Title Regenerative Treatment Following Mandibular Third Molar Extraction Leads to Increased Clinical Attachment Level at Adjacent Second Molars
Clinical Question In adult patients with impacted mandibular third molars, does regenerative therapy following surgical extraction lead to increased post-surgical clinical attachment level at the distal surface of adjacent second molars?
Clinical Bottom Line Regenerative treatment immediately following mandibular third molar extraction does result in a significant increase in future clinical attachment level (CAL) at the distal surface of adjacent mandibular second molars. This is supported by a recent systematic review which found that mandibular third molar sites receiving regenerative treatment exhibited significantly improved CAL. A variety of graft materials and membranes have been examined in the literature for this purpose. As such, there is currently no clear consensus regarding which regenerative procedure or material is most beneficial.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27085787Lee/2016140 adult patients in 7 included studiesSystematic review of randomized trials
Key resultsThis systematic review included seven clinical trials which focused on regenerative treatment following removal of impacted mandibular third molars. There was considerable heterogeneity among the included studies regarding the regenerative therapy provided. Three studies utilized guided tissue regeneration in which the investigators placed a membrane but no graft material. Two studies used a graft material alone with no membrane. One study utilized a combined technique using both a graft material and a membrane. Finally, one study included both a combined therapy group, and a graft only group. There was also substantial variation among the studies regarding the graft and membrane materials utilized. Overall, the review found a mean difference in CAL gain at the distal mandibular second molar site of 1.94 mm (95% CI 1.56 - 2.31 mm) compared to control sites.
Evidence Search Search (((((((third molar) AND tooth) AND extraction) AND graft) OR guided tissue regeneration) OR membrane) OR bone) AND attachment Filters: Review; published in the last 5 years
Comments on
The Evidence
Validity: Most of the studies included in this review utilized a split-mouth design, which is a highly effective way to examine regenerative treatment following third molar removal. The clinical trials described also had similar inclusion criteria, selecting for non-smoking, systemically healthy adult patients. Substantial heterogeneity did exist within the seven included trials. The studies were inconsistent regarding the angulation and type of impaction for the mandibular third molars included. For example, the research articles included different combinations of soft and hard tissue impactions, and mesio-angular and horizontally positioned teeth. Some of the studies only reported inclusion criteria for type of impaction, or angulation, but not both. Some also included only teeth with deep presurgical probing depths, while others included sites without presurgical defects. Due to these major variations, it is difficult to determine which specific presurgical criteria should be used to recommend regenerative treatment following mandibular third molar extraction. Perspective: It appears that patients with certain combinations of presurgical attachment loss and mesio-angular or horizontally impacted mandibular third molars will benefit from regenerative treatment following extraction. Greater standardization of study protocols will be needed to allow for consensus regarding choice of technique, material, and case selection. This may eventually allow for a consensus related to which patients and types of impaction should be routinely considered for regenerative treatment.
Applicability Extraction of impacted mandibular third molars is a commonly performed dental procedure. The additional cost and increased treatment time required for regenerative treatment following third molar extraction will likely prevent this from becoming a part of routine patient care. It is likely that some patients will benefit significantly from regenerative treatment. Additional focused research is needed to aid in identifying specific clinical parameters that can be used to guide treatment recommendations and material selection.
Specialty (General Dentistry) (Oral Surgery) (Periodontics)
Keywords third molar, graft, extraction, regeneration, clinical attachment
ID# 3366
Date of submission 11/20/2018
E-mail pesut@livemail.uthscsa.edu
Author Christopher Pesut
Co-author(s) e-mail
Faculty mentor Nicholas Hamlin PhD, DDS, MS
Faculty mentor e-mail nicholas.j.hamlin2.mil@mail.mil
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?)
None available
Comments and Evidence-Based Updates on the CAT
None available