Abstract
Background
Third molar displacement (TM) is a rare complication that occurs in both the maxilla and the mandible and can be of complete teeth or root fragments.
Objective
The objective of this article was to perform a systematic review of the articles published on third molar displacement during the surgical procedure, analyzing the predisposing factors, the cause, symptomatology, and treatment used to resolve this complication.
Material and Methods
A systematic review was performed. The review included articles on displacement of third molars to different anatomical spaces; articles dealing with displacement of teeth other than third molars, displacement of surgical instruments or displacement of materials were excluded.
Results
Fifty articles met the inclusion and exclusion criteria. The most frequent site to which a third molar is displaced in the maxilla is to the infratemporal fossa while in the mandible it is to the submandibular space. The incidence was higher in women than in men with a 2:1 rate.
Conclusion
When displacement occurs, the risk/benefit of immediate or delayed extraction should be assessed. If there is a risk to vital structures and there is no symptomatology, it can be kept under follow-up. CBCT is the best method for preoperative localization.
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References
Selvi F, Cakarer S, Keskin C, Ozyuvaci H (2011) Delayed removal of a maxillary third molar accidentally displaced into the infratemporal fossa. J Craniofac Surg 22(4):1391–1393. https://doi.org/10.1097/SCS.0b013e31821cc254
Bouloux GF, Steed MB, Perciaccante VJ (2007) Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 19(1):117–vii. https://doi.org/10.1016/j.coms.2006.11.013
Emes Y, Oncu B, Aybar B et al (2015) Measurement of the lingual position of the lower third molar roots using cone-beam computed tomography. J Oral Maxillofac Surg 73(1):13–17. https://doi.org/10.1016/j.joms.2014.06.460
Rashid H, Hussain A, Sheikh AH, Azam K, Malik S, Amin M (2018) Measure of frequency of alveolar osteitis using two different methods of osteotomy in mandibular third molar impactions: a double-blind randomized clinical trial. J Ayub Med Coll Abbottabad 30(1):103–106
Ohba S, Nakatani Y, Kakehashi H, Asahina I (2014) The migration pathway of an extracted maxillary third molar into the buccal fat pad. Odontology 102(2):339–342. https://doi.org/10.1007/s10266-013-0120-7
McKenna JD, Chidyllo SA (1984) Localization of maxillary third molar immobilized within an infected maxillary sinus. J Am Dent Assoc 108(2):208–9. https://doi.org/10.14219/jada.archive.1984.0461.PMID:6584495.10.14219/jada.archive.1984.0461
Shahakbari R, Mortazavi H, Eshghpour M (2011) First report of accidental displacement of mandibular third molar into infratemporal space. J Oral Maxillofac Surg 69(5):1301–3. https://doi.org/10.1016/j.joms.2010.06.215
Kocaelli H, Balcioglu HA, Erdem TL (2011) Displacement of a maxillary third molar into the buccal space: anatomical implications apropos of a case. Int J Oral Maxillofac Surg 40(6):650–3. https://doi.org/10.1016/j.ijom.2010.11.021
Pippi R, Perfetti G (2002) Lingual displacement of an entire lower third molar. Report of a case with suggestions for prevention and management. Minerva Stomatol 51(6):263–8
Lee D, Ishii S, Yakushiji N (2013) Displacement of maxillary third molar into the lateral pharyngeal space. J Oral Maxillofac Surg 71(10):1653–7. https://doi.org/10.1016/j.joms.2013.05.018
Primo BT, Stringhini DJ, da Costa DJ, Rebellato NLB, Scariot R (2016) Delayed removal of maxillary third molar displaced into the maxillary sinus. Stomatologija 18(4):128–132
Aznar-Arasa L, Figueiredo R, Gay-Escoda C (2012) Iatrogenic displacement of lower third molar roots into the sublingual space: report of 6 cases. J Oral Maxillofac Surg 70(2):e107–e115. https://doi.org/10.1016/j.joms.2011.09.039
Patel M, Down K (1994) Accidental displacement of impacted maxillary third molars. Br Dent J 177(2):57–59. https://doi.org/10.1038/sj.bdj.4808507
Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71
Sencimen M, Gülses A, Secer S, Zerener T, Özarslantürk S (2017) Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature. Oral Maxillofac Surg 21(1):1–6. https://doi.org/10.1007/s10006-016-0593-y. (Epub 2016 Nov 24 PMID: 27885569)
Gulbrandsen SR, Jackson IT, Turlington EG (1987) Recovery of a maxillary third molar from the infratemporal space via a hemicoronal approach. J Oral Maxillofac Surg 45(3):279–82. https://doi.org/10.1016/0278-2391(87)90130-3. (PMID: 3469371)
Tamer Y, Pektas ZO (2018) Accidental displacement of mandibular third molar roots into the pterygomandibular space. Niger J Clin Pract 21(8):1075–1077. https://doi.org/10.4103/njcp.njcp_427_17. (PMID: 30074013)
Xavier CB, Gonçalves FR, Batista SH, Veras Filho Rde O, Vogt BF (2011) Spontaneous migration of third molar following displacement to pterygomandibular fossa. J Oral Maxillofac Surg 69(4):1004–7. https://doi.org/10.1016/j.joms.2010.05.052
Tumuluri V, Punnia-Moorthy A (2002) Displacement of a mandibular third molar root fragment into the pterygomandibular space. Aust Dent J 47(1):68–71. https://doi.org/10.1111/j.1834-7819.2002.tb00307.x. (PMID: 12035962)
Mace T, Kahn A, Dechaufour P, Kün-Darbois JD (2020) An extremely rare case of a displaced third molar into the infratemporal fossa associated with a textiloma. J Stomatol Oral Maxillofac Surg 121(6):746–748. https://doi.org/10.1016/j.jormas.2020.04.004. (Epub 2020 Apr 14 PMID: 32302800)
Huang IY, Chen CM, Chang SW, Yang CF, Chen CH, Chen CM (2007) Surgical management of accidentally displaced mandibular third molar into the pterygomandibular space: a case report. Kaohsiung J Med Sci 23(7):370–4. https://doi.org/10.1016/S1607-551X(09)70424-3. (PMID: 17606433)
Lutz JC, Cazzato RL, Le Roux MK, Bornert F (2019) Retrieving a displaced third molar from the infratemporal fossa: case report of a minimally invasive procedure. BMC Oral Health 19(1):149. https://doi.org/10.1186/s12903-019-0852-z.PMID:31307439;PMCID:PMC6631546
Battisti A, Priore P, Giovannetti F, Barbera G, D’Alessandro F, Valentini V (2017) Rare complication in third maxillary molar extraction: dislocation in infratemporal fossa. J Craniofac Surg 28(7):1784–1785. https://doi.org/10.1097/SCS.0000000000003628. (PMID: 28708643)
Sverzut CE, Trivellato AE, Sverzut AT, de Matos FP, Kato RB (2009) Removal of a maxillary third molar accidentally displaced into the infratemporal fossa via intraoral approach under local anesthesia: report of a case. J Oral Maxillofac Surg 67(6):1316–20. https://doi.org/10.1016/j.joms.2008.09.018. (PMID: 19446223)
Orr DL 2nd (1999) A technique for recovery of a third molar from the infratemporal fossa: case report. J Oral Maxillofac Surg 57(12):1459–61. https://doi.org/10.1016/s0278-2391(99)90733-4. (PMID: 10596669)
Gómez-Oliveira G, Arribas-García I, Alvarez-Flores M, Gregoire-Ferriol J, Martínez-Gimeno C (2010) Delayed removal of a maxillary third molar from the infratemporal fossa. Med Oral Patol Oral Cir Bucal 15(3):e509-11. https://doi.org/10.4317/medoral.15.e509. (PMID: 20038889)
Dawson K, MacMillan A, Wiesenfeld D (1993) Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg 51(12):1395–7. https://doi.org/10.1016/s0278-2391(10)80149-1. (PMID: 8229423)
Ozer N, Uçem F, Saruhanoğlu A, Yilmaz S, Tanyeri H (2013) Removal of a maxillary third molar displaced into pterygopalatine fossa via intraoral approach. Case Rep Dent 2013:392148. https://doi.org/10.1155/2013/392148
Oberman M, Horowitz I, Ramon Y (1986) Accidental displacement of impacted maxillary third molars. Int J Oral Maxillofac Surg 15(6):756–8. https://doi.org/10.1016/s0300-9785(86)80118-1. (PMID: 3100679)
Chubb DWR, Kang B, Tong N (2021) Accidental displacement of mandibular Third molars into the submandibular space–two case reports, a suggested surgical approach and management algorithm. J Stomatol Oral Maxillofac Surg 122(2):203–207. https://doi.org/10.1016/j.jormas.2020.08.001. (Epub 2020 Aug 21 PMID: 32835858)
Campbell A, Costello BJ (2010) Retrieval of a displaced third molar using navigation and active image guidance. J Oral Maxillofac Surg 68(2):480–5. https://doi.org/10.1016/j.joms.2009.06.032. (Epub 2010 Jan 15 PMID: 20116728)
Yeh CJ (2002) A simple retrieval technique for accidentally displaced mandibular third molars. J Oral Maxillofac Surg 60(7):836–7. https://doi.org/10.1053/joms.2002.33257. (PMID: 12089704)
Torul D, Kazan D, Bereket MC, Karli R (2017) Persistent lingual paresthesia caused by a displaced tooth fragment: a case report and literature review. J Korean Assoc Oral Maxillofac Surg 43(Suppl 1):S9–S13. https://doi.org/10.5125/jkaoms.2017.43.S1.S9
Alexoudi VA, Tatsis D, Zamani K, Zelkas D, Paraskevopoulos K, Vaxtsevanos K (2020) Iatrogenic displacement of impacted mandibular third molars or their roots into adjacent soft tissues and spaces: A report of three cases. Natl J Maxillofac Surg 11(2):275–279. https://doi.org/10.4103/njms.NJMS_95_19
Kamburoglu K, Kursun S, Oztas B (2010) Submandibular displacement of a mandibular third molar root during extraction: a case report. Cases J 3:8. https://doi.org/10.1186/1757-1626-3-8.PMID:20148142;PMCID:PMC2820007
Nusrath MA, Banks RJ (2010) Unrecognised displacement of mandibular molar root into the submandibular space. Br Dent J 209(6):279–80. https://doi.org/10.1038/sj.bdj.2010.816. (PMID: 20871549)
Jolly SS, Rattan V, Rai SK (2014) Intraoral management of displaced root into submandibular space under local anaesthesia–a case report and review of literature. Saudi Dent J. 26(4):181–4. https://doi.org/10.1016/j.sdentj.2014.05.004
Bensing JR, McElroy KE, Perez L Jr (2021) Retrieval of displaced third molar into the sublingual space using 3-dimensional navigation assistance. J Oral Maxillofac Surg 79(3):537.e1-537.e7. https://doi.org/10.1016/j.joms.2020.11.019. (Epub 2020 Nov 27 PMID: 33358721)
Mellor TK, Finch LD (1987) Displaced third molar. Oral Surg Oral Med Oral Pathol 64(1):131. https://doi.org/10.1016/0030-4220(87)90129-0. (PMID: 3475651)
Silveira RJ, Garcia RR, Botelho TL, Franco A, Silva RF (2014) Accidental displacement of third molar into the sublingual space: a case report. J Oral Maxillofac Res 5(3):e5. https://doi.org/10.5037/jomr.2014.5305.PMID:25386232;PMCID:PMC4219864
Zhao S, Huang Z, Geng T, Huang L (2015) Intraoral management of iatrogenically displaced lower third molar roots in the sublingual space: a report of 2 cases. Int J Clin Exp Med 8(10):19591–5
Köseğlu BG, Gümrü O, Kocaelli HA (2002) Lower third molar displaced in the sublingual space. Dentomaxillofac Radiol 31(6):393. https://doi.org/10.1038/sj.dmfr.4600720. (PMID: 12424641)
Iwai T, Matsui Y, Hirota M, Tohnai I (2012) Endoscopic removal of a maxillary third molar displaced into the maxillary sinus via the socket. J Craniofac Surg 23(4):e295-6. https://doi.org/10.1097/SCS.0b013e318252f1cf. (PMID: 22801156)
Gao QM, Yang C, Zheng LY, Hu YK (2016) Removal of long-term broken roots displaced into the maxillary sinus by endoscopic assistant. J Craniofac Surg 27(1):e77-80. https://doi.org/10.1097/SCS.0000000000002235. (PMID: 26703040)
Sverzut CE, Trivellato AE, Lopes LM, Ferraz EP, Sverzut AT (2005) Accidental displacement of impacted maxillary third molar: a case report. Braz Dent J 16(2):167–70. https://doi.org/10.1590/s0103-64402005000200015. (PMID: 16475614)
Medeiros N, Gaffrée G (2008) Accidental displacement of inferior third molar into the lateral pharyngeal space: case report. J Oral Maxillofac Surg 66(3):578–80. https://doi.org/10.1016/j.joms.2005.10.042. (PMID: 18280399)
Ertas U, Yaruz MS, Tozoğlu S (2002) Accidental third molar displacement into the lateral pharyngeal space. J Oral Maxillofac Surg 60(10):1217. https://doi.org/10.1053/joms.2002.35802. (PMID: 12378505)
Esen E, Aydoğan LB, Akçali MC (2000) Accidental displacement of an impacted mandibular third molar into the lateral pharyngeal space. J Oral Maxillofac Surg 58(1):96–7. https://doi.org/10.1016/s0278-2391(00)80024-5. (PMID: 10632172)
Becker A, Brix M, Simon E, Devoti JF (2022) Iatrogenic displacement of an impacted third maxillary molar in the parapharyngeal space: a case report. J Stomatol Oral Maxillofac Surg 123(5):e376–e379. https://doi.org/10.1016/j.jormas.2022.04.006. (Epub 2022 Apr 14 PMID: 35430403)
Ogadako RM, Woods M, Shah N (2011) Dislodged lower right third molar tooth into the parapharyngeal space. Dent Update 38(9):631–2. https://doi.org/10.12968/denu.2011.38.9.631. (PMID: 22238995)
De Biase A, Guerra F, Giordano G, Salucci S, Solidani M (2005) Surgical removal of a left lower third molar root after iatrogenic displacement in soft tissue, Case report. Minerva Stomatol 54(6):389–93
Bobo M, Werther JR (1998) Self-induced displacement of a maxillary molar into the lateral pharyngeal space. Int J Oral Maxillofac Surg 27(1):38–9. https://doi.org/10.1016/s0901-5027(98)80093-3. (PMID: 9506297)
Gay-Escoda C, Berini-Aytés L, Piñera-Penalva M (1993) Accidental displacement of a lower third molar. Report of a case in the lateral cervical position. Oral Surg Oral Med Oral Pathol. 76(2):159–60. https://doi.org/10.1016/0030-4220(93)90197-c
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Crespo Reinoso, P., Cárdenas, N. & Caivinagua, A. Accidental Displacement of Third Molar: A Systematic Review. J. Maxillofac. Oral Surg. (2023). https://doi.org/10.1007/s12663-023-02038-8
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DOI: https://doi.org/10.1007/s12663-023-02038-8