Impacted Wisdom Teeth

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Theodorus G Mettes - One of the best experts on this subject based on the ideXlab platform.

  • surgical removal versus retention for the management of asymptomatic disease free Impacted Wisdom Teeth
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Hossein Ghaeminia, John Perry, M E L Nienhuijs, Verena Toedtling, Marcia Tummers, Theo J M Hoppenreijs, Wil J M Van Der Sanden, Theodorus G Mettes
    Abstract:

    Background Prophylactic removal of asymptomatic disease-free Impacted Wisdom Teeth is surgical removal of Wisdom Teeth in the absence of symptoms and with no evidence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free Impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free Wisdom Teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. Objectives To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents and adults. Search methods We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 24 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE Ovid (1946 to 24 May 2016) and Embase Ovid (1980 to 24 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing and unpublished studies to 24 May 2016. We imposed no restrictions on language or date of publication in our search of electronic databases. Selection criteria Studies comparing removal (or absence) with retention (or presence) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents or adults. We included randomised controlled trials (RCTs) with no restriction on length of follow-up, if available. We considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. Data collection and analysis Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently conducted risk of bias assessments in duplicate. When information was unclear, we contacted study authors for additional information. Main results This review includes two studies. The previous review included one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom; our new search for this update identified one prospective cohort study conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth on health-related quality of life Secondary outcomes We found only low to very low quality evidence of the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effect of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free Impacted Wisdom Teeth on periodontitis and caries associated with the distal of the adjacent second molar during a follow-up period of three to over 25 years. Very low quality evidence suggests that the presence of asymptomatic disease-free Impacted Wisdom Teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of Impacted Wisdom Teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free Impacted Wisdom Teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' Wisdom Teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free Impacted Wisdom Teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free Impacted Wisdom Teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent Teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). Authors' conclusions 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.

  • The Cochrane Library - Surgical removal versus retention for the management of asymptomatic disease‐free Impacted Wisdom Teeth
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Hossein Ghaeminia, John Perry, M E L Nienhuijs, Verena Toedtling, Marcia Tummers, Theo J M Hoppenreijs, Wil J M Van Der Sanden, Theodorus G Mettes
    Abstract:

    Background Prophylactic removal of asymptomatic disease-free Impacted Wisdom Teeth is surgical removal of Wisdom Teeth in the absence of symptoms and with no evidence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free Impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free Wisdom Teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. Objectives To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents and adults. Search methods We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 24 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE Ovid (1946 to 24 May 2016) and Embase Ovid (1980 to 24 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing and unpublished studies to 24 May 2016. We imposed no restrictions on language or date of publication in our search of electronic databases. Selection criteria Studies comparing removal (or absence) with retention (or presence) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents or adults. We included randomised controlled trials (RCTs) with no restriction on length of follow-up, if available. We considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. Data collection and analysis Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently conducted risk of bias assessments in duplicate. When information was unclear, we contacted study authors for additional information. Main results This review includes two studies. The previous review included one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom; our new search for this update identified one prospective cohort study conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth on health-related quality of life Secondary outcomes We found only low to very low quality evidence of the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effect of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free Impacted Wisdom Teeth on periodontitis and caries associated with the distal of the adjacent second molar during a follow-up period of three to over 25 years. Very low quality evidence suggests that the presence of asymptomatic disease-free Impacted Wisdom Teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of Impacted Wisdom Teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free Impacted Wisdom Teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' Wisdom Teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free Impacted Wisdom Teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free Impacted Wisdom Teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent Teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). Authors' conclusions 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.

  • surgical removal versus retention for the management of asymptomatic Impacted Wisdom Teeth
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Theodorus G Mettes, Hossein Ghaeminia, John Perry, M E L Nienhuijs, Wil J M Van Der Sanden, A J M Plasschaert
    Abstract:

    Background The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent Teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. Objectives To evaluate the effects of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention (conservative management) of these Wisdom Teeth. Search methods The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 30 March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 30 March 2012), and EMBASE via OVID (1980 to 30 March 2012). There were no restrictions on language or date of publication. Selection criteria All randomised controlled trials (RCTs) on adolescents and adults comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). Data collection and analysis Six review authors screened the results of the search and assessed whether trials met the inclusion criteria for the review. Data extraction and risk of bias assessment were conducted in duplicate and independently by six review authors. Where information was unclear, authors of studies were contacted for additional information. Main results No RCTs were identified that compared the removal of asymptomatic Wisdom Teeth with retention and reported quality of life. One RCT on adolescents was identified that compared the removal of Impacted mandibular Wisdom Teeth with retention and only examined the effect on late lower incisor crowding. This study at high risk of bias provided no evidence that extraction of Wisdom Teeth had an effect on lower incisor crowding over 5 years. Authors' conclusions Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured. Watchful monitoring of asymptomatic third molar Teeth may be a more prudent strategy.

  • The Cochrane Library - Surgical removal versus retention for the management of asymptomatic Impacted Wisdom Teeth.
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Theodorus G Mettes, Hossein Ghaeminia, John Perry, M E L Nienhuijs, Wil J M Van Der Sanden, A J M Plasschaert
    Abstract:

    Background The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent Teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. Objectives To evaluate the effects of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention (conservative management) of these Wisdom Teeth. Search methods The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 30 March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 30 March 2012), and EMBASE via OVID (1980 to 30 March 2012). There were no restrictions on language or date of publication. Selection criteria All randomised controlled trials (RCTs) on adolescents and adults comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). Data collection and analysis Six review authors screened the results of the search and assessed whether trials met the inclusion criteria for the review. Data extraction and risk of bias assessment were conducted in duplicate and independently by six review authors. Where information was unclear, authors of studies were contacted for additional information. Main results No RCTs were identified that compared the removal of asymptomatic Wisdom Teeth with retention and reported quality of life. One RCT on adolescents was identified that compared the removal of Impacted mandibular Wisdom Teeth with retention and only examined the effect on late lower incisor crowding. This study at high risk of bias provided no evidence that extraction of Wisdom Teeth had an effect on lower incisor crowding over 5 years. Authors' conclusions Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured. Watchful monitoring of asymptomatic third molar Teeth may be a more prudent strategy.

  • interventions for treating asymptomatic Impacted Wisdom Teeth in adolescents and adults
    Cochrane Database of Systematic Reviews, 2005
    Co-Authors: Theodorus G Mettes, M E L Nienhuijs, Wil J M Van Der Sanden, E H Verdonschot, A J M Plasschaert
    Abstract:

    BACKGROUND: The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent Teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom Teeth do not always fulfil a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care'. Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60% or more. It has been suggested that watchful monitoring of asymptomatic Wisdom Teeth may be an appropriate strategy. OBJECTIVES: To evaluate the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention of these Wisdom Teeth. SEARCH STRATEGY: The following electronic databases were searched:The Cochrane Oral Health Group Trials Register (4 August 2004), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 4 August 2004), PubMed (1966 to 4 August 2004), EMBASE (1974 to 4 August 2004). There was no restriction on language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. SELECTION CRITERIA: All randomised or controlled clinical trials (RCTs/CCTs) comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). DATA COLLECTION AND ANALYSIS: Assessment of relevance, validity and data extraction were conducted in duplicate and independently by three reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. A quality assessment of the trials was carried out. MAIN RESULTS: Only three trials were identified that satisfied the review selection criteria. Two were completed RCTs and both assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data. They intend to publish in the near future and information received will be included in updates. Although both completed trials met the inclusion criteria of the review, regarding participants characteristics, interventions and outcomes assessed, different outcomes measures were assessed which prevented pooling of data. AUTHORS' CONCLUSIONS: No evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. There is some reliable evidence that suggests that the prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents neither reduces nor prevents late incisor crowding.

A J M Plasschaert - One of the best experts on this subject based on the ideXlab platform.

  • surgical removal versus retention for the management of asymptomatic Impacted Wisdom Teeth
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Theodorus G Mettes, Hossein Ghaeminia, John Perry, M E L Nienhuijs, Wil J M Van Der Sanden, A J M Plasschaert
    Abstract:

    Background The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent Teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. Objectives To evaluate the effects of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention (conservative management) of these Wisdom Teeth. Search methods The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 30 March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 30 March 2012), and EMBASE via OVID (1980 to 30 March 2012). There were no restrictions on language or date of publication. Selection criteria All randomised controlled trials (RCTs) on adolescents and adults comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). Data collection and analysis Six review authors screened the results of the search and assessed whether trials met the inclusion criteria for the review. Data extraction and risk of bias assessment were conducted in duplicate and independently by six review authors. Where information was unclear, authors of studies were contacted for additional information. Main results No RCTs were identified that compared the removal of asymptomatic Wisdom Teeth with retention and reported quality of life. One RCT on adolescents was identified that compared the removal of Impacted mandibular Wisdom Teeth with retention and only examined the effect on late lower incisor crowding. This study at high risk of bias provided no evidence that extraction of Wisdom Teeth had an effect on lower incisor crowding over 5 years. Authors' conclusions Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured. Watchful monitoring of asymptomatic third molar Teeth may be a more prudent strategy.

  • The Cochrane Library - Surgical removal versus retention for the management of asymptomatic Impacted Wisdom Teeth.
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Theodorus G Mettes, Hossein Ghaeminia, John Perry, M E L Nienhuijs, Wil J M Van Der Sanden, A J M Plasschaert
    Abstract:

    Background The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent Teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. Objectives To evaluate the effects of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention (conservative management) of these Wisdom Teeth. Search methods The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 30 March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 30 March 2012), and EMBASE via OVID (1980 to 30 March 2012). There were no restrictions on language or date of publication. Selection criteria All randomised controlled trials (RCTs) on adolescents and adults comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). Data collection and analysis Six review authors screened the results of the search and assessed whether trials met the inclusion criteria for the review. Data extraction and risk of bias assessment were conducted in duplicate and independently by six review authors. Where information was unclear, authors of studies were contacted for additional information. Main results No RCTs were identified that compared the removal of asymptomatic Wisdom Teeth with retention and reported quality of life. One RCT on adolescents was identified that compared the removal of Impacted mandibular Wisdom Teeth with retention and only examined the effect on late lower incisor crowding. This study at high risk of bias provided no evidence that extraction of Wisdom Teeth had an effect on lower incisor crowding over 5 years. Authors' conclusions Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured. Watchful monitoring of asymptomatic third molar Teeth may be a more prudent strategy.

  • interventions for treating asymptomatic Impacted Wisdom Teeth in adolescents and adults
    Cochrane Database of Systematic Reviews, 2005
    Co-Authors: Theodorus G Mettes, M E L Nienhuijs, Wil J M Van Der Sanden, E H Verdonschot, A J M Plasschaert
    Abstract:

    BACKGROUND: The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent Teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom Teeth do not always fulfil a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care'. Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60% or more. It has been suggested that watchful monitoring of asymptomatic Wisdom Teeth may be an appropriate strategy. OBJECTIVES: To evaluate the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention of these Wisdom Teeth. SEARCH STRATEGY: The following electronic databases were searched:The Cochrane Oral Health Group Trials Register (4 August 2004), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 4 August 2004), PubMed (1966 to 4 August 2004), EMBASE (1974 to 4 August 2004). There was no restriction on language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. SELECTION CRITERIA: All randomised or controlled clinical trials (RCTs/CCTs) comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). DATA COLLECTION AND ANALYSIS: Assessment of relevance, validity and data extraction were conducted in duplicate and independently by three reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. A quality assessment of the trials was carried out. MAIN RESULTS: Only three trials were identified that satisfied the review selection criteria. Two were completed RCTs and both assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data. They intend to publish in the near future and information received will be included in updates. Although both completed trials met the inclusion criteria of the review, regarding participants characteristics, interventions and outcomes assessed, different outcomes measures were assessed which prevented pooling of data. AUTHORS' CONCLUSIONS: No evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. There is some reliable evidence that suggests that the prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents neither reduces nor prevents late incisor crowding.

  • The Cochrane Library - Interventions for treating asymptomatic Impacted Wisdom Teeth in adolescents and adults.
    Cochrane Database of Systematic Reviews, 2005
    Co-Authors: Theodorus G Mettes, M E L Nienhuijs, Wil J M Van Der Sanden, E H Verdonschot, A J M Plasschaert
    Abstract:

    BACKGROUND: The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent Teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom Teeth do not always fulfil a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care'. Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60% or more. It has been suggested that watchful monitoring of asymptomatic Wisdom Teeth may be an appropriate strategy. OBJECTIVES: To evaluate the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention of these Wisdom Teeth. SEARCH STRATEGY: The following electronic databases were searched:The Cochrane Oral Health Group Trials Register (4 August 2004), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 4 August 2004), PubMed (1966 to 4 August 2004), EMBASE (1974 to 4 August 2004). There was no restriction on language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. SELECTION CRITERIA: All randomised or controlled clinical trials (RCTs/CCTs) comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). DATA COLLECTION AND ANALYSIS: Assessment of relevance, validity and data extraction were conducted in duplicate and independently by three reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. A quality assessment of the trials was carried out. MAIN RESULTS: Only three trials were identified that satisfied the review selection criteria. Two were completed RCTs and both assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data. They intend to publish in the near future and information received will be included in updates. Although both completed trials met the inclusion criteria of the review, regarding participants characteristics, interventions and outcomes assessed, different outcomes measures were assessed which prevented pooling of data. AUTHORS' CONCLUSIONS: No evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. There is some reliable evidence that suggests that the prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents neither reduces nor prevents late incisor crowding.

Xue Liu - One of the best experts on this subject based on the ideXlab platform.

  • Comparative study of complications among routine method,high speed turbine handpiece and piezosurgery device after extraction of Impacted Wisdom Teeth
    Shanghai journal of stomatology, 2012
    Co-Authors: Zhao-zhong Guo, Heng Zhang, Yin Liu, Yang Wang, Chun-xia Yuan, Xue Liu
    Abstract:

    PURPOSE To investigate complications in extraction of complicated Impacted Wisdom Teeth whose root apex near to the inferior alveolar nerve(IAN) by using routine method(chisels),high speed turbine handpiece and piezosurgery device respectively. METHODS Three hundred qualified patients with Impacted Wisdom Teeth were divided into three groups randomly,one hundred patients in group A were extracted by routine method, one hundred patients in group B were extracted by high speed turbine handpiece, and one hundred patients in group C were extracted by piezosurgery device. The operation time, postoperative pain duration,dry socket and IAN injury were compared between each two groups. All statistical analysis was performed using SPSS 13.0 software package. Differences between groups were compared using a paired t test (quantitative data) or Chi-square test (qualitative data). RESULTS The operation time in group A was(14.12±0.12)min, (7.22±0.15)min in group B, (25.23±0.32)min in group C; Significant difference was found between group A and group B(P

  • comparative study of complications among routine method high speed turbine handpiece and piezosurgery device after extraction of Impacted Wisdom Teeth
    Shanghai journal of stomatology, 2012
    Co-Authors: Zhao-zhong Guo, Heng Zhang, Yin Liu, Yang Wang, Chun-xia Yuan, Xue Liu
    Abstract:

    PURPOSE To investigate complications in extraction of complicated Impacted Wisdom Teeth whose root apex near to the inferior alveolar nerve(IAN) by using routine method(chisels),high speed turbine handpiece and piezosurgery device respectively. METHODS Three hundred qualified patients with Impacted Wisdom Teeth were divided into three groups randomly,one hundred patients in group A were extracted by routine method, one hundred patients in group B were extracted by high speed turbine handpiece, and one hundred patients in group C were extracted by piezosurgery device. The operation time, postoperative pain duration,dry socket and IAN injury were compared between each two groups. All statistical analysis was performed using SPSS 13.0 software package. Differences between groups were compared using a paired t test (quantitative data) or Chi-square test (qualitative data). RESULTS The operation time in group A was(14.12±0.12)min, (7.22±0.15)min in group B, (25.23±0.32)min in group C; Significant difference was found between group A and group B(P<0.05), group B and group C(P<0.05),group A and group C(P<0.05).Postoperative pain duration was(62.15±1.51)h in group A, (48.23±1.23)h in group B, (14.34±O.80)h in group C; Significant difference was found between group A and group B(P<0.05), group B and group C(P<0.05),group A and group C(P<0.05).9 patients developed dry socket in group A, 2 in group B, and 1 in group C; Significant difference was found between group A and group B(P<0.05), group A and group C(P<0.05). Six patients had IAN injury in group A, 2 in group B, 0 in group C. Significant difference was found between group A and group C. CONCLUSIONS Compared with routine method, high speed turbine is better in extraction of Impacted Wisdom Teeth, which can shorten operation time, lessen postoperative complications. Although there was longer operation time compared with group A and B, piezosurgery device is more effective in reducing postoperative complications.

P. Proff - One of the best experts on this subject based on the ideXlab platform.

  • Three-dimensional localization of Impacted Teeth using magnetic resonance imaging
    Clinical Oral Investigations, 2010
    Co-Authors: O. Tymofiyeva, K. Rottner, P. M. Jakob, E.-j. Richter, P. Proff
    Abstract:

    Impacted Teeth remain embedded in the jawbone beyond the normal eruption time with completed root growth. They can often get infected or damage neighboring Teeth. Information about the three-dimensional position of Impacted Teeth is invaluable in orthodontic diagnosis and treatment planning. The purpose of this prospective study was to assess the feasibility of using magnetic resonance imaging (MRI) for the three-dimensional localization of Impacted Teeth in children and adults. The study included 39 patients from the pediatric age group with different tooth impactions and seven adults with Impacted Wisdom Teeth. MRI yielded a clear separation between Impacted Teeth and the surrounding tissue, and the position and angulation of Impacted Teeth in all three spatial dimensions could be assessed. Compared to conventional radiography, dental MRI provides the advantage of full volumetric morphology accompanied by complete elimination of ionizing radiation, which is particularly relevant for repeated examinations of the pediatric group.

Wil J M Van Der Sanden - One of the best experts on this subject based on the ideXlab platform.

  • surgical removal versus retention for the management of asymptomatic disease free Impacted Wisdom Teeth
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Hossein Ghaeminia, John Perry, M E L Nienhuijs, Verena Toedtling, Marcia Tummers, Theo J M Hoppenreijs, Wil J M Van Der Sanden, Theodorus G Mettes
    Abstract:

    Background Prophylactic removal of asymptomatic disease-free Impacted Wisdom Teeth is surgical removal of Wisdom Teeth in the absence of symptoms and with no evidence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free Impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free Wisdom Teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. Objectives To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents and adults. Search methods We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 24 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE Ovid (1946 to 24 May 2016) and Embase Ovid (1980 to 24 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing and unpublished studies to 24 May 2016. We imposed no restrictions on language or date of publication in our search of electronic databases. Selection criteria Studies comparing removal (or absence) with retention (or presence) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents or adults. We included randomised controlled trials (RCTs) with no restriction on length of follow-up, if available. We considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. Data collection and analysis Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently conducted risk of bias assessments in duplicate. When information was unclear, we contacted study authors for additional information. Main results This review includes two studies. The previous review included one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom; our new search for this update identified one prospective cohort study conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth on health-related quality of life Secondary outcomes We found only low to very low quality evidence of the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effect of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free Impacted Wisdom Teeth on periodontitis and caries associated with the distal of the adjacent second molar during a follow-up period of three to over 25 years. Very low quality evidence suggests that the presence of asymptomatic disease-free Impacted Wisdom Teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of Impacted Wisdom Teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free Impacted Wisdom Teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' Wisdom Teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free Impacted Wisdom Teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free Impacted Wisdom Teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent Teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). Authors' conclusions 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.

  • The Cochrane Library - Surgical removal versus retention for the management of asymptomatic disease‐free Impacted Wisdom Teeth
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Hossein Ghaeminia, John Perry, M E L Nienhuijs, Verena Toedtling, Marcia Tummers, Theo J M Hoppenreijs, Wil J M Van Der Sanden, Theodorus G Mettes
    Abstract:

    Background Prophylactic removal of asymptomatic disease-free Impacted Wisdom Teeth is surgical removal of Wisdom Teeth in the absence of symptoms and with no evidence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free Impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free Wisdom Teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. Objectives To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents and adults. Search methods We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 24 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE Ovid (1946 to 24 May 2016) and Embase Ovid (1980 to 24 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing and unpublished studies to 24 May 2016. We imposed no restrictions on language or date of publication in our search of electronic databases. Selection criteria Studies comparing removal (or absence) with retention (or presence) of asymptomatic disease-free Impacted Wisdom Teeth in adolescents or adults. We included randomised controlled trials (RCTs) with no restriction on length of follow-up, if available. We considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. Data collection and analysis Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently conducted risk of bias assessments in duplicate. When information was unclear, we contacted study authors for additional information. Main results This review includes two studies. The previous review included one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom; our new search for this update identified one prospective cohort study conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth on health-related quality of life Secondary outcomes We found only low to very low quality evidence of the effects of removal compared with retention of asymptomatic disease-free Impacted Wisdom Teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effect of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free Impacted Wisdom Teeth on periodontitis and caries associated with the distal of the adjacent second molar during a follow-up period of three to over 25 years. Very low quality evidence suggests that the presence of asymptomatic disease-free Impacted Wisdom Teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of Impacted Wisdom Teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free Impacted Wisdom Teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' Wisdom Teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free Impacted Wisdom Teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free Impacted Wisdom Teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent Teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). Authors' conclusions 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.

  • surgical removal versus retention for the management of asymptomatic Impacted Wisdom Teeth
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Theodorus G Mettes, Hossein Ghaeminia, John Perry, M E L Nienhuijs, Wil J M Van Der Sanden, A J M Plasschaert
    Abstract:

    Background The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent Teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. Objectives To evaluate the effects of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention (conservative management) of these Wisdom Teeth. Search methods The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 30 March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 30 March 2012), and EMBASE via OVID (1980 to 30 March 2012). There were no restrictions on language or date of publication. Selection criteria All randomised controlled trials (RCTs) on adolescents and adults comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). Data collection and analysis Six review authors screened the results of the search and assessed whether trials met the inclusion criteria for the review. Data extraction and risk of bias assessment were conducted in duplicate and independently by six review authors. Where information was unclear, authors of studies were contacted for additional information. Main results No RCTs were identified that compared the removal of asymptomatic Wisdom Teeth with retention and reported quality of life. One RCT on adolescents was identified that compared the removal of Impacted mandibular Wisdom Teeth with retention and only examined the effect on late lower incisor crowding. This study at high risk of bias provided no evidence that extraction of Wisdom Teeth had an effect on lower incisor crowding over 5 years. Authors' conclusions Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured. Watchful monitoring of asymptomatic third molar Teeth may be a more prudent strategy.

  • The Cochrane Library - Surgical removal versus retention for the management of asymptomatic Impacted Wisdom Teeth.
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Theodorus G Mettes, Hossein Ghaeminia, John Perry, M E L Nienhuijs, Wil J M Van Der Sanden, A J M Plasschaert
    Abstract:

    Background The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent Teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. Objectives To evaluate the effects of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention (conservative management) of these Wisdom Teeth. Search methods The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 30 March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 30 March 2012), and EMBASE via OVID (1980 to 30 March 2012). There were no restrictions on language or date of publication. Selection criteria All randomised controlled trials (RCTs) on adolescents and adults comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). Data collection and analysis Six review authors screened the results of the search and assessed whether trials met the inclusion criteria for the review. Data extraction and risk of bias assessment were conducted in duplicate and independently by six review authors. Where information was unclear, authors of studies were contacted for additional information. Main results No RCTs were identified that compared the removal of asymptomatic Wisdom Teeth with retention and reported quality of life. One RCT on adolescents was identified that compared the removal of Impacted mandibular Wisdom Teeth with retention and only examined the effect on late lower incisor crowding. This study at high risk of bias provided no evidence that extraction of Wisdom Teeth had an effect on lower incisor crowding over 5 years. Authors' conclusions Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured. Watchful monitoring of asymptomatic third molar Teeth may be a more prudent strategy.

  • interventions for treating asymptomatic Impacted Wisdom Teeth in adolescents and adults
    Cochrane Database of Systematic Reviews, 2005
    Co-Authors: Theodorus G Mettes, M E L Nienhuijs, Wil J M Van Der Sanden, E H Verdonschot, A J M Plasschaert
    Abstract:

    BACKGROUND: The prophylactic removal of asymptomatic Impacted Wisdom Teeth is defined as the (surgical) removal of Wisdom Teeth in the absence of local disease. Impacted Wisdom Teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent Teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom Teeth do not always fulfil a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free Wisdom Teeth, either Impacted or fully erupted, has long been considered as 'appropriate care'. Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60% or more. It has been suggested that watchful monitoring of asymptomatic Wisdom Teeth may be an appropriate strategy. OBJECTIVES: To evaluate the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents and adults compared with the retention of these Wisdom Teeth. SEARCH STRATEGY: The following electronic databases were searched:The Cochrane Oral Health Group Trials Register (4 August 2004), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 4 August 2004), PubMed (1966 to 4 August 2004), EMBASE (1974 to 4 August 2004). There was no restriction on language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. SELECTION CRITERIA: All randomised or controlled clinical trials (RCTs/CCTs) comparing the effect of prophylactic removal of asymptomatic Impacted Wisdom Teeth with no-treatment (retention). DATA COLLECTION AND ANALYSIS: Assessment of relevance, validity and data extraction were conducted in duplicate and independently by three reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. A quality assessment of the trials was carried out. MAIN RESULTS: Only three trials were identified that satisfied the review selection criteria. Two were completed RCTs and both assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data. They intend to publish in the near future and information received will be included in updates. Although both completed trials met the inclusion criteria of the review, regarding participants characteristics, interventions and outcomes assessed, different outcomes measures were assessed which prevented pooling of data. AUTHORS' CONCLUSIONS: No evidence was found to support or refute routine prophylactic removal of asymptomatic Impacted Wisdom Teeth in adults. There is some reliable evidence that suggests that the prophylactic removal of asymptomatic Impacted Wisdom Teeth in adolescents neither reduces nor prevents late incisor crowding.