J Korean Assoc Oral Maxillofac Surg.  2023 Feb;49(1):2-12. 10.5125/jkaoms.2023.49.1.2.

What do we know about uncommon complications associated with third molar extractions? A scoping review of case reports and case series

• Su N
• Harroui S
• Rozema F
• Listl S
• Lange Jd
• Heijden GJvd

• KMID: 2539699
• DOI: http://doi.org/10.5125/jkaoms.2023.49.1.2

Abstract

The current study aimed to explore the types and frequencies of uncommon complications associated with third molar extractions based on a scoping review of case reports and case series. The study used an electronic literature search based on PubMed and Embase up to March 31, 2020, with an update performed on October 22, 2021. Any case reports and case series that reported complications associated with third molar extractions were included. The types of complications were grouped and the main symptoms of each type of complication were summarized. A total of 51 types of uncommon complications were identified in 248 patients from 186 studies. Most types of complications were post-operative. In the craniofacial and cervical regions, the most frequent complications included iatrogenic displacement of the molars or root fragments in the craniofacial area, late mandibular fracture, and subcutaneous emphysema. In other regions, the most frequent complications include pneumomediastinum, pneumorrhachis, pneumothorax, and pneumopericardium. Of the patients, 37 patients had life-threatening uncommon complications and 20 patients had long-term/irreversible uncommon complications associated with third molar extractions. In conclusion, a variety of uncommon complications associated with third molar extractions were identified. Most complications occurred in the craniofacial and cervical regions and were mild and transient.

Keyword

Uncommon complications; Third molar; Tooth extraction; Case reports, Review

Figure

• 

  Fig. 1 Flow diagram of study inclusion.

Reference

References

1. McArdle LW, Renton T. 2012; The effects of NICE guidelines on the management of third molar teeth. Br Dent J. 213:E8. https://doi.org/10.1038/sj.bdj.2012.780. DOI: 10.1038/sj.bdj.2012.780. PMID: 22955790.

2. Friedman JW. 2007; The prophylactic extraction of third molars: a public health hazard. Am J Public Health. 97:1554–9. https://doi.org/10.2105/ajph.2006.100271. DOI: 10.2105/AJPH.2006.100271. PMID: 17666691. PMCID: PMC1963310.

3. Alfadil L, Almajed E. 2020; Prevalence of impacted third molars and the reason for extraction in Saudi Arabia. Saudi Dent J. 32:262–8. https://doi.org/10.1016/j.sdentj.2020.01.002. DOI: 10.1016/j.sdentj.2020.01.002. PMID: 32647474. PMCID: PMC7336025.

4. Mettes TG, Nienhuijs ME, van der Sanden WJ, Verdonschot EH, Plasschaert AJ. 2005; Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults. Cochrane Database Syst Rev. 2:CD003879. https://doi.org/10.1002/14651858.cd003879.pub2. DOI: 10.1002/14651858.CD003879.pub2. PMID: 15846686.

5. Anjrini AA, Kruger E, Tennant M. 2015; Cost effectiveness modelling of a 'watchful monitoring strategy' for impacted third molars vs prophylactic removal under GA: an Australian perspective. Br Dent J. 219:19–23. https://doi.org/10.1038/sj.bdj.2015.529. DOI: 10.1038/sj.bdj.2015.529. PMID: 26159980.

6. Santosh P. 2015; Impacted mandibular third molars: review of literature and a proposal of a combined clinical and radiological classification. Ann Med Health Sci Res. 5:229–34. https://doi.org/10.4103/2141-9248.160177. DOI: 10.4103/2141-9248.160177. PMID: 26229709. PMCID: PMC4512113.

7. Tüfekçi E, Svensk D, Kallunki J, Huggare J, Lindauer SJ, Laskin DM. 2009; Opinions of American and Swedish orthodontists about the role of erupting third molars as a cause of dental crowding. Angle Orthod. 79:1139–42. https://doi.org/10.2319/091708-481r.1. DOI: 10.2319/091708-481R.1. PMID: 19852606.

8. Hounsome J, Pilkington G, Mahon J, Boland A, Beale S, Kotas E, et al. 2020; Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation. Health Technol Assess. 24:1–116. https://doi.org/10.3310/hta24300. DOI: 10.3310/hta24300. PMCID: PMC7336222. PMID: 32589125.

9. Kennisinstituut Mondzorg. 2020. Klinische praktijkrichtlijn: derde molaar. Kennisinstituut Mondzorg;Utrecht:

10. Peñarrocha-Diago M, Camps-Font O, Sánchez-Torres A, Figueiredo R, Sánchez-Garcés MA, Gay-Escoda C. 2021; Indications of the extraction of symptomatic impacted third molars. A systematic review. J Clin Exp Dent. 13:e278–86. https://doi.org/10.4317/jced.56887. DOI: 10.4317/jced.56887. PMID: 33680330. PMCID: PMC7920557.

11. Chen YW, Chi LY, Lee OK. 2021; Revisit incidence of complications after impacted mandibular third molar extraction: a nationwide population-based cohort study. PLoS One. 16:e0246625. https://doi.org/10.1371/journal.pone.0246625. DOI: 10.1371/journal.pone.0246625. PMID: 33617575. PMCID: PMC7899344.

12. Sigron GR, Pourmand PP, Mache B, Stadlinger B, Locher MC. 2014; The most common complications after wisdom-tooth removal: part 1: a retrospective study of 1,199 cases in the mandible. Swiss Dent J. 124:1042–6. 1052–6. PMID: 25342545.

13. Lee CT, Zhang S, Leung YY, Li SK, Tsang CC, Chu CH. 2015; Patients' satisfaction and prevalence of complications on surgical extraction of third molar. Patient Prefer Adherence. 9:257–63. https://doi.org/10.2147/ppa.s76236. DOI: 10.2147/PPA.S76236. PMID: 25709411. PMCID: PMC4332291.

14. Sayed N, Bakathir A, Pasha M, Al-Sudairy S. 2019; Complications of third molar extraction: a retrospective study from a tertiary healthcare centre in Oman. Sultan Qaboos Univ Med J. 19:e230–5. https://doi.org/10.18295/squmj.2019.19.03.009. DOI: 10.18295/squmj.2019.19.03.009. PMID: 31728221. PMCID: PMC6839670.

15. Osunde O, Saheeb B, Bassey G. 2014; Indications and risk factors for complications of lower third molar surgery in a Nigerian teaching hospital. Ann Med Health Sci Res. 4:938–42. https://doi.org/10.4103/2141-9248.144919. DOI: 10.4103/2141-9248.144919. PMID: 25506490. PMCID: PMC4250995.

16. Brauer HU. 2009; Unusual complications associated with third molar surgery: a systematic review. Quintessence Int. 40:565–72. PMID: 19626231.

17. González-Navarro B, Arranz-Obispo C, Albuquerque R, Jané-Salas E, López-López J. 2017; Osteomyelitis of the jaw (with pathological fracture) following extraction of an impacted wisdom tooth. A case report. J Stomatol Oral Maxillofac Surg. 118:306–9. https://doi.org/10.1016/j.jormas.2017.05.003. DOI: 10.1016/j.jormas.2017.05.003. PMID: 28576461.

18. Gupta N. 2019; 585: Disseminated pneumococcal infection resulting in cerebral vasculopathy. Crit Care Med. 47:273. https://doi.org/10.1097/01.ccm.0000551337.15698.dc. DOI: 10.1097/01.ccm.0000551337.15698.dc.

19. Karaali S, Emekli U. 2018; Myositis ossificans traumatica of the medial pterygoid muscle after third molar tooth extraction: a case report and review of literature. J Oral Maxillofac Surg. 76:2284.e1–5. https://doi.org/10.1016/j.joms.2018.06.174. DOI: 10.1016/j.joms.2018.06.174. PMID: 30076806.

20. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. 2018; PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 169:467–73. https://doi.org/10.7326/m18-0850. DOI: 10.7326/M18-0850. PMID: 30178033.

21. Briscoe S, Bethel A, Rogers M. 2020; Conduct and reporting of citation searching in Cochrane systematic reviews: a cross-sectional study. Res Synth Methods. 11:169–80. https://doi.org/10.1002/jrsm.1355. DOI: 10.1002/jrsm.1355. PMID: 31127978. PMCID: PMC7079050.

22. Nakamura T, Igarashi H, Ito T, Jensen RT. 2014; Important of case-reports/series, in rare diseases: using neuroendocrine tumors as an example. World J Clin Cases. 2:608–13. https://doi.org/10.12998/wjcc.v2.i11.608. DOI: 10.12998/wjcc.v2.i11.608. PMID: 25405184. PMCID: PMC4233424.

23. Mathes T, Pieper D. 2017; Clarifying the distinction between case series and cohort studies in systematic reviews of comparative studies: potential impact on body of evidence and workload. BMC Med Res Methodol. 17:107. https://doi.org/10.1186/s12874-017-0391-8. DOI: 10.1186/s12874-017-0391-8. PMID: 28716005. PMCID: PMC5513097.

24. Dawson K. 1994; Guillain-Barré syndrome complicating the surgical removal of third molar teeth. J Oral Maxillofac Surg. 52:1316–7. https://doi.org/10.1016/0278-2391(94)90055-8. DOI: 10.1016/0278-2391(94)90055-8. PMID: 7965336.

25. Srinivasan B, Ethunandan M, Markus A. 2008; Sensorineural hearing loss after dental extraction under general anesthesia: report of a case. J Oral Maxillofac Surg. 66:1939–41. https://doi.org/10.1016/j.joms.2007.08.052. DOI: 10.1016/j.joms.2007.08.052. PMID: 18718404.

26. Rao A, Ramam M. 2014; The case for case reports. Indian Dermatol Online J. 5:413–5. https://doi.org/10.4103/2229-5178.142480. DOI: 10.4103/2229-5178.142480. PMID: 25396121. PMCID: PMC4228633.

27. Nissen T, Wynn R. 2014; The clinical case report: a review of its merits and limitations. BMC Res Notes. 7:264. https://doi.org/10.1186/1756-0500-7-264. DOI: 10.1186/1756-0500-7-264. PMID: 24758689. PMCID: PMC4001358.

28. Raimo N, Zito M, Caragnano A. Mihajlović D, Đorđević B, editors. 2019. Does national culture affect integrated reporting quality? A focus on GLOBE dimensions. The 9th International Symposium on Natural Resources Management book of proceedings. Leibniz Information Center for Economics;Zaječar: p. 383–392.