Many times, mandibular third molars may be extracted preventively due to impaction and crowding concerns, however, no real consensus exists among clinicians. The study was published in the American Journal of Orthodontics and Dentofacial Orthopedics.
The variability in decisions may shine a light on the need for evidence-based clinical guidelines for extracting asymptomatic third molars, the authors wrote.
"The significant variability in the prioritization of factors by orthodontists highlights the complexity of clinical decision-making in this area," wrote the authors, led by Hila Ziv-On of Tel Aviv University (Am J Orthod Dentofacial Orthop, February 18, 2025).
The prophylactic extraction of mandibular third molars is a controversial topic in orthodontics, with significant variability in clinical decision-making. This study aimed to explore the factors influencing such extractions among orthodontists in Israel, they wrote.
A cross-sectional survey was conducted in July 2024 using an online questionnaire distributed to 88 active orthodontic specialists and residents in Israel. Statistical analyses included descriptive statistics, chi-squared tests, the Fisher's exact test, Pearson's correlation, the Cochran's Q test, and multivariate logistic regression.
The average age of participants was approximately 51, ranging from 30 to 72 years. Most were specialists with over 10 years of practice (67%), while 17% had two to 10 years of experience, and 15.9% were residents or specialists with less than two years of experience, they wrote.
Impaction characteristics (35.2%) were the most frequently considered factor for prophylactic extraction followed by mandibular arch crowding (26.1%), with only 4.5% routinely referring patients for extraction.
While no significant correlations were found between demographic factors and extraction practices, a weak positive correlation was observed between age and consideration of mandibular arch crowding (r = 0.21, p = 0.049), and the Cochran's Q test revealed significant differences in the prioritization of factors (Q = 32.24, p < 0.001).
However, the study had limitations. The sample consisted mainly of orthodontists from four major institutions in Israel, which may limit the findings' applicability to other regions or countries, the authors added.
"Our findings underscore the need for evidence-based guidelines to support orthodontists in the management of third molars during orthodontic treatment," they concluded.
