Surgical approach of ectopic maxillary third molar avulsion: Systematic review and meta-analysis

Ectopic maxillary third molars (EMTM) are extracted mainly by the Caldwell-Luc technique but also by nasal endoscopy. There is currently no consensus on the treatment of this eruption and its management is heterogeneous and multidisciplinary. Two literature searches were performed with no time restrictions via Pubmed. In the first, we used the keywords "ectopic AND third molar" and in the second the keywords "dentigerous cyst AND ectopic third molar". For both articles, epidemiological, symptomatic, radiological and surgical data were recorded. Overall, 33 eligible articles were identified involving 39 cases of EMTM. 79% of patients were symptomatic. 87% of the teeth were associated with a dental cyst. In only 13% of cases was the location of the tooth in the sinus specified in the three planes of the space. Surgery was performed in 77% of patients by the Caldwell-Luc technique, by nasal endoscopy in 10% and by the Le Fort I approach in 3%. The indications for avulsion of EMTM are symptomatic patients or asymptomatic patients with an associated cyst. The intra-sinusal location of the tooth is not a factor in the choice of technique used, which depends rather on the individual skills of the surgeon. Although for a trained operator the Le Fort I osteotomy is an easy procedure, its interest in the treatment of EMTM is limited owing to the rare but potentially severe complications involved.