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Ectopic third mandibular molar: evaluation of surgical practices and meta-analysis

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Abstract

Objectives

To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis.

Materials and methods

A surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: “Ectopic teeth”, “Third molar”, “Mandibular”. One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles.

Results

From the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p < 0.001). In the meta-analysis, an extra-oral approach was only indicated when a cutaneous fistula was present (90% vs. 35.9%; p = 0.002), irrespective of ETMM location. In the questionnaire and meta-analysis, the presence of a cyst did not change the approach (p < 0.05). The indications for a graft or osteosynthesis were a condylar location (p < 0.001), while a cutaneous fistula decreased the indication (p = 0.04) and a cyst (p = 0.009) was only associated with a graft.

Conclusions

The preferential approach was intra-oral, except when the ETMM was condylar or a cutaneous fistula was present when an extra-oral approach was preferred. Osteosynthesis or a graft were more likely when the ETMM was in the condyle.

Clinical relevance

This study will help to orientate surgeons vis-à-vis ETMM treatment.

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Funding

The work was supported by the Department of Oral & Maxillofacial Surgery, of CHU Clermint Ferrand, France.

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Authors and Affiliations

  1. Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont Ferrand, 1 Place Lucie Aubrac, 63003, Clermont Ferrand Cedex 1, France

    Julia Caillet, Romain Courtot, Isabelle Barthélémy, Laurent Devoize & Arnaud Depeyre

  2. Faculty of Medicine, Université D’Auvergne, 63001, Clermont Ferrand cedex 1, France

    Julia Caillet, Romain Courtot, Isabelle Barthélémy & Laurent Devoize

  3. Odontology Department, Estaing Hospital, CHU Clermont Ferrand, 63003, Clermont Ferrand, France

    Julia Caillet, Romain Courtot & Laurent Devoize

  4. Biostatistics Unit, Department of Clinical Research and Innovation, CHU Clermont Ferrand, 63000, Clermont Ferrand, France

    Bruno Pereira

  5. Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, 63100, Clermont-Ferrand, France

    Isabelle Barthélémy & Laurent Devoize

  6. Hôpital Privé de La Loire, Ramsay Générale de Santé, 39 boulevard de la Palle, 42100, Saint Etienne, France

    Arnaud Depeyre

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  1. Julia Caillet
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Correspondence to Arnaud Depeyre.

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Appendix

Appendix

Table 4 Grid for the evaluation of risk of bias used to create Table 3
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Table 5 Summary of the data in the studies included in the meta-analysis
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Caillet, J., Pereira, B., Courtot, R. et al. Ectopic third mandibular molar: evaluation of surgical practices and meta-analysis. Clin Oral Invest 25, 4781–4799 (2021). https://doi.org/10.1007/s00784-021-04018-z

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