This Cochrane review of the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth updates the 2016 version. No new studies were identified so the conclusions are unchanged.
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This review comparing the effects of envelope and triangular flaps for mandibular third molar surgery included 20 RCTs involving 770 patients. A majority of the studies were of cross-over design with the findings suggesting no differences in teh outcomes between the two flap designs.
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This review of the effectiveness of platelet-rich fibrin (PRF) in reducing postoperative complications of third molar surgery included 10 small RCTs suggesting that PRF may reduce but not prevent some complications.
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33 studies were included in this review of the effectiveness of autologous platelet concentrates (APCs) in the preservation of fresh extraction sockets. The studies were mainly small and of less than 6 months duration suggesting a positive effect.
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This review of the effectiveness of chlorhexidine gel for the prevention of alveolar osteitis (AO) included 10 trials published since 2010. The findings suggest a 57% reduction in incidence of AO similar to other reviews of this topic.
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This review of the effectiveness of chlorhexidine for prevention of dry socket after third molar removal includes 18 RCTs. The finding suggest a 47% (95%CI,38-55) reduction in cases following its use.
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This update of an earlier Cochrane review comparing retention or extraction of of asymptomatic disease-free impacted third molars only identified 2 studies of low to very low quality evidence providing insufficient evidence to inform practice.
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This review of antibiotic prophylaxis for the removal of third molars included 22 RCTs and suggest that antibiotic use lowered the infection risk by 60%. The number pf patients needed to treat to prevent one infection was 14 (95%CI;11-19).
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10 RCTs were included in this review of preoperative antibiotics for removal of third molars. The use of antibiotics significantly reduced the odds of surgical site infection or alveolar osteitis (OR = 0.30; 95% CI, 0.19 to 0.47; P≤.00001)
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This trial compared eugenol dressing or chlorhexidine gel for dry socket prevention against no intervention. Both agents reduced the incidence of dry socket but the reduction was greater with eugenol.
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