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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.
Key words
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References
- 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
- 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
- Developmental position of lower third molar in relation to gonial angle and lower second molar.Angle Orthod. 1977; 47: 249
- A study of the periodontal hazard of third molars.J Periodont. 1962; 33: 209-219
- Indications for the removal of the mandibular impacted third molar.JCDA. 1982; 48: 731-734
- 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
- Responsibility of third molars for secondary crowding.Dental Abstracts. 1961; 6: 544-545
- 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
- The effect of methylprednisone on pain, trismus and swelling after removal of third molars.Oral Surg. 1986; 61: 134-138
- Kinin and pain in dry socket.Int J Oral Surg. 1972; 1: 34-42
- Etiology and pathogenesis of fibrinolytic alveolitis.Int J Oral Surg. 1973; 2: 211-263
- Mandibular growth and third molar impaction.Acta Odont Scand. 1956; 14: 231-272
- Normal and abnormal growth of the mandible.Eur J Orthod. 1983; 5: 1-36
- Removal of third molar germs. Studies of complications.Int J Oral Maxillofac Surg. 1987; 16: 385-390
- Polylactic acid surgical dressing material: postoperative therapy for dental extraction wounds.JCDA. 1986; 52: 599-602
- The influence of the third molars on the alignment of teeth.Am J Orthod. 1943; 29: 312-330
- Age of patients and morbidity associated with mandibular third molar surgery.JADA. 1980; 101: 240-245
- The effect of lavage on incidence of localized osteitis in mandibular third molar extraction.Oral Surg. 1977; 44: 14-20
- Effect of methylprednisilone on complications after removal of impacted mandibular third molars.Swed Dent J. 1985; 9: 65-69
- Postoperative pain control for outpatient oral surgery.Int J Oral Maxillofac Surg. 1987; 16: 319-324
- A controlled comparison of bupivicaine for postoperative pain control.Aust Dent J. 1983; 33: 288-290
- 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
- A study of odontogenic epithelium in the dental follicle.JADA. 1949; 39: 143-148
- Ameloblastic carcinoma: a clinico pathologic study and assessment of eight cases.Oral Surg. 1987; 64: 570-576
- An assessment of the use of prophylactic antibiotics in third molar surgery.Int J Oral Surg. 1974; 3: 1-6
- A survey of 3,874 routine full mouth radiographs II: a study of impacted teeth.Oral Surg. 1961; 14: 1165-1169
- Suppression of postoperative pain by preoperative administration of flurbiporfen in comparison to acetaminophen and oxycodone and acetaminophen.Curr Ther Res. 1983; 34: 15
- Manual of oral and maxillofacial surgery. Mosby, Boston1987: 16
- Comparison of primary and secondary closure techniques after removal of impacted mandibular third molars.J Oral Maxillofac Surg. 1982; 40: 631-634
- A double blind placebo controlled trial of the effects of dexamethasone on postoperative swelling.J Dent Res. 1982; 61: 556
- Pathological changes related to long term impaction of third molars: a radiographic study.Int J Oral Maxillofac Surg. 1989; 8: 210-212
- Effect of different surgical repair modalities on regeneration of rabbit mandibular nerve.J Oral Maxillofac Surg. 1989; 47: 257-276
- The response of the peripheral branches of the trigeminal nerve to trauma.Int J Oral Surg. 1985; 14: 41-46
- Prostaglandins, aspirin-like drugs and analgesia.Nature. 1972; 240: 200-203
- The eruption of third molars in adults: A 10-year longitudinal study.Oral Surg. 1989; 68: 9-13
- Tranexamic acid in alveolar socket in the prevention of ASD.Int J Oral Surg. 1979; 8: 421-429
- Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in private practice.JADA. 1985; III: 277-279
- The mandibular third molar: its predictive status and role in lower incisor crowding.in: Proc Finn Dent Soc. 77. 1991: 37-44
- Influence of mandibular third molars on related supporting tissues.Int J Oral Surg. 1973; 2: 137-142
- Sequellae and complications of the intraoral sagittal split osteotomy.Oral Surg. 1971; 32: 176-192
- Incidence of and progressive pathological changes associated with impacted third molar teeth.J Dent Res. 1982; 52 (special issue abstract): 14-28
- Third molar surgery.Br Dent J. 1984; 156: 389-394
- Vestibuloplasty and mucosal grafts.J Oral Surg. 1971; 29: 786-791
- Prevention of dry socket with local application of tetracycline.J Oral Surg. 1971; 29: 35-37
- 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
- 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
- Our third molar teeth: their eruption, presence and absence.Dental Cosmos. 1936; 78: 750-762
- Mandibular anterior crowding.JCDA. 1989; 55: 662
- 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
- The influence of methylprednisolone on postoperative swelling following oral surgery.Br J Oral Maxillofac Surg. 1987; 25: 293-299
- Dexamethasone in traumatic oral surgery.J Oral Surg. 1969; 27: 398-403
- The use of steroid in the prevention of some complications after traumatic oral surgery.J Oral Surg. 1974; 32: 864-866
- Prevention of damage to the inferior dental nerve during the extraction of mandibular third molars.Br Dent J. 1960; 109: 355-363
- Minor oral surgery.in: 3rd ed. Wright, Toronto1983: 36
- Comparison of meclofenamate sodium and hydrocortisone for controlling the postsurgical inflammatory response in rats.J Oral Maxillofac Surg. 1988; 46: 777-780
- Dysesthesia after mandibular third molar surgery: A retrospective analysis of 1,377 surgical procedures.JADA. 1980; 100: 185-192
- Alveolitis after operative removal of third molars in the mandible.Int J Oral Surg. 1981; 10: 173-179
- Post-operative complications after surgical removal of mandibular third molar — Effect of penicillin and chlorhexidine.Int J Oral Maxillofac Surg. 1986; 15: 25-29
- Periodontal healing after impacted lower third molar surgery: A retrospective study.Int J Oral Surg. 1985; 14: 29-40
- Periodontal healing two and four years after impacted lower third molar surgery.Int J Oral Maxillofac Surg. 1990; 19: 341-345
- Periodontal healing after impacted lower third molar surgery in adolescents and adults.Int J Oral Maxillofac Surg. 1991; 20: 18-24
- Evaluation of the third molar problems.JADA. 1971; 82: 824-828
- Marginal tissue reaction at osseointegrated titanium fixtures.Int J Oral Maxillofac Surg. 1986; 15: 53-61
- Correlation of acute pericoronitis and the position of the mandibular third molar.Oral Surg. 1986; 62: 245-250
- Alveolar osteotis associated with mandibular third molar extractions.JADA. 1974; 88: 802-806
- Extraction of third molars in cases of anticipated crowding of the lower Jaw.Am J Orthod. 1982; 81: 130-139
- The clinical evaluation of dexamethasone in oral surgery.Oral Surg. 1965; 20: 6-28
- A study of indications used for removal of the mandibular third molar.Int J Oral Maxillofac Surg. 1988; 17: 161-164
- Indications and contraindications for the removal of the impacted tooth.Dent Clin North Am. 1979; 23: 333-346
- 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
- The impacted lower wisdom tooth.Oxford University Press, Bristol1985
- 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
- Lingual nerve damage following lower third molar surgery.Int J Oral Maxillofac Surg. 1988; 17: 290-294
- The use of intraoral dexamethasone after extractions of mandibular third molars.Oral Surg. 1975; 40: 594-598
- Studies of traumatic neuralgia in the maxillofacial region: symptom complexes and response to microsurgery.J Oral Maxillofac Surg. 1990; 48: 135-140
- Post-operative morbidity with mandibular third molar surgery: a comparison of two techniques.J Oral Maxillofac Surg. 1988; 46: 474-476
- A controlled clinical trial of tinidazole for chemoprophylaxis in third molar surgery.Br Dent J. 1986; 160: 284-286
- Efficacy of a fibrin sealant on healing of extraction wounds.Int J Oral Maxillofac Surg. 1988; 17: 142-144
- The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery.J Oral Maxillofac Surg. 1990; 48: 179-187
- A roentgenographic study in detecting dentigerous cysts in the early stages.Oral Surg. 1964; 18: 54-61
- J Oral Surg. 38. 1980: 235-236 Consensus development conference on removal of third molars.
- Does an impacted tooth cause root resorption of the adjacent one?.Oral Surg. 1981; 51: 221-224
- On the genesis of dry socket.J Oral Maxillofac Surg. 1983; 42: 706-710
- Indication for surgical removal of third molars: Study of 2630 cases.Swed Dent J. 1987; 11: 23-29
- Accidental displacement of maxillary third molar.Int J Oral Maxillofac Surg. 1986; 15: 756-758
- A prospective study of complications related to third molar surgery.J Oral Maxillofac Surg. 1985; 43: 767-769
- Anaerobic bacteremia following tooth extraction and removal of osteosynthesis plates.J Oral Maxillofac Surg. 1987; 45: 477-480
- Decadron phosphate in the relief of complaints after third molar surgery.Int J Oral Surg. 1985; 14: 235-240
- Volumetric determination of extra-oral swelling from stereophotographs.Int J Oral Surg. 1985; 14: 229-234
- A comparison between two absorbable haemostatic agents: gelatin sponge and cellulose.Int J Oral Surg. 1984; 13: 406-410
- Local predisposing factors and clinical symptoms in pericoronitis.in: Proc Finn Dent Soc. 77. 1981: 278-282
- Surgical options for third molars: a review.J R Soc Med. 1981; 74: 911-913
- Unerupted third molars.JCDA. 1989; 55 (letter): 453
- History factors associated with symptoms of temporomandibular disorders.J Oal Rehab. 1988; 15: 117-124
- The age of eruption of third molar teeth.Acta Odont Scand. 1961; 25
- Odontogenic tumors: analysis of 706 cases.J Oral Surg. 1978; 36: 771-778
- JCDA. 1989; 55 (Responses to): 453
- JCDA. 1989; 55 (Responses to): 662
- Longitudinal study of three views of mandibular 3rd molar eruption in males.Am J Orthod. 1984; 86: 119-129
- The aetiology and prediction of mandibular third molar impaction.Angle Orthod. 1977; 47: 165-172
- The development of third molar impaction and its prevention.Int J Oral Surg. 1981; 10: 122-130
- Lower molar crowding in the early permanent dentition.Angle Orthod. 1985; 55: 51-57
- Lower third molar space.Angle Orthod. 1987; 57: 155-161
- 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
- Studies of the practice of abortion of lower third molars.Dent Clin North Am. 1979; 23: 393-411
- The prophylactic use of transexamic acid on ASD.Int J Oral Surg. 1973; 2: 196-199
- Lingual split technique.Br Dent J. 1983; 154: 402-403
- Degrees of injury to the inferior alveolar nerve.Br J Oral Surg. 1983; 21: 103-116
- Canadian dental law.in: Butterworths, 1987: 27
- 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
- The split bone technique for removal of impacted mandibular third molars.J Oral Surg. 1970; 28: 416-421
- Third molar surgery: relationship of root to mandibular canal and injuries to inferior dental nerve.Danish Dent J. 1983; 87: 619-631
- Periodontal damage to third molars prior to transplantation.Int J Oral Maxillofac Surg. 1989; 18: 55-58
- 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
- Evaluation of post-operative localized osteitis in mandibular third molars surgery.Oral Surg. 1974; 38: 352-358
- The influence of third molar germectomy: a comparative long term study.in: Cook JT Trans 3rd Int Orthodontic Congress. Staples, Toronto1974: 551-562
- Three types of nerve injury.Brain. 1943; 66: 237-288
- A radiographic 4 year follow up study of asymptomatic mandibular third molars in young adults.Int Dent J. 1990; 40: 24-30
- A textbook of oral pathology. WB Saunders, London1984 4th ed.
- Unerupted third molars.JCDA. 1989; 55 (letter): 453
- The influence of mandibular third molars on mandibular anterior teeth.A J Orthod. 1962; 48: 786-787
- Age-standardized incidence rates of ameloblastoma and dentigerous cyst on the Witwatersrand.Community Dent Oral Epid. 1978; 6: 195-199
- The muralameloblastoma: a review of the literature.J Oral Surg. 1978; 36: 866-872
- Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response.Oral Surg. 1985; 60: 137-145
- 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
- Pathological sequelae of “neglected” impacted third molar.J Oral Pathol. 1988; 17: 113-117
- Periodontal evaluation of two mucoperiosteal flaps used in removing impacted third molars.J Oral Maxillofac Surg. 1983; 42: 719-724
- The unerupted or impacted third molar: a critical appraisal of its pathologic potential.JCDA. 1989; 55: 201-207
- Prediction of lower third molar impaction from the frontal cephalometric projection.Eur J Orthod. 1985; 7: 1-16
- Reducing the incidence of dry socket: a clinical appraisal.JCDA. 1966; 32: 25-33
- Removing the mandibular third molar: Neurosensory deficits and consequent litigation.JCDA. 1989; 55: 383-386
- Double blind studies on the effectiveness of tetracycline in reducing the incidence of fibrinolytic alveolitis.J Oral Max Fac Surg. 1989; 47: 165-167
- Crevicular depth of the second molar in impacted third molar surgery.J Oral Surg. 1963; 21: 185-189
- Decision analysis of the evaluation of clinical strategies for the management of mandibular third molars.J Dent Ed. 1987; 51: 652-660
- The application of decision analysis to evaluate the need for extraction of asymptomatic third molars.J Oral Maxillofac Surg. 1987; 45: 855-865
- A photographic method of assessing swelling following third molar removal.Int J Oral Surg. 1975; 4: 121-129
- Clinical consequences of complaints and complications after removal of mandibular third molars.Int J Oral Surg. 1977; 6: 29-37
- A longitudinal study of mandibular arch perimeter.Anglo Orthod. 1962; 32: 187-192
- The effect of dexamethasone on neurapraxia following third molar surgery.Br J Oral Maxillofac Surg. 1989; 27: 477-480
- 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
- Primary intraosseous carcinoma of the mandibular with probable origin in an odontogenic cyst.Oral Surg. 1989; 67: 716-724
- The split bone technique for removal of mandibular third molars.Br Dent J. 1956; 101: 297-304
- Diagnostic and epidemiologic survey of 15,783 oral lesions.JADA. 1987; 115: 439-442
- The third molar question: to extract or not to extract.J Dent Child. 1984; 21: 277-281
- Displacement into maxillary sinus or infratemporal fossa of maxillary third molars.J Oral Surg. 1977; 35: 130-132
- Prospective study of dysesthesia following odontectomy of impacted mandibular third molars.J Oral Maxillofac Surg. 1987; 45: 15-19
- The molar extractions; periodontal implications of two flaps design.Gen Dent. 1978; 26: 52-56
- Principle and practice of oral radiologic interpretation.in: Year Book Med Publishers, Philadelphia1969: 77
- Dental radiograph.5th ed. CV Mosby, Chicago1981
- Preventive dentistry new concepts: preventing periodontal pockets.Va Dent J. 1975; 52: 11-13
Article info
Publication history
Accepted:
September 3,
1991
Identification
Copyright
© 1992 Munksgaard International Publishers Ltd. Published by Elsevier Inc.