Conservation and late avulsion of 3rd molars: serious complications. A case series

Professional recommendations on the indications for avulsions of 3rd molars recommend case-by-case decisions on germectomies. However, an overly restrictive interpretation of these recommendations has led to excessive conservation of 3rd molars. Late avulsion of these teeth entails considerably higher risks for the patient, compared with extraction between the ages of 16 and 20. The aim of this article is to illustrate, through a series of cases, the risks associated, on the one hand, with excessive retention of 3rd molars and, on the other hand, with the surgical complications associated with their avulsion too late.

Fifteen cases are detailed: infections, pericoronary cyst with suborbital extension, bucco-sinusal communication, tuberosity and mandibular fracture, neuro-sensory disorders.

Before the age of 15, the root formation of poorly formed and deeply impacted 3rd molars is incomplete and they are often deeply impacted, making their avulsion difficult and the post-operative after-effects significant for patients. Beyond the age of 25, the risk of paresthesia and fracture of the mandible increases significantly, and becomes problematic after the age of 30.

The period between 16 and 20 years of age represents a "window" where surgical risk and post-operative consequences are minimal. Avulsion of the 3rd molars may sometimes be indicated to prevent surgical difficulties and complications in the event of ultrasonic avulsion. Beyond the age of 25, or even 30, the benefit/risk ratio must be assessed particularly rigorously, even if this means considering therapeutic abstention (accompanied by appropriate monitoring) when possible.