • Addy A
        The value of penicillin in the prevention of pain, swelling and trismus following removal of ectopic mandibular third molars.
        Int J Oral Surg. 1980; 91: 66-72
        • MacGregor AJ
        The impacted lower wisdom tooth.
        Oxford University Press, Bristol1985
        • MacGregor AJ
        Discussion. The relationship between the indications for the surgical removal of impacted third molars and the incidence of alveolar osteitis.
        J Oral Maxillofac Surg. 1991; 49: 141-145
        • Mason DA
        Lingual nerve damage following lower third molar surgery.
        Int J Oral Maxillofac Surg. 1988; 17: 290-294
        • Messer E
        • Keller J
        The use of intraoral dexamethasone after extractions of mandibular third molars.
        Oral Surg. 1975; 40: 594-598
        • Meyer RA
        Studies of traumatic neuralgia in the maxillofacial region: symptom complexes and response to microsurgery.
        J Oral Maxillofac Surg. 1990; 48: 135-140
        • Middlehurst RJ
        • Barker GR
        • Rood JP
        Post-operative morbidity with mandibular third molar surgery: a comparison of two techniques.
        J Oral Maxillofac Surg. 1988; 46: 474-476
        • Mitchel DA
        A controlled clinical trial of tinidazole for chemoprophylaxis in third molar surgery.
        Br Dent J. 1986; 160: 284-286
        • Moller TF
        • Petersen JK
        Efficacy of a fibrin sealant on healing of extraction wounds.
        Int J Oral Maxillofac Surg. 1988; 17: 142-144
        • Montgomery M
        • Hogg J
        • Roberts D
        • Redding S
        The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery.
        J Oral Maxillofac Surg. 1990; 48: 179-187
        • Mourshed F
        A roentgenographic study in detecting dentigerous cysts in the early stages.
        Oral Surg. 1964; 18: 54-61
        • NIH
        Consensus development conference on removal of third molars. J Oral Surg. 38. 1980: 235-236
        • Nitzan D
        • Keren T
        • Marmary Y
        Does an impacted tooth cause root resorption of the adjacent one?.
        Oral Surg. 1981; 51: 221-224
        • Nitzan DW
        On the genesis of dry socket.
        J Oral Maxillofac Surg. 1983; 42: 706-710
        • Nordenram A
        • Hultin M
        • Kjellman O
        • Ramstrom G
        Indication for surgical removal of third molars: Study of 2630 cases.
        Swed Dent J. 1987; 11: 23-29
        • Oberman M
        • Horowitz I
        • Raymond I
        Accidental displacement of maxillary third molar.
        Int J Oral Maxillofac Surg. 1986; 15: 756-758
        • Osborn TP
        • Frederickson G
        • Small IA
        • Torgerson S
        A prospective study of complications related to third molar surgery.
        J Oral Maxillofac Surg. 1985; 43: 767-769
        • Otten JE
        • Peltz K
        • Christmann G
        Anaerobic bacteremia following tooth extraction and removal of osteosynthesis plates.
        J Oral Maxillofac Surg. 1987; 45: 477-480
        • Pedersen A
        Decadron phosphate in the relief of complaints after third molar surgery.
        Int J Oral Surg. 1985; 14: 235-240
        • Pedersen A
        • Maersk-Moller O
        Volumetric determination of extra-oral swelling from stereophotographs.
        Int J Oral Surg. 1985; 14: 229-234
        • Petersen JK
        • Crogsgaard J
        • Nielsen KM
        • Norgaard E
        A comparison between two absorbable haemostatic agents: gelatin sponge and cellulose.
        Int J Oral Surg. 1984; 13: 406-410
        • Pitronen J
        • Ylipaavalniemi P
        Local predisposing factors and clinical symptoms in pericoronitis.
        in: Proc Finn Dent Soc. 77. 1981: 278-282
        • Poswillo D
        Surgical options for third molars: a review.
        J R Soc Med. 1981; 74: 911-913
        • Price C
        Unerupted third molars.
        JCDA. 1989; 55 (letter): 453
        • Pullingen A
        • Monteiro A
        History factors associated with symptoms of temporomandibular disorders.
        J Oal Rehab. 1988; 15: 117-124
        • Rantanen A
        The age of eruption of third molar teeth.
        Acta Odont Scand. 1961; 25
        • Regezi JA
        • Kerr DA
        • Courtnex RM
        Odontogenic tumors: analysis of 706 cases.
        J Oral Surg. 1978; 36: 771-778
        • Stephens
        • et al.
        JCDA. 1989; 55 (Responses to): 453
        • Stephens
        • et al.
        JCDA. 1989; 55 (Responses to): 662
        • Richardson ER
        • Malhotra SK
        • Semenya K
        Longitudinal study of three views of mandibular 3rd molar eruption in males.
        Am J Orthod. 1984; 86: 119-129
        • Richardson ME
        The aetiology and prediction of mandibular third molar impaction.
        Angle Orthod. 1977; 47: 165-172
        • Richardson ME
        The development of third molar impaction and its prevention.
        Int J Oral Surg. 1981; 10: 122-130
        • Richardson ME
        Lower molar crowding in the early permanent dentition.
        Angle Orthod. 1985; 55: 51-57
        • Richardson ME
        Lower third molar space.
        Angle Orthod. 1987; 57: 155-161
        • Richardson ME
        The role of the third molar in the cause of late lower arch crowding: a review.
        Am J Orthod Dentofac Orthop. 1989; 95: 79-83
        • Rickets R
        Studies of the practice of abortion of lower third molars.
        Dent Clin North Am. 1979; 23: 393-411
        • Ritzau M
        The prophylactic use of transexamic acid on ASD.
        Int J Oral Surg. 1973; 2: 196-199
        • Rood JP
        Lingual split technique.
        Br Dent J. 1983; 154: 402-403
        • Rood JP
        Degrees of injury to the inferior alveolar nerve.
        Br J Oral Surg. 1983; 21: 103-116
        • Rosovsky LE
        Canadian dental law.
        in: Butterworths, 1987: 27
        • Rud J
        • Baggeson H
        • Floe M
        • Oller E
        The effect of sulfa cones and suturing on the incidence of pain after removal of impacted third molars.
        Int J Oral Surg. 1963; 21: 219-226
        • Rud J
        The split bone technique for removal of impacted mandibular third molars.
        J Oral Surg. 1970; 28: 416-421
        • Rud J
        Third molar surgery: relationship of root to mandibular canal and injuries to inferior dental nerve.
        Danish Dent J. 1983; 87: 619-631
        • Schliephake H
        • Neukam F
        Periodontal damage to third molars prior to transplantation.
        Int J Oral Maxillofac Surg. 1989; 18: 55-58
        • Schofield DF
        • Kogon SL
        • Donner A
        Long term comparison of two surgical flap designs for third molar surgery of the periodontal tissues of the second molar tooth.
        JCDA. 1988; 54: 689-691
        • Schow RR
        Evaluation of post-operative localized osteitis in mandibular third molars surgery.
        Oral Surg. 1974; 38: 352-358
        • Schwarze CW
        The influence of third molar germectomy: a comparative long term study.
        in: Cook JT Trans 3rd Int Orthodontic Congress. Staples, Toronto1974: 551-562
        • Seddon HJ
        Three types of nerve injury.
        Brain. 1943; 66: 237-288
        • Sewerin I
        • Von Wowern N
        A radiographic 4 year follow up study of asymptomatic mandibular third molars in young adults.
        Int Dent J. 1990; 40: 24-30
        • Shafer WG
        • Hine MR
        • Levy BM
        4th ed. A textbook of oral pathology. WB Saunders, London1984
        • Shafer S
        Unerupted third molars.
        JCDA. 1989; 55 (letter): 453
        • Shanley SS
        The influence of mandibular third molars on mandibular anterior teeth.
        A J Orthod. 1962; 48: 786-787
        • Shear M
        • Singh S
        Age-standardized incidence rates of ameloblastoma and dentigerous cyst on the Witwatersrand.
        Community Dent Oral Epid. 1978; 6: 195-199
        • Shteyer A
        • Lustmann NJ
        • Sowin-Epstein J
        The muralameloblastoma: a review of the literature.
        J Oral Surg. 1978; 36: 866-872
        • Sisk A
        • Bonnington G
        Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response.
        Oral Surg. 1985; 60: 137-145
        • Sowray JH
        An assessment of the value of lyophilised chymo trypsin in reduction of post-operative swelling after removal of impacted wisdom teeth.
        Br Dent J. 1991; 110: 130-133
        • Stanley HR
        • Alatter M
        • Collett WM
        • et al.
        Pathological sequelae of “neglected” impacted third molar.
        J Oral Pathol. 1988; 17: 113-117
        • Stephens JR
        • APP GR
        • Foreman DW
        Periodontal evaluation of two mucoperiosteal flaps used in removing impacted third molars.
        J Oral Maxillofac Surg. 1983; 42: 719-724
        • Stephens RG
        • Kogon SL
        • Reid JA
        The unerupted or impacted third molar: a critical appraisal of its pathologic potential.
        JCDA. 1989; 55: 201-207
        • Svendson H
        • Malmskov O
        • Bjork A
        Prediction of lower third molar impaction from the frontal cephalometric projection.
        Eur J Orthod. 1985; 7: 1-16
        • Swanson AE
        Reducing the incidence of dry socket: a clinical appraisal.
        JCDA. 1966; 32: 25-33
        • Swanson AE
        Removing the mandibular third molar: Neurosensory deficits and consequent litigation.
        JCDA. 1989; 55: 383-386
        • Swanson AE
        Double blind studies on the effectiveness of tetracycline in reducing the incidence of fibrinolytic alveolitis.
        J Oral Max Fac Surg. 1989; 47: 165-167
        • Szmyd L
        • Hester WR
        Crevicular depth of the second molar in impacted third molar surgery.
        J Oral Surg. 1963; 21: 185-189
        • Tulloch J
        • Antczak-Boukoms A
        Decision analysis of the evaluation of clinical strategies for the management of mandibular third molars.
        J Dent Ed. 1987; 51: 652-660
        • Tulloch J
        • Antczak-Boukoms A
        • Wilkes J
        The application of decision analysis to evaluate the need for extraction of asymptomatic third molars.
        J Oral Maxillofac Surg. 1987; 45: 855-865
        • Van Gool AV
        • Bosch Boering G
        A photographic method of assessing swelling following third molar removal.
        Int J Oral Surg. 1975; 4: 121-129
        • Van Gool AV
        • Ten Bosch Boering G
        Clinical consequences of complaints and complications after removal of mandibular third molars.
        Int J Oral Surg. 1977; 6: 29-37
        • Vego L
        A longitudinal study of mandibular arch perimeter.
        Anglo Orthod. 1962; 32: 187-192
        • Von Arx DP
        The effect of dexamethasone on neurapraxia following third molar surgery.
        Br J Oral Maxillofac Surg. 1989; 27: 477-480
        • von Wowern N
        • Nielsen HO
        The fate of impacted lower third molars after the age of 20: a four year clinical follow-up.
        Int J Oral Maxillofac Surg. 1989; 18: 277-280
        • Waldren CA
        • Mustoe TA
        Primary intraosseous carcinoma of the mandibular with probable origin in an odontogenic cyst.
        Oral Surg. 1989; 67: 716-724
        • Ward TG
        The split bone technique for removal of mandibular third molars.
        Br Dent J. 1956; 101: 297-304
        • Weir JC
        • Davenport WD
        • Skinner RL
        Diagnostic and epidemiologic survey of 15,783 oral lesions.
        JADA. 1987; 115: 439-442
        • Weiss J
        • Yablon P
        • Milton J
        The third molar question: to extract or not to extract.
        J Dent Child. 1984; 21: 277-281
        • Winkler S
        • von Wowern N
        Displacement into maxillary sinus or infratemporal fossa of maxillary third molars.
        J Oral Surg. 1977; 35: 130-132
        • Wofford DT
        • Miller RJ
        Prospective study of dysesthesia following odontectomy of impacted mandibular third molars.
        J Oral Maxillofac Surg. 1987; 45: 15-19
        • Woolf RH
        • Malmquist JP
        • Wright WH
        The molar extractions; periodontal implications of two flaps design.
        Gen Dent. 1978; 26: 52-56
        • Worth HM
        Principle and practice of oral radiologic interpretation.
        in: Year Book Med Publishers, Philadelphia1969: 77
        • Wuerhmann AH
        • Manson-Hing SR
        Dental radiograph.
        5th ed. CV Mosby, Chicago1981
        • Zeigler RS
        Preventive dentistry new concepts: preventing periodontal pockets.
        Va Dent J. 1975; 52: 11-13