Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth

Abstract

Insufficient evidence is available to determine whether or not asymptomatic disease-free impacted wisdom teeth should be removed. Although asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is of very low quality. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision making with patients who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.

Prophylactic Extraction of Third Molars: Evidence-Based Dentistry

“…(The term "asymptomatic" means that the patient has not manifested pain, complaint, or discomfort, or exhibited radiographic signs of pathosis related to one or more ITM (2,14).…”

“…At present, there is no general agreement among oral clinicians regarding the need for prophylactic removal of asymptomatic third molars (2,12,17). 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).…”

“…Additionally, there are potential intra and postoperative complications associated with the removal of ITM, including pain, bleeding, local swelling or infection of soft tissues and bone, trismus, mandibular fractures, oro-antral communication, dry socket, and nerve injuryresulting in a possible paresthesia or anesthesia-, which may the cause school or work absenteeism up to 10 days (5,17,23). 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 some cases, the eruptive process of these molars may be inhibited due to the lack of sufficient space in the dental arcades (1,2). Impacted third molars (ITM) are the most common developmental disorder of the human being (3).…”

A comparative study of the effect of suture and suture-less techniques on post-operative complications following lower third molar surgery

“…Although there is no evidence to support, or refute removal of asymptomatic impacted third molar teeth 10 , the American Association of Oral and Maxillofacial Surgeons (AAOMS) fully supports the elective prophylactic removal of asymptomatic impacted third molar teeth that are unlikely to erupt into a disease-free position 11 . The concept of prophylactic removal of asymptomatic third molar teeth is no longer accepted in the most recent National Institute for Health and Care Excellence (NICE) guidelines, which advise that the removal of impacted third molars, should be carried out for teeth with evidence of pathology (NICE, 2000) 12 .…”