Local anaesthesia for surgical extraction of mandibular third molars: a systematic review and network meta-analysis

Background and Objectives. Surgical extraction of mandibular third molars (3rd M) may cause inferior alveolar nerve injury (IANI), whereas in coronectomy the crowns of 3rd M are removed, keeping the roots intact to avoid IANI. This study aims to review the literature which evaluated coronectomy effectiveness as an alternative for surgical extraction of 3rd M that have a high risk of trauma to the inferior alveolar canal. A computerized literature search was conducted on the databases PubMed, SCOPUS, and ScienceDirect to gather information regarding the coronectomy procedure from inception till June 5, 2020. A total of 97 articles were identified, and seven studies were finally included for conducting qualitative analysis: 3 randomized clinical trials and 4 clinical controlled trials. Cochrane Collaboration’s tool was used for assessing risk of bias. Coronectomy procedures were performed on 15–171 teeth. In the control group, extraction procedures were done on 15–178 teeth. Results. No study reported permanent inferior alveolar nerve injury (p-IANI) regarding coronectomy; however, transient inferior alveolar nerve injury (t-IANI) was reported in 0–2.20% of successful coronectomy and 0–8% of failed coronectomy. Postextraction t-IANI ranged from 0% to 16.66% while p-IANI from 0% to 3.63%. In 5 studies, root migration occurred in 2% to 85.3% of cases and the distance rate was 2.33–3.43 mm at 6 months postoperatively; then the migration gradually decreased and stopped at 12 months. Conclusion. This systematic review revealed that coronectomy is an efficient alternative for the management of impacted 3rd M with a high risk of IANI. Patients who got antibiotics postcoronectomy procedures had lower infection rates than those who did not receive antibiotic therapy. We recommend further research on coronectomy with longer follow-up periods to assess the retained roots’ long-term outcomes and to assess the effect of antibiotics administration on postcoronectomy infection rate. This systematic review is registered under number CRD42020198394.

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PP110 The Prophylactic Removal Of Impacted Third Molars: A Systematic Review

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318002490 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 107-108

Author(s):

Gerlinde Pilkington ◽

Juliet Hounsome ◽

Tara Renton ◽

Rumona Dickson

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Standard Care ◽

Meta Analysis ◽

Pathological Changes ◽

Third Molars ◽

Inclusion Criteria ◽

Related Quality ◽

Mandibular Third Molars ◽

Meta Analyses

Introduction:Impacted third molars (I3Ms) are blocked from fully erupting; many I3Ms are asymptomatic, however there could be pain and pathological changes. Historically, I3Ms were removed prophylactically. Current options in the United Kingdom include either retention with standard care (watchful waiting), or removal due to pathological changes. We conducted a systematic review of the prophylactic removal of asymptomatic impacted mandibular third molars (IM3Ms) compared with standard care.Methods:We searched five electronic databases from 1999 onwards. Inclusion criteria: randomized and non-randomized trials, observational studies, and systematic reviews (SRs) comparing the prophylactic removal of IM3Ms with standard care or studies assessing the outcomes of either approach; outcomes included pathology associated with retention, postoperative complications, adverse effects of treatment and health-related quality of life. Two reviewers independently screened all titles and/or abstracts, applied inclusion criteria to potentially relevant publications, and quality assessed and data extracted the included studies. No meta-analysis or network meta-analyses were undertaken.Results:Following screening of 11,373 references, 13 studies (four cohort studies and nine SRs) were included. One cohort study investigated the prophylactic removal of asymptomatic IM3Ms in comparison with standard care and retention, two investigated the prophylactic removal of asymptomatic IM3Ms, and one studied the retention and standard care of asymptomatic IM3Ms. Two studies reporting surgical complications found no serious complications; however, one study reported intense pain and postoperative infection. Pathological changes due to retention of asymptomatic IM3Ms were reported by three studies. Nine SRs of the management of third molars were included in this review, however none focused solely on IM3Ms.Conclusions:Consistent with previous systematic reviews, we found no RCT data to support or refute the prophylactic removal of asymptomatic IM3Ms, despite extensive searching of the literature. The review however did identify evidence from two longitudinal studies demonstrating the outcomes when asymptomatic IM3Ms are left in situ.

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