Journal of the Korean Association of Oral and Maxillofacial Surgeons

  • 제49권4호
  • /
  • Pages.184-191
  • /
  • 2023
  • /
  • 2234-7550(pISSN)
  • /
  • 2234-5930(eISSN)
대한구강악안면외과학회 (The Korean Association of Oral and Maxillofacial Surgeons)
권호 표지
DOI QR코드

DOI QR Code

Surgical removal of third molars in a young adult: review of indications and surgical techniques

  • Sukkarn Themkumkwun (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University) ;
  • Supasan Sawatdeenarunat (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University) ;
  • Pattamawan Manosuthi (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University)
  • 투고 : 2022.09.12
  • 심사 : 2022.10.28
  • 발행 : 2023.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Germectomy is a surgical method most typically performed in young adults. The indications for treatment are controversial. The purpose of this review was to determine the correct indications for germectomy and to discuss the advantages and disadvantages of the procedure. We reviewed the surgical techniques (anesthetic methods, patient preparation, and flap designs) and complications. Germectomy for orthodontic purposes is a common indication for surgical removal of tooth germ among young patients. Several studies have supported removal at an earlier age to produce fewer surgical complications. Several surgical techniques have been described in the literature.

키워드

과제정보

The authors thank the staff and postgraduate students including colleagues and co-workers in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, for their aid and Mr. Bryan Roderick Hamman for his assistance with the English-language presentation of the manuscript.

참고문헌

  1. Eklund SA, Pittman JL. Third-molar removal patterns in an insured population. J Am Dent Assoc 2001;132:469-75. https://doi.org/10.14219/jada.archive.2001.0209 
  2. Cunha-Cruz J, Rothen M, Spiekerman C, Drangsholt M, McClellan L, Huang GJ; Northwest Practice-Based Research Collaborative in Evidence-Based Dentistry. Recommendations for third molar removal: a practice-based cohort study. Am J Public Health 2014;104:735-43. https://doi.org/10.2105/ajph.2013.301652 
  3. Knutsson K, Brehmer B, Lysell L, Rohlin M. General dental practitioners' evaluation of the need for extraction of asymptomatic mandibular third molars. Community Dent Oral Epidemiol 1992;20:347-50.  https://doi.org/10.1111/j.1600-0528.1992.tb00696.x
  4. Massler M, Schour I, Poncher HG. Developmental pattern of the child as reflected in the calcification pattern of the teeth. Am J Dis Child 1941;62:33-67. https://doi.org/10.1001/archpedi.1941.02000130042004 
  5. Chiapasco M, Crescentini M, Romanoni G. Germectomy or delayed removal of mandibular impacted third molars: the relationship between age and incidence of complications. J Oral Maxillofac Surg 1995;53:418-22; discussion 422-3. https://doi.org/10.1016/0278-2391(95)90715-7 
  6. Finne K, Klamfeldt A. Removal of lower third molar germs by lateral trepanation and conventional technique. A comparative study. Int J Oral Surg 1981;10:251-4. https://doi.org/10.1016/s0300-9785(81)80067-1 
  7. Pogrel MA, Dodson TB, Swift JQ, Bonine FL, Rafetto LK, Kennedy JE, et al. White paper on third molar data. American Association of Oral and Maxillofacial Surgeons; 2007. 
  8. Sivolella S, Berengo M, Bressan E, Di Fiore A, Stellini E. Osteotomy for lower third molar germectomy: randomized prospective crossover clinical study comparing piezosurgery and conventional rotatory osteotomy. J Oral Maxillofac Surg 2011;69:e15-23. https://doi.org/10.1016/j.joms.2010.12.036 
  9. Ling XF, Heng TL, Mohamad AF. Which procedure is better: germectomy or surgical removal of mandibular third molar? Int J Oral Maxillofac Surg 2017;46 Suppl 1:110-1. https://doi.org/10.1016/j.ijom.2017.02.390 
  10. Haddad J. Management of third molars. Dental Economics 2020. https://dentalacademyofce.com/courses/management-of-third-molars 
  11. Chossegros C, Guyot L, Cheynet F, Belloni D, Blanc JL. Is lingual nerve protection necessary for lower third molar germectomy? A prospective study of 300 procedures. Int J Oral Maxillofac Surg 2002;31:620-4. https://doi.org/10.1054/ijom.2002.0236 
  12. Monaco G, Daprile G, Tavernese L, Corinaldesi G, Marchetti C. Mandibular third molar removal in young patients: an evaluation of 2 different flap designs. J Oral Maxillofac Surg 2009;67:15-21. https://doi.org/10.1016/j.joms.2007.05.032 
  13. Mazur M, Ndokaj A, Marasca B, Sfasciotti GL, Marasca R, Bossu M, et al. Clinical indications to germectomy in pediatric dentistry: a systematic review. Int J Environ Res Public Health 2022;19:740. https://doi.org/10.3390/ijerph19020740 
  14. Monaco G, Tavernese L, Agostini R, Marchetti C. Evaluation of antibiotic prophylaxis in reducing postoperative infection after mandibular third molar extraction in young patients. J Oral Maxillofac Surg 2009;67:1467-72. https://doi.org/10.1016/j.joms.2008.12.066 
  15. Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973;45:211-27. 
  16. Melo M, Ata-Ali F, Ata-Ali J, Martinez Gonzalez JM, Cobo T. Demirjian and Cameriere methods for age estimation in a Spanish sample of 1386 living subjects. Sci Rep 2022;12:2838. https://doi.org/10.1038/s41598-022-06917-x 
  17. Bjornland T, Haanaes HR, Lind PO, Zachrisson B. Removal of third molar germs. Study of complications. Int J Oral Maxillofac Surg 1987;16:385-90. https://doi.org/10.1016/s0901-5027(87)80072-3 
  18. Bartuli FN, Piva P, Savo A, Di Dio M, Luciani F, Arcuri C. Lower third molar germectomy: the flap recovery on the lower second molar. A clinical study. Int J Clin Dent 2014;7:289-94. 
  19. Zhang QB, Zhang ZQ. Early extraction: a silver bullet to avoid nerve injury in lower third molar removal? Int J Oral Maxillofac Surg 2012;41:1280-3. https://doi.org/10.1016/j.ijom.2012.03.030 
  20. Laskin DM. Evaluation of the third molar problem. J Am Dent Assoc 1971;82:824-8. https://doi.org/10.14219/jada.archive.1971.0130 
  21. Richardson ME. The role of the third molar in the cause of late lower arch crowding: a review. Am J Orthod Dentofacial Orthop 1989;95:79-83. https://doi.org/10.1016/0889-5406(89)90139-x 
  22. Staderini E, Patini R, Guglielmi F, Camodeca A, Gallenzi P. How to manage impacted third molars: germectomy or delayed removal? A systematic literature review. Medicina (Kaunas) 2019;55:79. https://doi.org/10.3390/medicina55030079 
  23. Sverzut CE, Trivellato AE, Sverzut AT, de Matos FP, Kato RB. Removal of a maxillary third molar accidentally displaced into the infratemporal fossa via intraoral approach under local anesthesia: report of a case. J Oral Maxillofac Surg 2009;67:1316-20. https://doi.org/10.1016/j.joms.2008.09.018 
  24. Primo BT, Stringhini DJ, da Costa DJ, Rebellato NLB, Scariot R. Delayed removal of maxillary third molar displaced into the maxillary sinus. Stomatologija 2016;18:128-32. 
  25. Roshanghias K, Peisker A, Zieron JO. Maxillary tooth displacement in the infratemporal fossa. Dent Res J (Isfahan) 2016;13:373-5. https://doi.org/10.4103/1735-3327.187881 
  26. Nogueira EFC, Almeida RAC, Catunda IS, Vasconcelos BCDE, Leite Segundo AV. Impacted maxillary third molar displaced to the infratemporal space: a critical review and case report. Gen Dent 2019;67:16-20. 
  27. Dodson TB. The trouble with exact change. J Oral Maxillofac Surg 2017;75:445-6. https://doi.org/10.1016/j.joms.2016.12.033 
  28. Lee YJ, Kook YA, Park JH, Park J, Bayome M, Vaid NR, et al. Short-term cone-beam computed tomography evaluation of maxillary third molar changes after total arch distalization in adolescents. Am J Orthod Dentofacial Orthop 2019;155:191-7. https://doi.org/10.1016/j.ajodo.2018.04.023 
  29. Flores-Mir C, McGrath L, Heo G, Major PW. Efficiency of molar distalization associated with second and third molar eruption stage. Angle Orthod 2013;83:735-42. https://doi.org/10.2319/081612-658.1 
  30. Chaparro-Avendano AV, Perez-Garcia S, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Morbidity of third molar extraction in patients between 12 and 18 years of age. Med Oral Patol Oral Cir Bucal 2005;10:422-31. 
  31. Harradine NW, Pearson MH, Toth B. The effect of extraction of third molars on late lower incisor crowding: a randomized controlled trial. Br J Orthod 1998;25:117-22. https://doi.org/10.1093/ortho/25.2.117 
  32. Cassetta M, Altieri F. The influence of mandibular third molar germectomy on the treatment time of impacted mandibular second molars using brass wire: a prospective clinical pilot study. Int J Oral Maxillofac Surg 2017;46:905-11. https://doi.org/10.1016/j.ijom.2017.03.027 
  33. Bisconte P, Matarrese L, Del Rosso E, Farronato. Germectomy of third molars in orthodontic therapy: usefulness of volumetric analysis with TC cone beam. Austin J Radiol 2017;4:1072. https://doi.org/10.26420/austinjradiol.2018.1072 
  34. Monaco G, Cecchini S, Gatto MR, Pelliccioni GA. Delayed onset infections after lower third molar germectomy could be related to the space distal to the second molar. Int J Oral Maxillofac Surg 2017;46:373-8. https://doi.org/10.1016/j.ijom.2016.09.011 
  35. Maria A, Malik M, Virang P. Comparison of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars. J Maxillofac Oral Surg 2012;11:276-83. https://doi.org/10.1007/s12663-011-0287-9 
  36. Chaudhary M, Singh M, Singh S, Singh SP, Kaur G. Primary and secondary closure technique following removal of impacted mandibular third molars: a comparative study. Natl J Maxillofac Surg 2012;3:10-4. https://doi.org/10.4103/0975-5950.102141 
  37. Cardarelli A, Pecora CN, Arun KG. Early third molar extraction: when germectomy is the best choise. IPDOAJ 2020;4:350-3. https://doi.org/10.32474/IPDOAJ.2020.04.000192 
  38. Nolla CM. The development of the permanent teeth. J Dent Child 1960;27:254-66. 
  39. Oyri H, Jensen JL, Barkvoll P, Jonsdottir OH, Reseland J, Bjornland T. Incidence of alveolar osteitis after mandibular third molar surgery. Can inflammatory cytokines be identified locally? Acta Odontol Scand 2021;79:205-11. https://doi.org/10.1080/00016357.2020.1817546 
  40. Kaposvari I, Kormoczi K, Csurgay K, Horvath F, Ashourioun AH, Buglyo A, et al. Delayed-onset infections after lower third molar surgery: a Hungarian case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;132:641-7. https://doi.org/10.1016/j.oooo.2021.04.052 
  41. Ganss C, Hochban W, Kielbassa AM, Umstadt HE. Prognosis of third molar eruption. Oral Surg Oral Med Oral Pathol 1993;76:688-93. https://doi.org/10.1016/0030-4220(93)90035-3