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

Abstract

The present systematic review was performed to investigate if there is evidence justifying the prophylactic extraction of third molars, one of the most frequent procedures in oral surgery. A series of searches was carried out for randomized, clinical trials and systematic reviews in seven databases (MEDLINE, BBO, LILACS, Web of Science, EMBASE, BIREME and Cochrane Library), with no restrictions regarding year or language. A supplemental manual search of the references of retrieved articles was also performed. The search strategy resulted in 260 papers. Both the data extracted and the quality of each paper were evaluated independently by two reviewers. After selection based on the preestablished eligibility criteria, four papers qualified for the final analysis. A medium degree of quality and methodological consistency was found in three studies, and low quality was found in one study. No studies showed a high degree of consistency. The most significant flaw was an inadequate sample size. The results of the present review indicate a lack of scientific evidence to justify the indication of the prophylactic extraction of third molars.

Prophylactic Extraction of Third Molars: Evidence-Based Dentistry

“…In general, prophylactic removal of third molars has been suggested in young patients in order to reduce the morbidity due to the tooth retention, mainly the high incidence of tooth impaction (13,17,18), and following the concept "an asymptomatic third molar does not necessarily reflect the absence of disease" (19). Thus, some clinicians have advocated the prophylactic extraction for reasons comprising lack of a vital role in the oral cavity, increased risk of distal caries in second molars, pericoronal pathosis like cysts or tumors if these teeth are retained, and for avoiding a higher trauma or discomfort when the surgical extraction is performed at older ages (1,13,20).…”

“…Although a substantial number of clinical studies have been published on this topic, the conflicting results still hinder the decisionmaking process in the clinical setting (18,22). These controversial findings are the product of differences among the studies, regarding to diverse methodological issues, such as study design, sample size or monitoring (follow-up) time (6,18).…”

“…Although a substantial number of clinical studies have been published on this topic, the conflicting results still hinder the decisionmaking process in the clinical setting (18,22). These controversial findings are the product of differences among the studies, regarding to diverse methodological issues, such as study design, sample size or monitoring (follow-up) time (6,18). Additionally, Friedman (7) expresses that, even currently, five "historical" myths regarding third molars prevail among the dental community: (i) third molars have a high incidence of pathology; (ii) early removal of third molars is less traumatic; (iii) pressure of erupting third molars causes crowding of anterior teeth; (iv) the risk of pathology in ITM increases with age; and (v) there is little risk of harm in the removal of third molars.…”

The third permanent molars and their influence on the dentoalveolar arches

“…M. Costa и соавт. в 2013 г. делают заключение об отсутствии ис-следований, научно доказывающих целесообраз-ность профилактического удаления третьих моля-ров [19]. Американская ассоциация оральных и че-люстно-лицевых хирургов (2011) обращает внима-ние на связь «бессимптомных» третьих моляров с заболеваниями пародонта и твердо поддерживает хирургическое лечение, если есть патология, свя-занная с ними, либо разумная вероятность ее воз-никновения [20].…”

A practical approach to evidence-based dentistry: IX

“…19 In contrast, the investigators of several systematic reviews did not find sufficient evidence to support removal over retention. [20][21][22] You read that annually in the United States, approximately 10 million third molars are extracted from approximately 5 million people, with total costs exceeding $3 billion. 23 You found an economic evaluation that compared removal versus retention of asymptomatic, disease-free mandibular third molars, using a decision model.…”