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Intervention Review

Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults

  1. Dirk TG Mettes1,*,
  2. Marloes MEL Nienhuijs2,
  3. Wil JM van der Sanden1,
  4. Emiel H Verdonschot1,
  5. Alphons Plasschaert1

Editorial Group: Cochrane Oral Health Group

Published Online: 20 APR 2005

Assessed as up-to-date: 6 FEB 2005

DOI: 10.1002/14651858.CD003879.pub2


How to Cite

Mettes DTG, Nienhuijs MMEL, van der Sanden WJM, Verdonschot EH, Plasschaert A. Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003879. DOI: 10.1002/14651858.CD003879.pub2.

Author Information

  1. 1

    University Medical Centre St Radboud Nijmegen, Preventative and Curative Dentistry, Nijmegen, Netherlands

  2. 2

    University Medical Centre St Radboud Nijmegen, Oral and Maxillofacial Surgery, Nijmegen, Netherlands

*Dirk TG Mettes, Preventative and Curative Dentistry, University Medical Centre St Radboud Nijmegen, PO Box 9101, Philips van Leydenlaan 25, Nijmegen, 6500 HB, Netherlands. d.mettes@dent.umcn.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The prophylactic removal of asymptomatic impacted wisdom teeth is defined as the (surgical) removal of wisdom teeth in the absence of local disease. Impacted wisdom teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom teeth do not always fulfil a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free wisdom teeth, either impacted or fully erupted, has long been considered as 'appropriate care'. Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60% or more. It has been suggested that watchful monitoring of asymptomatic wisdom teeth may be an appropriate strategy.

Objectives

To evaluate the effect of prophylactic removal of asymptomatic impacted wisdom teeth in adolescents and adults compared with the retention of these wisdom teeth.

Search methods

The following electronic databases were searched: The Cochrane Oral Health Group Trials Register (4 August 2004), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 4 August 2004), PubMed (1966 to 4 August 2004), EMBASE (1974 to 4 August 2004). There was no restriction on language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials.

Selection criteria

All randomised or controlled clinical trials (RCTs/CCTs) comparing the effect of prophylactic removal of asymptomatic impacted wisdom teeth with no-treatment (retention).

Data collection and analysis

Assessment of relevance, validity and data extraction were conducted in duplicate and independently by three reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. A quality assessment of the trials was carried out.

Main results

Only three trials were identified that satisfied the review selection criteria. Two were completed RCTs and both assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data. They intend to publish in the near future and information received will be included in updates. Although both completed trials met the inclusion criteria of the review, regarding participants characteristics, interventions and outcomes assessed, different outcomes measures were assessed which prevented pooling of data.

Authors' conclusions

No evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. There is some reliable evidence that suggests that the prophylactic removal of asymptomatic impacted wisdom teeth in adolescents neither reduces nor prevents late incisor crowding.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults

Wisdom teeth, or third molars, generally erupt into the mouth between the ages of 17 to 24 years. However, more than other teeth, wisdom teeth often fail to erupt or erupt only partially. An impacted wisdom tooth is called asymptomatic if the patient does not experience signs or symptoms of pain or discomfort associated with this tooth.
General agreement exists that removal is appropriate in case of symptoms of pain or pathological conditions. Controversial statements exist with regard to the prophylactic removal of asymptomatic or disease-free impacted third molars. This review found no evidence to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults; no studies of adults met the criteria for inclusion. However, it found some reliable evidence that suggests that the prophylactic removal of impacted third molars in adolescents to reduce or prevent late incisor crowding cannot be justified. Such removal neither reduces or prevents late incisor crowding.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

青少年及成人之無症狀阻生智齒的介入治療

預防性移除無症狀阻生智齒是指在智齒未造成任何局部病症時利用手術方式移除智齒。智齒會產生一些病理性改變,如牙齒周圍牙齦發炎、牙根吸收、牙齦及齒槽骨疾病、臨牙傷害、囊腫及腫瘤的產生,而其他支持預防性移除智齒的理由也被提出。智齒在口中通常沒有功能;當在老年人需要施行手術移除時,術後併發症的、疼痛及不舒服的風險都會提升。儘管如此,在大部分已發展國家,預防性移除沒有病症的智齒,無論是阻生或是完全萌發,始終被認為是適當的照護。依據特殊的指示謹慎的做出決定,可減少手術數量60%甚至更多,建議注意觀察無症狀的智齒可能是個適當的策略。

目標

評估預防性移除和保留青少年及成人之無症狀阻生智齒的影響的比較。

搜尋策略

搜尋以下的電子期刊資料庫:The Cochrane Oral Health Group Trials Register(2004年8月4日)、the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966至2004年8月4日), PubMed (1966至2004年8月4日), EMBASE (1974至2004年8月4日),不限定任何語言;重要的期刊則用手動搜尋,並試圖找出進行中且未發表的試驗。

選擇標準

包含所有比較預防性移除及不治療(保留)無症狀阻生齒之影響的隨機臨床試驗 randomised clinical trials (RCTs)或控制的臨床試驗controlled clinical trials (CCTs)。

資料收集與分析

關連性、正確性及資料選取的評估分別由三位檢閱者備份處理。若有不確定性存在時,提供作者們更多有關於隨機選取及徹回的資訊。將試驗用量化評估方式呈現。

主要結論

只有三個試驗符合我們選擇的標準。兩個是已完成的隨機的臨床試驗,且兩者都是評估預防性移除對於晚期青少年前牙擁擠的影響。一個是進行中的隨機臨床試驗,但是研究者無法提供任何資料,他們打算近期就要發表,將包含更新過的資料。雖然兩個已完成的試驗符合我們選擇的標準,對於受試者人格、介入治療及結果評估,利用不同的結果計算方式,避免共同使用資料。

作者結論

沒有証據支持或反駁常規預防性移除成人的無症狀之阻生智齒。一些可靠的証據顯示,預防性移除青少年的無症狀之阻生智齒既不會減少也無法預防之後前牙擁擠的情況。

翻譯人

本摘要由臺灣大學附設醫院張妤欣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

智齒,或第三大臼齒,一般在17到24歲時會萌發。然而,和其他牙齒比起來,較多的智齒是不萌發或是部分萌發的。一個阻生的智齒,且病患沒有和這顆牙齒相關的疼痛或不舒服的徵兆或症狀,稱為無症狀。一般同意移除有疼痛症狀或病理情況的智齒是適當的。關於預防性移除成人的無症狀或沒有疾病之阻生智齒是受到爭議的。沒有成人的研究符合我們篩選的標準,然而,一些可靠的証據顯示,預防性移除青少年阻生的第三大臼齒對於減少或預防之後的前牙擁擠是不能證實的。有時移除了牙齒既不能減少也不能預防之後前牙擁擠的情形。