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Title Periodontal Healing Impaired After Extraction of impacted Third Molars in Patients Older Than 25 Years
Clinical Question In patients with impacted third molar extraction’s, does being 25 years of age or younger as compared to greater than or equal to 26 years of age at the time of extraction, improve periodontal healing?
Clinical Bottom Line Periodontal healing after impacted third molar extraction’s can be impaired with increased patient age. Post-operative intra bony defects are less prevalent in patients less than or equal to 25 years of age than compared to older patients. These defects are also found to improve over time in the younger patient population. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 2019777Kugelberg/1991176 pts , 93 less than or equal to 20 years of age, 83 greater than or equal to 30 years.Comparative study
Key resultsPeriodontal healing after impacted lower 3rd molar surgery was impaired in individuals over 30 years. Early removal of impacted lower 3rd molars with large angulations and close positional relationship to the adjacent 2nd molars proved to have a beneficial effect on the periodontal health of the patients.
#2) 2128310Kugelberg/199051 subjects (23 males and 28 females; age range 17 to 53 years) were selected at random from 215 participants in a retrospective survey.Comparative study
Key resultsTwo years post-operatively, 16.7% of the cases aged less than or equal to 25 years showed intra-bony defects exceeding 4 mm, compared with 40.7% in the age group greater than or equal to 26 years. At the 4-year re-examination, the corresponding figures were 4.2% and 44.4%, respectively. The improvement concerning the alveolar bone level was mainly seen in individuals under 25 years of age.
#3) 2333601Kugelberg/199051 patients 2 and 4 years post impacted mandibular third molar surgery.Comparative study
Key resultsImprovement concerning postoperative IBD, between the two examinations, was mainly seen in individuals less than or equal to 25 years of age. No case in this age group increased in depth, while 29.6% of postoperative IBD deteriorated in individuals greater than or equal to 26 years.
#4) 2019777Kugelberg/1991144 persons (age range 16-53 years; mean 27.2 years).Comparative study
Key resultsRegression model analysis of the difference between the postoperative and the preoperative IBDs explained 60% of the variance with an R2 of 0.62. Using this model, postoperative IBD and age at the time of surgery explained 57% of the variance. The authors suggested that the length of time before surgery with the impacted third molar in an unfavorable contact with the adjacent second molar root may be an underlining contributor to postoperative IBDs, however more research is needed.
Evidence Search "Wound Healing"[Mesh] Search "Tooth, Impacted/surgery"[Mesh] "Adolescent"[Mesh] AND "Adult"[Mesh]) AND "Molar, Third"[Mesh]
Comments on
The Evidence
All of the articles were comparative studies, one prospective study and three retrospective studies. These articles were written by C.F. Kugelberg et. al., from the Institute for Post-graduate Dental Education, Jonkoping, Sweden. It is unclear if there are any bias or competing interests.
Applicability Patients used by Kugelberg et. al., were representative of a general patient pool at UTHSCSA dental school, including patients of either gender and of varying age, needing impacted third molar removal. Increased patient age should be evaluated as a potential risk factor for compromised periodontal healing when performing an impacted third molar removal.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords molar, third; tooth, extraction; wound healing; adolescent; adult
ID# 570
Date of submission: 03/31/2010spacer
E-mail Nakashiman@livemail.uthscsa.edu
Author Nicole Nakashima
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments on the CAT
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by Kevin Coppola (San Antonio, TX) on 04/25/2012
A search was done on April 25, 2012 did not reveal any new research that could indicate that being over the age of 25 is a risk factor for impacted third molar extraction.
by Demitri Villarreal (San Antonio, TX) on 07/13/2011
At this time, there are no new studies/evidence that contradict the statement that increased age can be a potential risk factor for compromised periodontal healing in regards to impacted third molar surgery.

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