Advertisement

Third molar surgery: Past, present, and the future

Published:March 14, 2021DOI:https://doi.org/10.1016/j.oooo.2021.03.004
      Third molar surgery is the most common ambulatory procedure done by oral and maxillofacial surgeons. Surgical approaches for the removal of third molars have been published since the 20th century. This article reviews the history and development of extraction techniques through a literature review. The literature was selected through a search of an electronic database. Key words for the Medline search were “mandibular/maxillary third molar,” “impacted mandibular/maxillary third molar,” “mandibular/maxillary third molar flap design,” and “mandibular/maxillary third molar incision.” The search was restricted to English-language articles. Additionally, a manual search in the major oral surgery journals and books was performed. The aim of this article is to examine the evolution of third molar surgery, recognize pioneering techniques, and compare these techniques to current approaches. Common approaches employed today are discussed and treatment philosophies with thoughts for future therapies are provided.
      To read this article in full you will need to make a payment

      References

        • Coppa A
        • Bondioli L
        • Cucina A
        • et al.
        Paleontology: early Neolithic tradition of dentistry.
        Nature. 2006; 440: 755-756
        • Wynbrandt J.
        The Excruciating History of Dentistry: Toothsome Tales and Oral Oddities from Babylon to Braces.
        St. Martin's Press, New York, NY1998
        • Aristotle
        Minor Works.
        Harvard University Press, Cambridge, MA1936
        • Guerini V.
        A History of Dentistry From the Most Ancient Times Until the End of the 18th Century.
        Milford, Pound Ridge, NY1969
        • Gualteri H.
        Acute treatment of diseases of children with various observations. Cramer & Perachon, 1727
        • Grooss KS.
        Cornelis Solingen: A Seventeenth-Century Surgeon and His Instruments. Leiden:Museum Boerhaave, Netherlands1990
        • Kells CE.
        Impacted lower third molars.
        Dental Cosmos. 1918; 60: 101-107
        • Kells CE.
        Impacted lower third molars.
        Dental Cosmos. 1921; 63: 101-114
        • Kells CE.
        Removal of the impacted third molar: stereoscopic Skiagraphy.
        Dent Dig. 1904; 10: 1-17
        • Winter GB.
        Principles of Exodontia as Applied to the Impacted Mandibular Third Molar. A Complete Treatise on the Operative Technic With Clinical Diagnoses and Radiographic Interpretations.
        American Medical Book Comp., St. Louis, MO1926
        • Mead SV.
        Incidence of impacted teeth.
        Int J Orthod. 1930; 16: 885-890
        • Thoma KH.
        The management of malposed inferior third molars.
        J Dent Res. 1932; 12: 175-208
        • Fry WK.
        The third molar.
        Br Dent J. 1933; 54: 385-388
        • Fish EW.
        The removal of the impacted third lower molar.
        Br Dent J. 1934; 56: 225-234
        • James WW.
        Operation for the removal of impacted third mandibular molars.
        Br Dent J. 1937; 63: 450-454
        • Ward TG.
        The split bone technique for removal of lower third molars.
        Br Dent J. 1956; 201: 297-304
        • Kilpatrick H.
        Removal of impacted third molars utilizing speeds up to 200,000 R.P.M.
        Oral Surg Oral Med Oral Pathol. 1958; 11: 364-369
        • Kruger GO.
        Management of impactions.
        Dent Clin North Am. 1959; 3: 707-722
        • Ries Centeno GA
        The Impacted Lower Third Molar.
        El Ateneo, Buenos Aire, Argentina1960
        • Partsch C.
        Third report of the Polyclinic for Oral and Dental Diseases of the University of Breslau.
        Dt Mschr Zahnhk. 1896; 14: 486-499
        • Berwick WA.
        Alternative method of flap reflection.
        Br Dent J. 1966; 121: 295-296
        • Szmyd L.
        Impacted teeth.
        Dent Clin North Am. 1971; 15: 299-318
        • Magnus WW
        • Castner DV
        • Hiatt WR.
        An alternative method of flap reflection for mandibular third molars.
        Mil Med. 1972; 137: 232-233
        • Donlon WC
        • Truta MP.
        Minimally invasive third molar surgery.
        Int J Oral Maxillofac Surg. 1999; 28: 57
        • Nageshwar P.
        Comma incision for impacted mandibular third molars.
        J Oral Maxillofac Surg. 2002; 60: 1506-1509
        • Bouloux GF
        • Steed MB
        • Perciaccante VJ.
        Complications of third molar surgery.
        Oral Maxillofac Surg Clin North Am. 2012; 20: 233-251
        • Ngeow WC
        • Lim D.
        Do corticosteroids still have a role in the management of third molar surgery?.
        Adv Ther. 2016; 33: 1105-1139
        • Herrera-Briones FJ
        • Prados Sánchez E
        • Reyes Botella C
        • et al.
        Update on the use of corticosteroids in third molar surgery: systematic review of the literature.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116: e342-e351
        • Pasupathy S
        • Alexander M.
        Antibiotic prophylaxis in third molar surgery.
        J Craniofac Surg. 2011; 22: 551-553
        • Siddiqi A
        • Morkel JA
        • Zafar S.
        Antibiotic prophylaxis in third molar surgery: a randomized double-blind placebo-controlled clinical trial using split-mouth technique.
        Int J Oral Maxillofac Surg. 2010; 39: 107-114
        • Calvo AM
        • Brozoski DT
        • Giglio FPM
        • et al.
        Are antibiotics necessary after lower third molar removal?.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114: S199-S208
        • Vlcek D
        • Razavi A
        • Kuttenberger JJ.
        Antibiotics in third molar surgery.
        Swiss Dent J. 2014; 124: 294-302
        • Erdogan Ö
        • Tatlı U
        • Üstün Y
        • et al.
        Influence of two different flap designs on the sequelae of mandibular third molar surgery.
        Oral Maxillofac Surg. 2011; 15: 147-152
        • Baqain ZH
        • Al-Shafii A
        • Hamdan AA
        • et al.
        Flap design and mandibular third molar surgery: a split mouth randomized clinical study.
        Int J Oral Maxillofac Surg. 2012; 41: 1020-1024
        • Kirk DG
        • Liston PN
        • Tong DC
        • et al.
        Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: e1-e6
        • Bello SA
        • Olaitan AA
        • Ladeinde AL.
        A randomized comparison of the effect of partial and total wound closure techniques on postoperative morbidity after mandibular third molar surgery.
        J Oral Maxillofac Surg. 2011; 69: e24-e30
        • Pachipulusu PK
        • Manjula S.
        Comparative study of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars.
        Oral Maxillofac Surg. 2018; 22: 261-266
        • Ferreira Cerqueira PR
        • Do Egito Vasconcelos BC
        • Bessa-Nogueira RV
        Comparative study of the effect of a tube drain in impacted lower third molar surgery.
        J Oral Maxillofac Surg. 2004; 62: 57-61
        • Kumar B
        • Bhate K
        • Dolas RS
        • et al.
        Comparative evaluation of immediate post-operative sequelae after surgical removal of impacted mandibular third molar with or without tube drain—split-mouth study.
        J Clin Diagn Res. 2016; 10: ZC46-ZC49
        • Zandi M.
        Comparison of corticosteroids and rubber drain for reduction of sequelae after third molar surgery.
        Oral Maxillofac Surg. 2008; 12: 29-33
        • Nogales CG
        • Ferrari PH
        • Kantorovich EO
        • et al.
        Ozone therapy in medicine and dentistry.
        J Contemp Dent Pract. 2008; 1: 75-84
        • Sivalingam VP
        • Panneerselvam E
        • Raja KVB
        • et al.
        Does topical ozone therapy improve patient comfort after surgical removal of impacted mandibular third molar? A randomized controlled trial.
        J Oral Maxillofac Surg. 2017; 75 (51.e1-51.e9)
        • Kazancioglu HO
        • Kurklu E
        • Ezirganli S.
        Effects of ozone therapy on pain, swelling, and trismus following third molar surgery.
        Int J Oral Maxillofac Surg. 2014; 43: 644-648
        • Gelesko S
        • Long L
        • Faulk J
        • et al.
        Cryotherapy and topical minocycline as adjunctive measures to control pain after third molar surgery: an exploratory study.
        J Oral Maxillofac Surg. 2011; 69: e324-e332
        • Van der Westhuijzen AJ
        • Becker PJ
        • Morkel J
        • et al.
        A randomized observer blind comparison of bilateral facial ice pack therapy with no ice therapy following third molar surgery.
        Int J Oral Maxillofac Surg. 2005; 34: 281-286
        • Zandi M
        • Amini P
        • Keshavarz A.
        Effectiveness of cold therapy in reducing pain, trismus, and oedema after impacted mandibular third molar surgery: a randomized, self-controlled, observer-blind, split-mouth clinical trial.
        Int J Oral Maxillofac Surg. 2016; 45: 118-123
        • Greenstein G.
        Therapeutic efficacy of cold therapy after intraoral surgical procedures: a literature review.
        J Periodontol. 2007; 78: 790-800
        • Altiparmak N
        • Bayram B
        • Diker N
        • et al.
        Efficacy of ice pack therapy after impacted third molar surgery: a randomized controlled clinical trial.
        Turkiye Klinikleri Journal of Dental Sciences. 2017; 24: 19-25
        • Ibikunle AA
        • Adeyemo WL.
        Oral health–related quality of life following third molar surgery with or without application of ice pack therapy.
        Oral Maxillofac Surg. 2016; 20: 239-247
        • Laureano Filho JR
        • De Oliveira e Silva ED
        • Camargo IB
        • et al.
        The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction: a preliminary study.
        J Am Dent Assoc. 2005; 136: 774-778
        • do Nascimento-Júnior EM
        • dos Santos GMS
        • Tavares Mendes ML
        • et al.
        Cryotherapy in reducing pain, trismus, and facial swelling after third-molar surgery: systematic review and meta-analysis of randomized clinical trials.
        J Am Dent Assoc. 2019; 150: 269-277
        • Gassling V
        • Douglas T
        • Warnke PH
        • et al.
        Platelet-rich fibrin membranes as scaffolds for periosteal tissue engineering.
        Clin Oral Implants Res. 2010; 21: 543-549
        • Kobayashi E
        • Flückiger L
        • Fujioka-Kobayashi M
        • et al.
        Comparative release of growth factors from PRP, PRF, and advanced-PRF.
        Clin Oral Investig. 2016; 20: 2353-2360
        • Ogundipe OK
        • Ugboko VI
        • Owotade FJ.
        Can autologous platelet-rich plasma gel enhance healing after surgical extraction of mandibular third molars?.
        J Oral Maxillofac Surg. 2011; 69: 2305-2310
        • Ozgul O
        • Senses F
        • Er N
        • et al.
        Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: randomized multicenter split-mouth clinical trial.
        Head Face Med. 2015; 26: 37
        • Yelamali T
        • Saikrishna D.
        Role of platelet rich fibrin and platelet rich plasma in wound healing of extracted third molar sockets: a comparative study.
        J Maxillofac Oral Surg. 2015; 14: 410-416
        • Al-Hamed FS
        • Tawfik MAM
        • Abdelfadil E
        • et al.
        Efficacy of platelet-rich fibrin after mandibular third molar extraction: a systematic review and meta-analysis.
        J Oral Maxillofac Surg. 2017; 75: 1124-1135
        • Barona-Dorado C
        • González-Regueiro I
        • Martín-Ares M
        • et al.
        Efficacy of platelet-rich plasma applied to post-extraction retained lower third molar alveoli. A systematic review.
        Med Oral Patol Oral Cir Bucal. 2014; 1: e142-e148
        • do Canellas JVS
        • Ritto FG
        • Medeiros PJD
        Evaluation of postoperative complications after mandibular third molar surgery with the use of platelet-rich fibrin: a systematic review and meta-analysis.
        Int J Oral Maxillofac Surg. 2017; 46: 1138-1146
        • Xiang X
        • Shi P
        • Zhang P
        • et al.
        Impact of platelet-rich fibrin on mandibular third molar surgery recovery: a systematic review and meta-analysis.
        BMC Oral Health. 2019; 19: 1-10
        • He Y
        • Chen J
        • Huang Y
        • et al.
        Local application of platelet-rich fibrin during lower third molar extraction improves treatment outcomes.
        J Oral Maxillofac Surg. 2017; 75: 2497-2506
        • Amarillas-Escobar ED
        • Toranzo-Fernández JM
        • Martínez-Rider R
        • et al.
        Use of therapeutic laser after surgical removal of impacted lower third molars.
        J Oral Maxillofac Surg. 2010; 68: 319-324
        • Coluzzi DJ
        • Convissar RA.
        Lasers in clinical dentistry.
        Dent Clin North Am. 2004; 48: xi-xii
        • Ferrante M
        • Petrini M
        • Trentini P
        • et al.
        Effect of low-level laser therapy after extraction of impacted lower third molars.
        Lasers Med Sci. 2013; 28: 845-849
        • López-Ramírez M
        • Vílchez-Pérez MÁ
        • Gargallo-Albiol J
        • et al.
        Efficacy of low-level laser therapy in the management of pain, facial swelling, and postoperative trismus after a lower third molar extraction. A preliminary study.
        Lasers Med Sci. 2012; 27: 559-566
        • Sierra SO
        • Deana AM
        • Bussadori SK
        • et al.
        Choosing between intraoral or extraoral, red or infrared laser irradiation after impacted third molar extraction.
        Lasers Surg Med. 2016; 48: 511-518
        • Keyhan SO
        • Fallahi HR
        • Cheshmi B
        • Mokhtari S
        • Zandian D
        • Yousefi P.
        Use of piezoelectric surgery and Er:YAG laser: which one is more effective during impacted third molar surgery?.
        Maxillofac Plast Reconstr Surg. 2019; 41: 1-10
        • Sortino F
        • Pedullà E
        • Masoli V.
        The piezoelectric and rotatory osteotomy technique in impacted third molar surgery: comparison of postoperative recovery.
        J Oral Maxillofac Surg. 2008; 66: 2444-2448
        • Basheer SA
        • Jay Govind R
        • Daniel A
        • et al.
        Comparative study of piezoelectric and rotary osteotomy technique for third molar impaction.
        J Contemp Dent Pract. 2017; 1: 60-64
        • Magesty RA
        • Galvão EL
        • de Castro Martins C
        • et al.
        Rotary instrument or piezoelectric for the removal of third molars: a meta-analysis.
        J Maxillofac Oral Surg. 2017; 16: 13-21
        • O'Malley BW
        • Weinstein GS
        • Snyder W
        • Hockstein NG.
        Transoral robotic surgery (TORS) for base of tongue neoplasms.
        Laryngoscope. 2006; 116: 1465-1472
        • Durmus K
        • Apuhan T
        • Ozer E.
        Transoral robotic surgery for retromolar trigone tumours.
        Acta Otorhinolaryngol Ital. 2013; 33: 425-427
        • Weinstein GS
        • O'Malley BW
        • Snyder W
        • Sherman E
        • Quon H
        Transoral robotic surgery: radical tonsillectomy.
        Arch Otolaryngol Head Neck Surg. 2007; 133: 1220-1226
        • Demian N
        • Pearl C
        • Woernley TC
        • Wilson J
        • Seaman J.
        Surgical navigation for oral and maxillofacial surgery.
        Oral Maxillofac Surg Clin North Am. 2019; 31: 531-538