What’s the most effective way to surgically remove mandibular wisdom teeth?

This is a summary of the Cochrane Systematic Review: Surgical techniques for the removal of mandibular wisdom teeth (Review, 2014)

Coulthard P, Bailey E, Esposito M, Furness S, Renton TF, Worthington HV

Full-text of the Systematic Review (PDF)

Summary of the Systematic Review 

Context

• This research assesses the benefits and harms of the different ways to surgically remove wisdom teeth from the lower jaw. Removing wisdom teeth is one of the most common operations in dental surgery.
• Various techniques have been developed to carry this out, but which is the most effective?
• The review considered the following risks from surgery: pain after treatment, swelling, infection, the ability to open the jaw fully, damage to the nerves supplying sensation to the tongue and jaw fractures.

Purpose of the Review

The systematic review was conducted to identify evidence of the most effective way to surgically remove mandibular wisdom teeth.

Key Findings

• Slight changes to the position of the cut into the gum may reduce dry socket (infection) and pain after surgery.
• It is possible to protect a nerve to the tongue from damage by placement of a special surgical tool; however, there were no good quality trials available to show that this reduces permanent nerve injury and the consequent loss of or altered sensations.
• Some surgeons will remove the top part of the wisdom tooth and leave the root in place when the root is close to the nerve in the jaw (supplying feeling to the lower lip and skin of the chin). Although it would seem likely that this should reduce the risk of nerve injury, the two trials which looked at this were of poor quality and had unreliable data.
• Due to the poor quality of most of the trials in this review, recommendations for surgical practice are limited.

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