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Cystic and Neoplastic Lesions in Pericoronal Follicles of Asymptomatic Third Molars: A Systematic Review and
Joelma Silva de Andrade Tutu1, Paula de Sousa Lopes Cascaes1, Mariela Peralta-Mamani2
1Master Student, Oral Radiology Division, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil.
Background:
The management of fully impacted and asymptomatic third molars remains a matter of debate. Significant histological alterations have been reported in follicles with a normal pericoronal space on radiographic examination.
Purpose:
To determine the prevalence of cystic and neoplastic lesions in pericoronal follicles with a normal radiographic appearance (≤3 mm) associated with asymptomatic impacted third molars.
Study Selection:
Observational studies were systematically searched in multiple databases and grey literature up to November 2025. Two independent reviewers performed study selection according to predefined eligibility criteria.
Data Extraction, Synthesis, And Main Outcomes:
Data were extracted using a standardized form, and risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. Descriptive synthesis and meta-analyses estimated the prevalence of cystic alterations and dentigerous cysts with random-effects models. Heterogeneity was evaluated using Cochran's Q, τ2, and I2 statistics, and pooled estimates were calculated using OpenMetaAnalyst software.
Results:
Seven studies (592 pericoronal follicles) were included, identifying a spectrum of histopathological alterations, predominantly inflammatory and cystic lesions. Dentigerous cysts were the most frequent finding. The pooled prevalences of cystic changes and dentigerous cysts were respectively 26.7%, (95% CI: 3.7 to 49.6%) and 21.6% (95% CI: 12.9 to 32.2%), both with very high heterogeneity (I2 > 97%). Most studies showed a moderate risk of bias, and only one study showed a high risk of bias.
Conclusions And Relevance:
Radiographically normal asymptomatic pericoronal follicles may harbor histopathological alterations, including neoplastic and cystic lesions. However, these findings should be interpreted with caution due to substantial heterogeneity and methodological limitations. Histopathological analysis of follicles is necessary for accurate diagnosis, although current evidence does not support prophylactic extraction based solely on these findings. These results emphasize the importance of routine histopathological analysis of surgically removed pericoronal follicles.
