Cochrane · intervention · CD003879
Surgical removal versus retention for the management of asymptomatic disease‐free impacted wisdom teeth
Ghaeminia, H, Nienhuijs, MEL, Toedtling, V, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
13
current version
GRADE rated
9
No studies
4
Included studies
2
as reported
No studies 4 · 30.8%Ungraded 0 · 0%Very low 6 · 46.2%Low 3 · 23.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Individuals (males and females of all ages) with asymptomatic disease-free impacted (maxillary or mandibular) wisdom teeth (not erupted into a normal functional position; partially or completely covered by soft tissue and/or bone) | Two studies (493 analysed participants): one RCT of adolescents (77 analysed; 55% female) previously orthodontically treated; one prospective cohort of 416 healthy male volunteers aged 24 to 84 years |
| Intervention | Removal (or absence) of asymptomatic disease-free impacted wisdom teeth | Surgical removal of asymptomatic disease-free impacted wisdom teeth (n=1); Absence (previous removal or agenesis) (n=1) |
| Comparison | Retention (or presence) of asymptomatic disease-free impacted wisdom teeth | Retention of asymptomatic disease-free impacted wisdom teeth (n=1); Presence of asymptomatic disease-free impacted wisdom teeth (n=1) |
| Outcomes | Primary: health-related quality of life. Secondary (retention): pericoronitis; periodontitis (probing depth or alveolar bone loss); caries; root resorption; dimensional changes; cyst formation; tumour formation; inflammation/infection. Secondary (removal): alveolar osteitis/postoperative infection; nerve injury; damage to adjacent teeth; bleeding; osteonecrosis; inflammation/infection. Costs: days off work/study; direct costs. | Little's irregularity index (n=1); Intercanine width (n=1); Arch length (n=1); Periodontitis - distal alveolar bone loss second molar (n=1); Periodontitis - distal probing depth > 4 mm second molar (n=1); Caries affecting the second molar (n=1) |
| Study designs | RCTs (any follow-up); quasi-RCTs and prospective cohort studies if outcomes measured at five years or longer | RCT (parallel-group, Harradine 1998) (n=1); prospective cohort study (Nunn 2013) (n=1) |
| Timing | Not specified | Follow up: 5 years mean 66 months (n=1); follow-up of between three and over 25 years (n=1) |
Search date: 2019-05-10. Databases: Cochrane Oral Health's Trials Register; CENTRAL (2019, Issue 4); MEDLINE Ovid (1946 to 10 May 2019); Embase Ovid (1980 to 10 May 2019); ClinicalTrials.gov; WHO ICTRP
Questions and results
Current version onlySurgical removal (extraction) of asymptomatic disease-free impacted wisdom teeth vs Retention (conservative management) of asymptomatic disease-free impacted wisdom teeth
Population: Adolescents or adults with asymptomatic disease-free impacted wisdom teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Other pathological changes associated with retention (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) | No included studies reported pericoronitis, root resorption, cyst formation, tumour formation or inflammation/infection. | 0 studies | No studies |
Undesirable outcomes associated with removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth, bleeding, osteonecrosis, inflammation/infection) | Undesirable outcomes associated with removal: Not measured. No included studies measured outcomes or adverse events associated with removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent… | 0 studies | No studies |
Arch length (dimensional changes in the dental arch) 5 years (66 months) | MD -1.03 [-1.50, -0.56] -1.03 [-1.50, -0.56] mm | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Little's irregularity index (dimensional changes in the dental arch) 5 years (66 months) | MD -0.3 [-1.3, 0.7] -0.30 [-1.30, 0.70] mm | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Costs (days off work/study; direct costs of retention or removal) | Costs: Not measured. The included studies did not measure days off work/study or direct costs associated with retention or removal of wisdom teeth and treatment of associated symptoms or complications. | 0 studies | No studies |
Health-related quality of life | Health-related quality of life: Our primary outcome was not assessed in the included studies. | 0 studies | No studies |
Intercanine width (dimensional changes in the dental arch) 5 years (66 months) | MD -0.01 [-0.37, 0.35] -0.01 [-0.37, 0.35] mm | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Absence (previous removal or agenesis) of asymptomatic disease-free impacted wisdom teeth vs Presence (retention) of asymptomatic disease-free impacted wisdom teeth
Population: Adults (416 healthy male volunteers aged 24 to 84 years) with asymptomatic disease-free impacted wisdom teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Periodontitis (distal probing depth greater than 4 mm, adjacent second molar) Follow-up 3 to over 25 years · Soft tissue impaction | RR 0.15 [0.07, 0.34] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Caries affecting the (distal) adjacent second molar Follow-up 3 to over 25 years · Soft tissue impaction | RR 1.20 [0.17, 9.10] | 1 study · 416 participants | Very low Downgraded: risk of bias, imprecision |
Periodontitis (distal alveolar bone loss, adjacent second molar) Follow-up 3 to over 25 years · Bony impaction | RR 0.32 [0.19, 0.54] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Periodontitis (distal probing depth greater than 4 mm, adjacent second molar) Follow-up 3 to over 25 years · Bony impaction | RR 0.63 [0.37, 1.04] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Caries affecting the (distal) adjacent second molar Follow-up 3 to over 25 years · Bony impaction | RR 0.69 [0.27, 1.82] | 1 study · 416 participants | Very low Downgraded: risk of bias, imprecision |
Periodontitis (distal alveolar bone loss, adjacent second molar) Follow-up 3 to over 25 years · Soft tissue impaction | RR 0.11 [0.06, 0.22] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Surgical removal (extraction) of asymptomatic disease-free impacted wisdom teeth vs Retention (conservative management) of asymptomatic disease-free impacted wisdom teeth
Population: Adolescents or adults with asymptomatic disease-free impacted wisdom teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Other pathological changes associated with retention (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) | No included studies reported pericoronitis, root resorption, cyst formation, tumour formation or inflammation/infection. | 0 studies | No studies |
Costs (days off work/study; direct costs of retention or removal) | Costs: Not measured. The included studies did not measure days off work/study or direct costs associated with retention or removal of wisdom teeth and treatment of associated symptoms or complications. | 0 studies | No studies |
Little's irregularity index (dimensional changes in the dental arch) 5 years (66 months) | MD -0.3 [-1.3, 0.7] -0.30 [-1.30, 0.70] mm | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Intercanine width (dimensional changes in the dental arch) 5 years (66 months) | MD -0.01 [-0.37, 0.35] -0.01 [-0.37, 0.35] mm | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Undesirable outcomes associated with removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth, bleeding, osteonecrosis, inflammation/infection) | Undesirable outcomes associated with removal: Not measured. No included studies measured outcomes or adverse events associated with removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent… | 0 studies | No studies |
Arch length (dimensional changes in the dental arch) 5 years (66 months) | MD -1.03 [-1.50, -0.56] -1.03 [-1.50, -0.56] mm | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Health-related quality of life | Health-related quality of life: The primary outcome was not assessed in the included studies. | 0 studies | No studies |
Absence (previous removal or agenesis) of asymptomatic disease-free impacted wisdom teeth vs Presence (retention) of asymptomatic disease-free impacted wisdom teeth
Population: Adults (416 healthy male volunteers aged 24 to 84 years) with asymptomatic disease-free impacted wisdom teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Periodontitis (distal alveolar bone loss, adjacent second molar) Follow-up 3 to over 25 years · Bony impaction | RR 0.32 [0.19, 0.54] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Periodontitis (distal alveolar bone loss, adjacent second molar) Follow-up 3 to over 25 years · Soft tissue impaction | RR 0.11 [0.06, 0.22] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Caries affecting the (distal) adjacent second molar Follow-up 3 to over 25 years · Bony impaction | RR 0.69 [0.27, 1.82] | 1 study · 416 participants | Very low Downgraded: risk of bias, imprecision |
Periodontitis (distal probing depth greater than 4 mm, adjacent second molar) Follow-up 3 to over 25 years · Bony impaction | RR 0.63 [0.37, 1.04] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Periodontitis (distal probing depth greater than 4 mm, adjacent second molar) Follow-up 3 to over 25 years · Soft tissue impaction | RR 0.15 [0.07, 0.34] | 1 study · 416 participants | Very low Downgraded: risk of bias |
Caries affecting the (distal) adjacent second molar Follow-up 3 to over 25 years · Soft tissue impaction | RR 1.20 [0.17, 9.10] | 1 study · 416 participants | Very low Downgraded: risk of bias, imprecision |
Prophylactic surgical removal of asymptomatic impacted wisdom teeth vs Retention (conservative management / monitoring) of asymptomatic impacted wisdom teeth
Population: Individuals (males and females of all ages) with asymptomatic impacted wisdom teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects associated with removal (nerve damage, alveolar osteitis/dry socket, infection, mandibular fracture) | There is no information from this trial about adverse effects of prophylactic removal (temporary or permanent nerve damage, dry socket, infection, mandibular fracture). | 0 studies | No studies |
Health-related quality of life (after at least 5 years follow-up) At least 5 years | Quality of life after at least 5 years follow-up: No RCTs. Footnote: There was only one study which looked at one small aspect of the quality of life measure: crowding of lower teeth. This study, at high risk of bias,… | 0 studies | No studies |
Little's irregularity index (late lower incisor crowding) 5 years | MD -0.30 [-1.30, 0.70] | 1 study · 77 participants | Ungraded |
Intercanine width 5 years | MD 0.01 [-0.35, 0.37] | 1 study · 77 participants | Ungraded |
Arch length (dental arch dimensional change) 5 years | MD 1.03 [0.56, 1.50] | 1 study · 77 participants | Ungraded |
Other pathological changes associated with retention (pericoronitis, caries, cysts, tumours, root resorption) | This trial did not report any information concerning the outcomes of pericoronitis, caries, cysts, tumours or root resorption in participants whose wisdom teeth were retained. | 0 studies | No studies |
Costs (direct costs and days off work/study) | There is no information from this trial concerning costs. The only included trial did not address cost issues. | 0 studies | No studies |
Prophylactic surgical removal of asymptomatic impacted wisdom teeth vs Retention (non-intervention) of asymptomatic impacted wisdom teeth
Population: Adolescents and adults with asymptomatic impacted wisdom teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Little's irregularity index (late lower incisor crowding) 5 years (mean 66 months) | MD -0.30 | 1 study · 164 participants | Ungraded |
Costs (cost-effectiveness of treatment) | Neither of the two included studies shed any light on patients' perspectives or on cost issues. | 0 studies | No studies |
Intercanine width 5 years (mean 66 months) | For the intercanine width there was no clinical or statistically significant difference (whole-sample mean decrease 0.4 mm, SD 0.78). | 1 study · 164 participants | Ungraded |
Arch length (dental arch dimensional change) Harradine 1998: 5 years; Lindqvist 1982: at least 3 years | MD 1.0 | 2 studies · 216 participants | Ungraded |
Health-related quality of life (Quality of Adjusted Life Years) | No evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults; the primary quality-of-life (QALY) outcome was not assessed by the two included trials, which… | 0 studies | No studies |
Prophylactic surgical removal of trouble-free impacted wisdom teeth vs Retention of trouble-free impacted wisdom teeth
Population: Adults (aged 16 years and older) with trouble-free impacted wisdom teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Protocol only (no results). Planned comparison: prophylactic removal versus retention of trouble-free impacted wisdom teeth. Planned primary outcome: Quality of Adjusted Life Years (pathological changes and… | 0 studies | No studies |