PROPHYLACTIC REMOVAL OF IMPACTED 3RD MOLARS - AN ASSESSMENT OF PUBLISHED REVIEWS

Objective To evaluate published reviews of the appropriateness of prop hylactic removal of impacted third molars. Design Systematic review an d critical appraisal of relevant reviews. Methods Computerised databas es (Medline and Embase), the Index to Dental Literature, and the refer ences of articles were searched to identify relevant reviews. Main out come measures Pathologies associated with impacted third molars and ou tcomes following surgical removal of third molars. Results Twelve publ ished reviews were assessed. Major methodological problems in these in clude that authors did not describe review methods such as literature search strategy and criteria for inclusion of primary studies. Reviews with similar aims included different sets of primary studies as evide nce. Details of primary studies quoted were seldom sufficient for read ers to judge the reliability of the evidence. With the exception of tw o reviews with poorer quality, the reviews concluded that there is a l ack of evidence to support the prophylactic removal of impacted third molars. Two decision analyses also concluded that, on average, patient s' long-term wellbeing is maximised if extraction is confined to those impacted third molars with pathology. Conclusions In the absence of g ood evidence to support prophylactic removal, there appears to be litt le justification for the removal of pathology-free impacted third mola rs.