Surgical techniques for the removal of mandibular wisdom teeth

Background

The removal of wisdom teeth is a common operation, but it can cause short‐ and long‐term side effects. People may have their wisdom teeth removed if they are causing pain or infection, or if they are damaging other teeth or not breaking through the gum properly. Surgery has a risk of complications. One of the most common is dry socket (also known as alveolar osteitis). This is when a blood clot fails to form in the socket that the tooth has come out of, or the clot is disturbed before the socket has properly healed. Because the bones and nerves underlying the socket are exposed, it can be a very painful condition.

Review question

We aimed to find out the benefits and harms of different surgical techniques used to remove wisdom teeth from the lower jaw, specifically how surgeons can reduce the risk of complications following surgery. We considered the most important outcomes to be: dry socket, wound infection, long‐term damage to the nerves supplying sensation to the tongue and skin of the lower lip and chin, and problems such as excessive bleeding or a broken jaw.

Study characteristics

We searched for relevant studies up to 8 July 2019. We included 62 studies with 4643 participants. Many studies excluded people who were not in excellent health so the participants in the trials may not be truly representative.

Key results

The available evidence is inconclusive.

It is unclear if the position of the cut into the gum makes any difference to the outcomes.

It is unclear whether it is possible to avoid damaging a nerve to the tongue by using a surgical instrument called a lingual retractor.

It is unclear as to whether the type of surgical tool (a chisel or a rotating drill) used to remove bone from the jaw makes a difference to the likelihood of the wound becoming infected.

It is unclear if the amount and method of delivering saltwater to clean the tooth socket after the extraction makes any difference to the outcomes.

It is unclear whether different methods to stitch the gum after the tooth is removed makes any difference to the outcomes.

Placing products that are derived from the patient’s own blood into the tooth socket may help to reduce the occurrence of dry socket (a condition that causes intense pain a few days after extraction).

Another three surgical approaches were tested in the studies, but they did not measure the important outcomes.

Certainty of the evidence

None of the included studies were at low risk of bias. All of the studies were quite small. The quality of the studies varied, with most having flaws that could have biased their results. In addition, some of the results were very imprecise, with variation between them that could not be explained. For these reasons, we consider the available evidence to be uncertain. Future research may be able to provide dental surgeons and patients with clearer conclusions than those listed above.

Bailey  E, Kashbour  W, Shah  N, Worthington  HV, Renton  TF, Coulthard  P. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD004345. DOI: 10.1002/14651858.CD004345.pub3.

Read the full review.