Removal of mandibular third molars: An overview of risks, a proposal for international community and guidance.

The aim of this proposal is to (1) review the current literature, (2) shed light on the importance of creating universally accepted guidelines, (3) provide help and guidance in the decision-making process with regard to the removal of mandibular third molars (M3Ms), and (4) reduce the risk of exposing the patient to unnecessary harm and complications due to the inappropriate removal or retention of M3Ms.It is obvious that the indications for the extraction of M3Ms will continue to be an area of controversy and strong debate. The evidence for or against prophylactic extraction is ambivalent; there is evidence to accept or reject the stance against prophylactic extraction in some specific cases, and there are published articles to support both opposing views. The available guidelines on the extraction of third molars are limited in number, and are mostly tailored to fit specific settings or countries. There are no available guidelines that might be widely used to help in the decision-making process for the international community. We hope this proposal will constitute an important first step toward creating universally accepted guidance.

Chronological age estimation based on dental mineralization for Syrian population.

Dental age assessment based on evaluating dental mineralization status is one of the most common methods used in forensic practice. The aim of this study is to enhance the accuracy of age diagnostics and provide reference data from the Syrian population for forensic application. After several selection steps, a total of 280 orthopantomograms (OPGs) from 140 males and 140 females from the Syrian population divided into 14 age groups between 12 and 25 years were analysed. Based on Demirjian's classification system, the mineralization stages of third molars (18, 28, 38 and 48) as well as lower second molars (37 and 47) were evaluated. Statistical investigations and evaluations were carried out to estimate the marginal probabilities of the subjects having attained ages 14 and 18 by generalized estimating equation models. Our results show that no significant differences can be revealed in the mineralization status with respect to jaw side and sex. In the Syrian population, third molars showing mineralization stage G provide evidence of reaching the age of 14 years with the highest standard of proof ("beyond reasonable doubt"). A completed mineralization in lower second molars (stage H) provides very high marginal probabilities (more than 90%) of the subjects having attained age 14 years. Nevertheless, this cannot exclude an age under 14 years. For the age threshold of 18 years, third molars showing incomplete root development (G dental stage or lower) are associated with a low probability (less than 40%) of the subject having reached 18 years of age. A person's probability of having attained 18 years of age is very high (82- 95%) when the roots of third molars are fully developed (stage H). Nevertheless, third molars at stage H do not conclusively exclude an age under 18 years.

Analysing inflammatory responses after mandibular third molar extraction: a comparison of suture-less and multiple suture techniques.

PURPOSE: This study aims to compare the outcomes of suture-less and multiple suture closure methods on postoperative pain, swelling, and trismus, and associated complications. MATERIALS AND METHODS: This prospective, randomized clinical trial was conducted at the Department of Oral & Maxillofacial Surgery, Goa Dental College & Hospital. Inclusion criteria encompassed subjects aged between 17 and 55 years, classified as American Society of Anaesthesiologists (ASA) I, with asymptomatic impacted third molars falling within the moderately difficult impaction range (Pederson's difficulty index: 5-7). Study excluded individuals classified as ASA II, III, or IV, those with known or suspected allergies to the anaesthetic solution, immunocompromised patients, and individuals taking medications that could affect healing. Pregnant or lactating females and those with a history of bleeding disorders were also excluded. Wound closure methods were compared: Group A underwent primary closure with silk sutures, while Group B had suture-less closure. Subjects were allocated to the specific groups using a simple randomization method. This involved using a lottery-based random sequence to assign each participant to either Group A or Group B. Pain intensity, facial swelling, and trismus were key outcomes. Secondary outcomes included lingual nerve sensation and postoperative complications. Demographics factors, surgical details, radiographic and perioperative data, and physiological parameters were considered. Non-parametric tests and parametric test (repeated measure ANOVA) were employed. Statistical significance was set at P < 0.05. RESULTS: Among 101 participants, both closure techniques exhibited similar outcomes in pain, swelling, and lingual nerve function. However, suture-less closure resulted in significantly less trismus and fewer cases of delayed wound healing. CONCLUSIONS: Suture-less method after surgical removal of third molar may reduce trismus compared to multiple sutures. While pain, swelling, and lingual nerve function management were comparable.

Artificial Intelligence Application in a Case of Mandibular Third Molar Impaction: A Systematic Review of the Literature.

Objective: This systematic review aims to summarize the evidence on the use and applicability of AI in impacted mandibular third molars. Methods: Searches were performed in the following databases: PubMed, Scopus, and Google Scholar. The study protocol is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202460081). The retrieved articles were subjected to an exhaustive review based on the inclusion and exclusion criteria for the study. Articles on the use of AI for diagnosis, treatment, and treatment planning in patients with impacted mandibular third molars were included. Results: Twenty-one articles were selected and evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) evidence quality scale. Most of the analyzed studies dealt with using AI to determine the relationship between the mandibular canal and the impacted mandibular third molar. The average quality of the articles included in this review was 2+, which indicated that the level of evidence, according to the SIGN protocol, was B. Conclusions: Compared to human observers, AI models have demonstrated decent performance in determining the morphology, anatomy, and relationship of the impaction with the inferior alveolar nerve canal. However, the prediction of eruptions and future horizons of AI models are still in the early developmental stages. Additional studies estimating the eruption in mixed and permanent dentition are warranted to establish a comprehensive model for identifying, diagnosing, and predicting third molar eruptions and determining the treatment outcomes in the case of impacted teeth. This will help clinicians make better decisions and achieve better treatment outcomes.

Mandibular third-molar germectomy: case report.

Introduction and importance: Third molars are often removed in order to prevent complications and various other problems associated with impacted teeth. Case presentation: A healthy 17-year-old girl with no history was referred to the Department of Oral Surgery by her orthodontist to remove mandibular third-molar germs. Panoramic radiography showed the presence of impacted mandibular third-molar germs, vertically positioned, with incomplete root formation. The tooth germs (48, 38) were extracted under local-regional anesthesia. The postoperative period was uneventful. Clinical discussion: Germectomy is still relevant in the management of mandibular third molars (MTM). It is a surgical removal of the dental germ at a particularly specific developmental period. However, the need to extract the MTM germs is still controversial. Conclusion: Germectomy is well justified in light of clinical symptomatology and/or a suspicious radiographic image. Nonetheless, in asymptomatic MTM, it is important to assess the procedure's cost-benefit ratio.

Comparing the efficacy of adrenaline, clonidine, and dexmedetomidine in enhancing local anesthesia for impacted third molar extraction: a randomized controlled trial.

Background: In human dentition, the most commonly impacted teeth are the mandibular third molars (M3M). The removal or extraction of these teeth often causes anxiety in patients due to the perceived pain involved in the process. Therefore, pain must be effectively managed using anesthesia. The use of newer local anesthetic drugs can help minimize side effects and drug interactions. Traditionally, adrenaline is used as a vasoconstrictor along with lignocaine. When combined with lignocaine, the alpha agonists dexmedetomidine and clonidine can extend the duration of anesthesia, thereby reducing the need for additional pain-relieving medications. Methods: This study used a randomized, triple-blind, parallel-arm design. Sixty patients were screened, and 45 systemically healthy patients requiring unilateral surgical removal of impacted mandibular third molars with similar difficulty (moderate-to-difficult according to the Modified Pederson's Index) were included in the study. Patients were allocated into three groups as follows: Group A: 2% Lignocaine Hydrochloride with 1:100,000 Adrenaline, Group C: 2% Lignocaine Hydrochloride with 15 µg/mL Clonidine, and Group D: 2% Lignocaine Hydrochloride with 1 µg/mL Dexmedetomidine. The evaluated parameters were the time of onset of anesthesia, depth of anesthesia, hemodynamic parameters, and duration of postoperative analgesia. Results: Group D had a faster onset of action and prolonged duration of postoperative analgesia compared with Groups A and C. No statistically significant differences were observed between the three groups in terms of the depth of anesthesia and hemodynamic parameters. Conclusion: Group D exhibited a significantly more rapid onset of anesthesia than Groups A and C, and the postoperative analgesic effect in Group D was significantly prolonged (7.22 hours) compared with that in Groups A (4.54 hours) and C (2.1 hours). Patients receiving the Group D solution experienced an extended period of comfort without the need for analgesics for up to 7.22 hours post-procedure.

Soft tissue inflammation around upper third molar cause limited mouth opening: common but overlooked.

OBJECTIVES: The aim of this study was to explore inflammation of soft tissue around the upper third molar as a prevalent cause of limited mouth opening, identify the clinical and radiographic features, and summarize the therapeutic effectiveness of tooth extraction. MATERIALS AND METHODS: A retrospective analysis of data from 264 patients with limited mouth opening over the last five years was performed. RESULTS: Among the 264 patients, 24 (9.1%) had inflammation of the soft tissue around the upper third molar, which was the second most common cause of limited mouth opening. Twenty-one of the twenty-four affected patients, with an average mouth opening of 19.1 ± 7.6 mm, underwent upper third molar extraction. Gingival tenderness around the upper third molar or maxillary tuberosity mucosa was a characteristic clinical manifestation (p < 0.05). The characteristic features on maxillofacial CT included soft tissue swelling around the upper third molar and gap narrowing between the maxillary nodules and the mandibular ascending branch. Post extraction, the average mouth opening increased to 31.4 ± 4.9 mm (p < 0.05), and follow-up CT demonstrated regression of the inflammatory soft tissue around the upper third molar. CONCLUSIONS: Inflammation of soft tissue around the upper third molar is a common cause of limited mouth opening. Symptoms of pain associated with the upper third molar and distinctive findings on enhanced maxillofacial CT scans are crucial for diagnosis. Upper third molar extraction yields favorable therapeutic outcomes. CLINICAL RELEVANCE: Inflammation of the soft tissue around the maxillary third molar commonly causes limited mouth opening, but this phenomenon has long been overlooked. Clarifying this etiology can reduce the number of misdiagnosed patients with restricted mouth opening and enable more efficient treatment for patients.

The morphology of alveolar bone of the mandibular second and third molars in skeletal Class III patients.

OBJECTIVES: To investigate the alveolar bone morphology of the mandibular second and third molars in skeletal Class III patients from a buccolingual direction. METHODS: Sixty skeletal Class III patients were recruited. The alveolar bone width, buccal cortical bone thickness and lingual cortical bone thickness were measured in five planes from mesial to distal and at five depths from gingival to root. The effects of the gender of the patients, the second molar lingual inclination and the third molar on alveolar bone width and cortical bone thickness were evaluated. To explore the effect of third molar extraction on alveolar bone morphology, the measurements before and after third molar extraction were compared. RESULTS: The impacted third molar had significantly greater alveolar bone width and thicker buccal cortical bone at the cervical third of the molar, while the erupted third molar had greater alveolar bone width at the apical third. Three weeks after third molar extraction, these advantages would weaken owing to the reconstruction of the alveolar bone. Patients with lingually inclined molar were observed to own thicker lingual cortical bone. Males tended to have greater alveolar bone width, but no significant differences were shown in this study. CONCLUSIONS: The growth of the third molar and the second molar lingual inclination affect the alveolar bone morphology of the mandibular second and third molars significantly, but gender has trivial effects on the morphology. The alveolar bone morphology of the mandibular second and third molars would change 3 weeks after third molar extraction.

Effect of platelet-rich fibrin on the recovery after third molar surgery: A systematic review and meta-analysis.

This meta-analysis aimed to elucidate the effects of platelet-rich fibrin (PRF) on the recovery of alveolar bone after surgical removal of the mandibular third molars. PubMed, Cochrane Library, Web of Science, and Embase databases were searched from the inception to February 2023 for relevant studies on the application of PRF after the extraction of impacted mandibular third molars, with the language limited to English. Literature screening was conducted by two independent researchers. The Cochrane risk-of-bias tool was adopted for quality evaluation, and Stata 15.0 was used for statistical analysis. A total of 33 randomized controlled trials were included in the present study. Following surgical removal of the mandibular third molars, 1139 tooth sockets were filled with PRF, while 1138 sockets were sutured after conventional saline irrigation. The meta-analyses showed that PRF can relieve pain [(RR 0.454; 95% CI 0.23, 0.891); (SMD -0.74; 95% CI -0.97, 0.52)], improve swelling (SMD -1.48; 95% CI -1.90, -1.06), alleviate trismus (SMD -0.35; 95% CI -0.51, -0.19), reduce dry socket (SMD -0.18; 95% CI -030, -0.05), and promote bone tissue healing (SMD 2.34; 95% CI 0.18, 4.51). The current study confirms that PRF can reduce some postoperative complications. Local application of PRF after lower third molar extraction is a viable method for relieving pain and swelling, reducing the incidence of dry socket and trismus, and increasing bone density. However, whether it can promote soft tissue healing remains unclear. For patients undergoing complicated surgical extraction, local application of PRF into the sockets might be a good option.

Deep Learning for Predicting the Difficulty Level of Removing the Impacted Mandibular Third Molar.

BACKGROUND: Preoperative assessment of the impacted mandibular third molar (LM3) in a panoramic radiograph is important in surgical planning. The aim of this study was to develop and evaluate a computer-aided visualisation-based deep learning (DL) system using a panoramic radiograph to predict the difficulty level of surgical removal of an impacted LM3. METHODS: The study included 1367 LM3 images from 784 patients who presented from 2021-2023 to the University Dental Hospital; images were collected retrospectively. The difficulty level of surgically removing impacted LM3s was assessed via our newly developed DL system, which seamlessly integrated 3 distinct DL models. ResNet101V2 handled binary classification for identifying impacted LM3s in panoramic radiographs, RetinaNet detected the precise location of the impacted LM3, and Vision Transformer performed multiclass image classification to evaluate the difficulty levels of removing the detected impacted LM3. RESULTS: The ResNet101V2 model achieved a classification accuracy of 0.8671. The RetinaNet model demonstrated exceptional detection performance, with a mean average precision of 0.9928. Additionally, the Vision Transformer model delivered an average accuracy of 0.7899 in predicting removal difficulty levels. CONCLUSIONS: The development of a 3-phase computer-aided visualisation-based DL system has yielded a very good performance in using panoramic radiographs to predict the difficulty level of surgically removing an impacted LM3.

Optimal tooth sectioning using a surgical handpiece and elevator: a finite element study of horizontally deeply impacted mandibular third molars.

OBJECTIVES: To conduct a finite element analysis of the impact of different variables on tooth sectioning efficiency and trauma to surrounding tissues when utilizing high-speed surgical handpieces and elevators. METHODS: CBCT data from the horizontally impacted third mandibular molar (M3M) of a patient were utilized to establish digital models of the M3M, adjacent M2M, and surrounding bone. To simulate tooth sectioning, a 3D finite element model was established with the following variables: remaining tooth tissue thickness (1-5 mm), tooth section fissure width (1-3 mm), elevator depth in fissure (2-6 mm), elevator position (buccal, lingual, central), elevator width (2-5 mm), and application of force (rotating, levering). Using this model, the distribution of stress on the M3M and the surrounding tissue was assessed while measuring tooth sectioning efficiency and trauma to the surrounding tissue. RESULTS: Factors associated with uniform stress at the site of sectioning included thin (≤ 3 mm) remaining tooth tissue, appropriate fissure width (~ 2 mm), a wide (≥ 4 mm) elevator, and central elevator positioning. Levering the elevator yielded greater stress on the M3M than rotating force. Greater sectioning efficiency was associated with increased stress placed on the distobuccal side of M2M. CONCLUSIONS: Tooth sectioning efficiency can be improved by adjusting the high-speed surgical handpiece and elevator. However, it is important to remain attentive to the trauma to which adjacent teeth are exposed during this process. CLINICAL SIGNIFICANCE: These results offer guidance for approaches to improving operator efficiency and reducing trauma to surrounding tissues during tooth sectioning.

Demographic and Radiographic Characteristics Associated with the Occurrence of Impacted Third Molars in Indonesian Patients: A Retrospective Study.

An impacted third molar is one of the most common abnormalities of the tooth position, impacting patients and their quality of life. Based on the impact and the invasive removal procedure, this study aimed to evaluate the characteristics of impacted third molars based on their radiographic features as well as their association with demographic characteristics. Outpatient dental records of the oral and maxillofacial surgery department of Hasan Sadikin Hospital, Bandung, Indonesia, from 1 January 2018 to 31 December 2019, were sorted, and relevant clinical and demographic data and panoramic radiographic examination results were extracted from these records. All data were then tabulated and analyzed by using SPSS version 29. As many as 3019 impacted third molars were identified. Our findings suggested the association between age to the occurrence of impacted third molars where patients aged between 17 and 29 years old showed high occurrences of impacted third molars. Male patients with impacted third molars are more likely to have multiple impacted third molars, while this risk decreases in females. Radiographic examination showed that the mesioangular position is the most common position for mandibular third molars. The variation in high occurrences of the impacted third molar is associated with several demographic factors.

Effect of impacted mandibular third molar extraction on periodontal microbiota and clinical parameters of adjacent teeth: A randomized clinical trial.

It is urgently necessary to clarify the effect of extraction of impacted mandibular third molar (IMTM) on the periodontal tissue of adjacent second molars (ASMs). In this study, the ASM periodontal condition and pathogenic microbes were assessed before IMTM extraction and at 1, 4, 8 and 12 weeks postoperatively. Based on the inclusion and exclusion criteria, our study revealed that IMTM extractions adversely affected distal － periodontal probing depth (dPPD), attachment loss (dAL), plaque index (dPLI) and bleeding on probing (dBOP) within 8 weeks, but these indices gradually normalize after 12 weeks. The subgingival pathogens near the ASMs distal surface, Porphyromonas and Pseudomonas, were significantly increased postoperatively. Moreover, relevance of ASMs clinical indices and subgingival microbes after IMTM extractions was found. In contrast to the situation in chronic periodontitis, the effects of IMTM extraction on dPPD, dAL, dPLI and dBOP of ASMs were mainly correlated with Pseudomonas. Additionally, while the IMTM extractions have adverse distal periodontal indices of ASMs within 8 weeks and increase subgingival pathogens, the modified triangular flap (MTF) had fewer distal periodontal indices and less Pseudomonas. Compared to the traditional envelope flap and triangular flap, the MTF benefits the periodontal health, which could be considered as the priority option for IMTM extractions.

Prevalence of surgical site infections following extraction of impacted mandibular third molars: A systematic review and meta-analysis.

Our research aims to assess the prevalence of surgical site infections (SSI) following impacted mandibular third molar extractions. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus and Cochrane Central databases. The pooled prevalence, accompanied by 95% confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Our meta-analysis included seventeen eligible studies, encompassing a total of 37,585 impacted mandibular third molar extractions. The overall prevalence of SSI following impacted mandibular third molar extractions was estimated at 1.7% (95% CI 1%-2.6%), indicating considerable heterogeneity among the studies. No study was identified as critically influential. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.

Comparison of the Cameriere's third molar maturity index and Olze et al.'s stages of radiographic visibility of the root pulp in a Turkish population.

Purpose: The purpose of this study was to compare the Cameriere's third molar maturity index and Olze et al.'s stages of radiographic visibility of the root pulp in estimating the age of maturity in the Turkish population. The age of majority, which is legally significant, marks the transition from childhood to adulthood. In Turkey, the age of majority is set at 18 years. As the third molars continue to develop at this age, they can serve as an indicator of dental age. Materials and methods: A total of 705 panoramic radiographs obtained from individuals aged 15 to 22 years, including children and adults, were included in this study. The left mandibular third molars were evaluated on panoramic radiographs using Cameriere's third molar maturity index and Olze's method of radiographic root pulp visibility (RPV) stages. Minimum and maximum values were noted for each stage, and a median with upper and lower quartiles, as well as mean and standard deviation were calculated. Sensitivity and specificity values were calculated. Results: In males, Cameriere's third molar maturity index demonstrated a sensitivity of 0.77% and specificity of 0.96%, while in females, it showed a sensitivity of 0.57% and specificity of 0.92%. Regarding Olze et al.'s stage 0, the sensitivity and specificity values were 0.86% and 0.79% in males, and 0.85% and 0.75% in females, respectively. Conclusion: Although both methods can be used to distinguish individuals below or above the age of 18, the cut-off value suggested by Cameriere's method resulted in a higher rate of type 2 error (false negativity). Therefore, the method proposed by Olze et al., based on the radiographic visibility of the root pulp, can be employed to differentiate between adults and minors in the Turkish population.

Retrospective analysis of the effects of impacted third molar on hematologic patients undergoing hematopoietic stem cell transplantation.

Objective: This study aimed to investigate the incidence, treatment status, and impact position of impacted third molars (ITM) and their effects on patients undergoing hematopoietic stem cell transplantation (HSCT). Methods: A retrospective analysis was conducted on the medical records of 454 patients who underwent HSCT, out of which 188 patients had ITM. The presence of ITM and its association with transplant-related infections and complications were recorded and analyzed. Results: Patients with ITM were significantly younger. The number of mandibular ITM was notably higher than maxillary ones, and the risk of pericoronitis in mandibular ITM was significantly higher than in maxillary ones. Out of 311 ITM in 188 patients, 25 were extracted before transplantation. The proportion of extraction and treatment for ITM with pericoronitis or caries was significantly higher than that for ITM without such problems. Moreover, patients with a history of pre-transplant pericoronitis had a significantly higher probability of developing tooth-related complications during transplantation, caused by pericoronitis in ITM compared to patients without a history of pericoronitis. Conclusion: Pre-transplant examination and treatment of ITM are essential, especially in cases with a history of pericoronitis. Oral intervention can significantly reduce the occurrence of tooth-related complications related to ITM during transplantation.

Prevalence and Anatomical Characteristics of Bifid and Trifid Mandibular Canals: A Computer Tomography Analysis.

PURPOSE: To assess the prevalence and configuration of bifid (BMC) and trifid (TMC) mandibular canals using computed tomography (CT), describing the anatomical characteristics of the accessory canals, especially of the retromolar type. MATERIALS AND METHODS: CT scans of 123 patients were analysed. BMCs were identified and the patterns of bifurcation were classified, including trifid canals. The width of accessory canals was measured. Retromolar canals were further classified according to their course and morphology, while their position and width were evaluated using linear measurements on CT images. RESULTS: The majority of patients (53.6%) presented at least one BMC or TMC. 36.2% of mandibular canals were bifid, while 4.5% were trifid. The forward canals (12.6%) and retromolar canals (10.2%) were the most common among BMCs. In relation to the retromolar canals, 60% were vertical and 40% curved, with a mean width of 1.03 ± 0.28mm. CONCLUSION: BMCs and TMCs are common 3D radiographic findings, so that they should be considered as anatomical variations, not anomalies. Preoperative CT or CBCT evaluation should aid in identifying these variations and analysing their position and course in surgical planning.

Does the use of intra-alveolar honey after lower third molar extraction reduce postoperative inflammatory complications? A systematic review and meta-analysis.

BACKGROUND: Protocols are currently being studied in preventing postoperative complications after exodontia. PURPOSE: This systematic review and meta-analysis aims to evaluate whether the application of intra-alveolar honey reduces inflammatory complications after the extraction of mandibular third molars (CRD 42.023.467.041). METHODS: Searches were carried out in six electronic databases. Clinical trials comparing intra-alveolar honey administration with non-intervention or placebo after mandibular third molar extraction were selected to assess their impact on postoperative inflammatory parameters. The Cochrane ROB 2 tool was used to assess the bias risk in included studies, Stata software to conduct a meta-analysis for quantitative synthesis, and the GRADE system to evaluate the certainty of the evidence. RESULTS: This systematic review included 5 studies with 330 participants, and two studies were included in the meta-analysis. The results of the meta-analysis demonstrated that postoperative pain on the second day [MD: - 1.05; 95% CI - 2 to - 0.1] and fifth day [MD: - 0.97; 95% CI - 1.97 to - 0.03] was lower in the honey group compared to the control group. Total analgesic consumption [MD: - 4.77; 95% CI - 6.73 to - 2.81] was also lower in patients in the intervention group. The descriptive results indicated that honey appears to be beneficial in controlling edema, reducing trismus, and improving healing after extraction of third molars. Alveolar osteitis showed inconclusive results. CONCLUSIONS: The use of intra-alveolar honey after extraction of mandibular third molars seem to be associated with pain reduction. For the other outcomes, the results remain uncertain.

Residual enamel removal to improve outcomes of mandibular third molar coronectomy: A single-center retrospective cohort study.

This study aimed to analyze post-coronectomy complications, chronological root survival rate (success rate) using Kaplan-Meier analysis, and postoperative radiographic signs for root extraction. A total of 555 mandibular third molar coronectomies were clinically and radiologically evaluated (mean follow-up period, 27.2 months; range, 1 month to 10.5 years). Complications were observed in 22 (4.0%) cases. Temporary inferior alveolar nerve damage was observed in one (0.2%) case, and 21 (3.8%) retained roots required extraction between 1 and 64 months after coronectomy due to dry socket (two cases, 0.4%), primary non-wound closure (10 cases, 1.8%), secondary root exposure (seven cases, 1.3%), and submucosal root eruption (two cases, 0.4%). Residual enamel after coronectomy was more significantly found on 13 (61.9%) of 21 extracted roots than on 30 (5.6%) of 534 surviving roots. Kaplan-Meier analysis revealed an overall survival rate of 93.8% at 5 years and 92.2% at 10 years. The 5-year survival rates differed significantly (p < 0.001) between the enamel-free (97.0%) and residual enamel-attached (58.3%) roots. The Cox proportional hazards model showed a hazard ratio of 20.87 (95% confidence interval, 8.58-50.72). The long-term outcomes of coronectomy were satisfactory, and a higher success rate is expected when the enamel is completely removed during coronectomy.

Is the third molar the most frequently extracted tooth? A population-based study utilizing dental panoramic radiographs in adults.

OBJECTIVES: The study aimed to examine the authenticity of the often-mentioned statement that the third molar is the most frequently extracted tooth. This finding has not been shown previously in a large population-based sample. MATERIALS AND METHODS: Data comprised a nationally representative sample of 6082 panoramic radiographs taken from adults in the cross-sectional Health 2000 Survey. From the radiographs, all missing teeth were recorded. Information on congenital agenesis of individual teeth was retrieved from two published meta-analyses. Primary outcome was the frequency of missing teeth by tooth type. Explanatory variables were age, sex, and the jaw (maxilla/mandible). Statistical analyses included χ2 test and binomial logistic regression. RESULTS: Mean age of participants (46% men, 54% women) was 53 years (SD 14.6; range 30‒97 years). Missing teeth occurred more often in women than in men (P < 0.001). The third molar was most frequently missing and the canine least frequently. In the maxilla and mandible, the third molar was missing more often than each of the other tooth types up to the age of 80 years (P < 0.01). CONCLUSIONS: When considering the rates of congenital agenesis of individual teeth, it is concluded that the third molar remained the most common tooth extracted up till the age of 80 years. CLINICAL RELEVANCE: The third molar is the most common target for extraction, but also the most common tooth associated with malpractice claims, and therefore, calls for skills, adequate equipment, and other resources for a successful extraction.