Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(5) > 1032486

Park, Jin-Hak, Kang, Kim, Kim, Choi, and Lee: Reconsideration of decision making for third molar extraction

Abstract

Introduction

Third molar extraction is one of the most common procedures in oral and maxillofacial surgery. The impacted third molar causes many pathological conditions, such as pericoronitis, caries, periodontitis, resorption of adjacent teeth, and cyst or tumors associated with impacted teeth. Extraction is often considered the treatment of choice for impacted lower third molars. On the other hand, imprudent extraction of deeply impacted third molars can cause permanent complications, such as inferior alveolar nerve damage. Therefore, guidelines for the extraction of lower third molars should be set to prevent embarrassing complications. This study examined the indication and current trends of the extracted lower third molars in the dental hospital of a dental college.

Materials and Methods

557 extracted third molars were evaluated at the department of oral and maxillofacial surgery of Yonsei University. The chief complaint, diagnosis, age and degree of impaction were analyzed to determine the tendency for the extraction of asymptomatic lower third molars.

Results

The percentage of asymptomatic third molars was 40.8%. In cases of full impacted tooth or full erupted tooth, the percentage of asymptomatic teeth was more than 50% (52.4% and 54.3, respectively). Among those partially impacted teeth, 73.1% of them showed symptoms, such as pain, tenderness and swelling. In terms of age, pericoronitis was evident at a younger age, and dental caries/periodontitis was the main cause of removal in those aged over 50. Twenty nine cases (1.6%) had teeth associated with pathological changes.

Conclusion

The incidence of pathological changes to the lower third molar was relatively low. Surgical extraction is recommended in cases of partially impacted teeth. In Korea, the incidence of asymptomatic third molar extraction was relatively higher than in European countries. More careful attention would be desirable to consider the risks and benefits of lower third molar extraction.

References

1. Atchison KA, Gironda MW, Black EE, Schweitzer S, Der-Martirosian C, Felsenfeld A, et al. Baseline characteristics and treatment preferences of oral surgery patients. J Oral Maxillofac Surg. 2007; 65:2430–7.
crossref
2. Brickley M, Shepherd J, Mancini G. Comparison of clinical treatment decisions with US National Institutes of Health consensus indications for lower third molar removal. Br Dent J. 1993; 175:102–5.
crossref
3. Friedman JW. The prophylactic extraction of third molars: a public health hazard. Am J Public Health. 2007; 97:1554–9.
crossref
4. Tilley C, Mcintosh E, Bahrami M, Clarkson J, Deery C, Pitts N. An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies. J Health Serv Res Policy. 2005; 10:143–9.
crossref
5. Song F, O'Meara S, Wilson P, Golder S, Kleijnen J. The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth. Health Technol Assess. 2000; 4:1–55.
crossref
6. Bruce RA, Frederickson GC, Small GS. Age of patients and morbidity associated with mandibular third molar surgery. J Am Dent Assoc. 1980; 101:240–5.
7. Hinds EC, Frey KF. Hazards of retained third molars in older persons: report of 15 cases. J Am Dent Assoc. 1980; 101:246–50.
crossref
8. Laskin DM. Evaluation of the third molar problem. J Am Dent Assoc. 1971; 82:824–8.
9. Removal of third molars. Sponsored by the National Institute of Dental Research, November 28–30, 1979. Natl Inst Health Consens Dev Conf Summ. 1979; 2:65–8.
10. Kugelberg CF, Ahlstro ¨m U, Ericson S, Hugoson A. Periodontal healing after impacted lower third molar surgery. A retrospective study. Int J Oral Surg. 1985; 14:29–40.
11. Sewerin I, von Wowern N. A radiographic four-year follow-up study of asymptomatic mandibular third molars in young adults. Int Dent J. 1990; 40:24–30.
12. Stanley HR, Alattar M, Collett WK, Stringfellow HRJ, Spiegel EH. Pathological sequelae of “neglected”impacted third molars. J Oral Pathol. 1988; 17:113–7.
13. Mercier P, Precious D. Risks and benefits of removal of impacted third molars. A critical review of the literature. Int J Oral Maxillofac Surg. 1992; 21:17–27.
14. Edwards MJ, Brickley MR, Goodey RD, Shepherd JP. The cost, effectiveness and cost effectiveness of removal and retention of asymptomatic, disease free third molars. Br Dent J. 1999; 187:380–4.
15. Knutsson K, Lysell L, Rohlin M. Dentists'decisions on prophylactic removal of mandibular third molars: a 10-year follow-up study. Community Dent Oral Epidemiol. 2001; 29:308–14.
16. Knutsson K, Lysell L, Rohlin M, Brickley M, Shepherd JP. Comparison of decisions regarding prophylactic removal of mandibular third molars in Sweden and Wales. Br Dent J. 2001; 190:198–202.
crossref
17. Song F, Landes DP, Glenny AM, Sheldon TA. Prophylactic removal of impacted third molars: an assessment of published reviews. Br Dent J. 1997; 182:339–46.
crossref
18. Venta ¨ I, Ylipaavalniemi P, Turtola L. Long-term evaluation of estimates of need for third molar removal. J Oral Maxillofac Surg. 2000; 58:288–91.
19. Elter JR, Offenbacher S, White RP, Beck JD. Third molars associated with periodontal pathology in older Americans. J Oral Maxillofac Surg. 2005; 63:179–84.
crossref
20. White RP Jr, Madianos PN, Offenbacher S, Phillips C, Blakey GH, Haug RH, et al. Microbial complexes detected in the second/third molar region in patients with asymptomatic third molars. J Oral Maxillofac Surg. 2002; 60:1234–40.
crossref
21. White RP Jr, Offenbacher S, Phillips C, Haug RH, Blakey GH, Marciani RD. Inflammatory mediators and periodontitis in patients with asymptomatic third molars. J Oral Maxillofac Surg. 2002; 60:1241–5.
crossref
22. Hanson BP, Cummings P, Rivara FP, John MT. The association of third molars with mandibular angle fractures: a metaanalysis. J Can Dent Assoc. 2004; 70:39–43.
23. Lee JT, Dodson TB. The effect of mandibular third molar presence and position on the risk of an angle fracture. J Oral Maxillofac Surg. 2000; 58:394–8.
crossref
24. Ma' aita J, Alwrikat A. Is the mandibular third molar a risk factor for mandibular angle fracture? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89:143–6.
25. Zhu SJ, Choi BH, Kim HJ, Park WS, Huh JY, Jung JH, et al. Relationship between the presence of unerupted mandibular third molars and fractures of the mandibular condyle. Int J Oral Maxillofac Surg. 2005; 34:382–5.
crossref
26. Iida S, Nomura K, Okura M, Kogo M. Influence of the incompletely erupted lower third molar on mandibular angle and condylar fractures. J Trauma. 2004; 57:613–7.
crossref
27. Patel V, Moore S, Sproat C. Coronectomy – oral surgery's answer to modern day conservative dentistry. Br Dent J;209:. 111–4.
28. Pogrel MA. Partial odontectomy. Oral Maxillofac Surg Clin North Am. 2007; 19:85–91.
crossref
29. Dolanmaz D, Yildirim G, Isik K, Kucuk K, Ozturk A. A preferable technique for protecting the inferior alveolar nerve: coronectomy. J Oral Maxillofac Surg. 2009; 67:1234–8.
crossref
30. Bonetti GA, Parenti SI, Checchi L. Orthodontic extraction of mandibular third molar to avoid nerve injury and promote periodontal healing. J Clin Periodontol. 2008; 35:719–23.
31. Alessandri Bonetti G, Bendandi M, Laino L, Checchi V, Checchi L. Orthodontic extraction: riskless extraction of impacted lower third molars close to the mandibular canal. J Oral Maxillofac Surg. 2007; 65:2580–6.
crossref
32. Park W, Park JS, Kim YM, Yu HS, Kim KD. Orthodontic extrusion of the lower third molar with an orthodontic mini implant. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;110: e1–6.

Table 1.
The classifications of the mandibular third moalrs by the symptom and impaction type
  Erupted Partially covered by soft tissue Completely covered by soft tissue Completely covered by hard tissue Total
Asymptomatic 44 (7.9) 75 (13.5) 76 (13.6) 32 (5.7) 227 (40.8)
Symptomatic 37 (45.7) 202 (73.1) 62 (44.9) 29 (47.6) 330 (59.2)
  Pain/tenderness s 14 (2.5) 69 (12.4) 27 (4.8) 12 (2.2) 122 (21.9)
  Swelling 13 (2.3) 126 (22.6) 30 (5.4) 16 (2.9) 185 (33.2)
  Other symptom s 10 (1.8) 7 (1.3) 5 (0.9) 1 (0.2) 23 (4.1)
 Total 81 (14.5) 277 (49.7) 138 (24.8) 61 (11.0) 557 (100)

Values are presented as no (%).

Wonse Park et al: Reconsideration of decision making for third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

Table 2.
The relationship betweenthe ages and the diagnosis for the mandibular third moalrs
Age 10–19 20–29 30–39 40–49 50- Total
Non – pathologic 26 (4.7) 109 (19.6) 14 (2.5) 13 (2.3) 8 (1.4) 170 (30.5)
Pathologic            
  Pericoronitis 26 (4.7) 177 (31.8) 56 (10.1) 32 (5.7) 13 (2.3) 304 (54.6)
  Periodontitis 0 (0) 1 (0.2) 0 (0) 6 (1.1) 6 (1.1) 13 (2.3)
  Dental caries 0 (0) 12 (2.2) 15 (2.7) 20 (3.6) 11 (2.0) 58 (10.4)
  Root resorption 3 (0.5) 3 (0.5) 3 (0.5) 2 (0.3) 1 (0.2) 12 (2.2)
 Total 55 (9.8) 302 (54.2) 88 (15.8) 73 (13.1) 39 (7.0) 557 (100)

Values are presented as no (%).

Wonse Park et al: Reconsideration of decision making for third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

Table 3.
The relationship between the ages of the patients and the degree of the eruption of the mandibular third moalrs
  10–19 20–29 30–39 40–49 50- Total
Erupted 0 (0) 10 (1.8) 21 (3.8) 31 (5.6) 19 (3.4) 81 (14.5)
Partially covered by soft tissue 19 (3.4) 170 (30.5) 48 (8.6) 29 (5.2) 11 (2.0) 277 (49.7)
Completely covered by soft tissue 25 (4.5) 89 (16.0) 11 (2.0) 7 (1.3) 6 (1.1) 138 (24.8)
Completely covered by hard tissue 11 (2.0) 33 (5.9) 8 (1.4) 6 (1.1) 3 (0.5) 61 (11.0)
Total 55 (9.8) 302 (54.2) 88 (15.8) 73 (13.1) 39 (7.0) 557 (100)

Values are presented as number (%).

Wonse Park et al: Reconsideration of decision making for third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

Table 4.
Mandibular third molar related diseases or trauma
  Cyst Tumor Fracture Osteomyeliti Total
No 15 2 11 1 29

Wonse Park et al: Reconsideration of decision making for third molar extraction. J Korean Assoc Oral Maxillofac Surg 2011

TOOLS
Similar articles