{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T03:23:09Z","timestamp":1777605789213,"version":"3.51.4"},"reference-count":40,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T00:00:00Z","timestamp":1553558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Objectives: The aim of this systematic review is to evaluate and compare the risks and benefits of germectomy and delayed removal of third molars and develop a patient management algorithm for second molar eruption in syndrome\/incompliant patients. Materials and Methods: A literature search was performed in the following databases; the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, and Web of Science. Last search was done on July 2nd, 2018 including articles published from the last 18 years. The search aimed to identify all relevant studies written in English language. Gray literature was excluded. Risk of bias was evaluated with specific predetermined criteria. This systematic literature review was reported according to the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: 104261. Results: Literature search war performed on July 2018 and updated on February 2019. A total of 1610 articles were screened. After abstract screening and discarding duplicates, 86 full-text articles were obtained and subjected to additional evaluation. Four articles were included in the review. Three studies were considered as having a medium risk of bias and one was assessed as at high risk. Due to the heterogeneity of presenting results and a very low number of included studies a quantitative analysis was not possible. Only qualitative analysis was made. Considering the limited number of studies included and the level of risk of bias there is no sufficient evidence to state the benefits of preventive removal of impacted third molars, especially in patients with poor oral hygiene due to intellectual disability. Early germectomy represents an elective approach of pathologic alteration of tooth germ; orthodontic issues meet appropriate indication for a delayed removal. Conclusions: Given the best evidence-based information regarding patients\u2019 medical condition, we highlight the need to provide an ethical-based comprehensive approach in the diagnostic workflow and the assessment of treatment outcome.<\/jats:p>","DOI":"10.3390\/medicina55030079","type":"journal-article","created":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T05:03:12Z","timestamp":1553662992000},"page":"79","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["How to Manage Impacted Third Molars: Germectomy or Delayed Removal? A Systematic Literature Review"],"prefix":"10.3390","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1339-9172","authenticated-orcid":false,"given":"Edoardo","family":"Staderini","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7358-8763","authenticated-orcid":false,"given":"Romeo","family":"Patini","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1812-0479","authenticated-orcid":false,"given":"Federica","family":"Guglielmi","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5919-3842","authenticated-orcid":false,"given":"Andrea","family":"Camodeca","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrizia","family":"Gallenzi","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Dentistry and Maxillofacial Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,3,26]]},"reference":[{"key":"ref_1","first-page":"153","article-title":"Some factors related to mandibular third molar impaction","volume":"45","author":"Kaplan","year":"1975","journal-title":"Angle Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.ijom.2017.03.027","article-title":"The influence of mandibular third molar germectomy on the treatment time of impacted mandibular second molars using brass wire: a prospective clinical pilot study","volume":"46","author":"Cassetta","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ajodo.2011.09.012","article-title":"Orthodontic uprighting of severely impacted mandibular second molars","volume":"143","author":"Lau","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.14219\/jada.archive.2003.0074","article-title":"Surgical uprighting and repositioning of severely impacted mandibular second molars","volume":"134","author":"McAboy","year":"2003","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/S0889-5406(95)70081-1","article-title":"The surgical uprighting of mandibular second molars","volume":"108","author":"Pogrel","year":"1995","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/0278-2391(95)90715-7","article-title":"Germectomy or delayed removal of mandibular impacted third molars: the relationship between age and incidence of complications","volume":"53","author":"Chiapasco","year":"1995","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/j.1600-0528.1992.tb00696.x","article-title":"General dental practitioners\u2019 evaluation of the need for extraction of asymptomatic mandibular third molars","volume":"20","author":"Knutsson","year":"1992","journal-title":"Commun. Dent. Oral Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/0278-2391(92)90390-L","article-title":"Asymptomatic mandibular third molars: Oral surgeons\u2019 judgement of the need for extraction","volume":"50","author":"Knutsson","year":"1992","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jclinepi.2009.06.006","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration","volume":"62","author":"Liberati","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_10","first-page":"422","article-title":"Morbidity of third molar extraction in patients between 12 and 18 years of age","volume":"10","year":"2005","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"735","DOI":"10.2105\/AJPH.2013.301652","article-title":"Recommendations for third molar removal: A practice-based cohort study","volume":"104","author":"Rothen","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_12","first-page":"165","article-title":"Early third molar extractions: US dental school departments\u2019 recommendations from 1998\/99 to 2004\/05","volume":"39","author":"Jasinevicius","year":"2008","journal-title":"Quintessence Int."},{"key":"ref_13","first-page":"408","article-title":"Correction of eruption of permanent molars utilizing the brass wire technique","volume":"22","author":"Kupietzky","year":"2000","journal-title":"Pediatr. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/0030-4220(93)90005-O","article-title":"Side effects and complications associated with third molar surgery","volume":"76","author":"Chiapasco","year":"1993","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S0266-4356(97)90713-0","article-title":"Routine review of patients after extraction of third molars: is it justified","volume":"35","author":"Preshaw","year":"1997","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_16","first-page":"235","article-title":"NIH Consensus Conference for removal of third molars","volume":"38","author":"Guralnick","year":"1980","journal-title":"J. Oral Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S0901-5027(88)80022-5","article-title":"A study of indications used for removal of the mandibular third molar","volume":"17","author":"Lysell","year":"1988","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"240","DOI":"10.14219\/jada.archive.1980.0183","article-title":"Age of patients and morbidity associated with mandibular third molar surgery","volume":"101","author":"Bruce","year":"1980","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"77","DOI":"10.14219\/jada.archive.1992.0041","article-title":"Removing third molars: A review for the general practitioner","volume":"123","author":"Leonard","year":"1992","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1038\/sj.bdj.4806453","article-title":"Factors affecting the onset and severity of pain following the surgical removal of unilateral impacted mandibular third molar teeth","volume":"164","author":"Fisher","year":"1998","journal-title":"Br. Dent. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/0030-4220(92)90312-E","article-title":"Alveolar osteitis after surgical removal of impacted mandibular third molars. Identification of the patient at risk","volume":"73","author":"Larsen","year":"1992","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/joor.12589","article-title":"Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars-A comparison of two techniques and review of the literature","volume":"45","author":"Ali","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.11138\/ads\/2017.8.2.045","article-title":"Prevention of neurological injuries during mandibular third molar surgery: Technical notes","volume":"8","author":"Vozza","year":"2017","journal-title":"Ann. Stomatol. (Roma)"},{"key":"ref_24","first-page":"e505","article-title":"Coronectomy of impacted mandibular third molars: A meta-analysis and systematic review of the literature","volume":"21","year":"2016","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1259\/dmfr.22.4.8181642","article-title":"Judgement on removal of asymptomatic mandibular third molars: influence of the perceived likelihood of pathology","volume":"22","author":"Lysell","year":"1993","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1034\/j.1600-0528.2001.290411.x","article-title":"Dentists\u2019 decisions on early removal of mandibular third molars: A 10-year follow-up study","volume":"29","author":"Knuttson","year":"2001","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1177\/00220345000790121101","article-title":"Dentists\u2019 judgment strategies on early removal of mandibular third molars","volume":"79","author":"Knuttson","year":"2000","journal-title":"J. Dent. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1038\/sj.bdj.4809697","article-title":"Intra-observer reliability regarding removal of asymptomatic third molars","volume":"184","author":"Kostopoulou","year":"1998","journal-title":"Br. Dent. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1002\/j.0022-0337.1987.51.11.tb02158.x","article-title":"Decision analysis in the evaluation of clinical strategies for the management of mandibular third molars","volume":"51","author":"Tulloch","year":"1987","journal-title":"J. Dent. Educ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0901-5027(05)80447-3","article-title":"Risks and benefits of removal of impacted third molars. A critical review of the literature","volume":"21","author":"Mercler","year":"1992","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1067\/moe.2001.115461","article-title":"Third molar outcomes from age 18 to 26: Findings from a population-based New Zealand longitudinal study","volume":"92","author":"Kruger","year":"2001","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1038\/sj.bdj.4800285","article-title":"The cost, effectiveness and cost effectiveness of removal and retention of asymptomatic, disease free third molars","volume":"187","author":"Edwards","year":"1999","journal-title":"Br. Dent. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta4150","article-title":"The effectiveness and cost-effectiveness of early removal of wisdom teeth","volume":"4","author":"Song","year":"2000","journal-title":"Health Technol. Assess."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1046\/j.1528-1157.2003.04003.x","article-title":"Dental status andoral health of patients with epilepsy: an epidemiologic study","volume":"44","author":"Kivovics","year":"2003","journal-title":"Epilepsia"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/scd.12181","article-title":"Overcoming the oral aspects of self-mutilation: Description of a method","volume":"36","author":"Shapira","year":"2016","journal-title":"Spec. Care Dent."},{"key":"ref_36","first-page":"472","article-title":"Multidisciplinary surgical management of Cowden syndrome: Report of a case","volume":"18","author":"Patini","year":"2016","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_37","first-page":"e820","article-title":"A rare case of oral multisystem Langerhans cell histiocytosis","volume":"9","author":"Facciolo","year":"2017","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_38","first-page":"5775","article-title":"Relationship between oral microbiota and periodontal disease: A systematic review","volume":"22","author":"Patini","year":"2018","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_39","first-page":"e707","article-title":"Is telephone follow-up really effective in early diagnosis of inflammatory complications after tooth extraction?","volume":"23","author":"Pippi","year":"2018","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Singh Gill, A., Morrissey, H., and Rahman, A. (2018). A systematic review and meta-analysis evaluating antibiotic prophylaxis in dental implants and extraction procedures. Medicina (Kaunas), 54.","DOI":"10.3390\/medicina54060095"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/3\/79\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:40:46Z","timestamp":1760186446000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/3\/79"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,26]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,3]]}},"alternative-id":["medicina55030079"],"URL":"https:\/\/doi.org\/10.3390\/medicina55030079","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,26]]}}}