Citation Information :
Fehlhofer J, Fernandez-Ulrich C, Wohlers A, Kesting MR, Rau A, Buchbender M. A Retrospective Analysis of Postoperative Abscess Formation Following Wisdom Tooth Removal and Their Clinical Condition and Localization. J Contemp Dent Pract 2022; 23 (11):1079-1084.
Aim: As a common procedure in oral surgery, the removal of wisdom teeth (3M) is associated with a variety of postoperative complications. This study reports of deep tissue abscesses after the removal of 3M in correlation to several factors.
Materials and methods: Patients between 2012 and 2017 with removed 3M were retrospectively evaluated in terms of clinical condition and localization and thus assigned tog A (removal of asymptomatic 3M) or group B (removal of symptomatic 3M). Moreover, they were analyzed in terms of abscesses after the removal and correlation with various parameters: localization of the abscess, general diseases, perioperative antibiotic treatment, number of days from removal of the tooth to abscess formation, and postoperative complications after primary abscess incision.
Results: About 82 patients (male n = 44, female n = 38) were included, with 88 wisdom teeth removed and postoperative abscesses. Postoperative abscesses occurred more frequently in group B (n = 53) with n = 29 in IIB localization, without a significant correlation. Patients in this group were older, and there were more surgical abscess incisions needed, despite a longer treatment with oral and intravenous antibiosis that correlated with neurologic diseases and age. Younger patients reported significantly more pain.
Conclusions: Detection of potential 3M pathologies at an early and asymptomatic stage is essential to avoid postoperative complications following 3M removal. Additional prospective studies are necessary to develop corresponding guidelines.
Clinical significance: Wisdom tooth extraction is the most common operation in oral surgery, and therefore, adequate risk evaluation is still required.
Yamada SI, Hasegawa T, Yoshimura N, et al. Prevalence of and risk factors for postoperative complications after lower third molar extraction: A multicenter prospective observational study in Japan. Medicine (Baltimore) 2022;101(32):e29989. DOI: 10.1097/MD.0000000000029989.
Carter K, Worthington S. Morphologic and demographic predictors of third molar agenesis: A systematic review and meta-analysis. J Dent Res 2015;94(7):886–894. DOI: 10.1177/0022034515581644.
Olze A, Peschke C, Schulz R, et al. Studies of the chronological course of wisdom tooth eruption in a German population. J Forensic Leg Med 2008;15(7):426–429. DOI: 10.1016/j.jflm.2008.02.008.
Olze A, Ishikawa T, Zhu BL, et al. Studies of the chronological course of wisdom tooth eruption in a Japanese population. Forensic Sci Int 2008;174(2–3):203–206. DOI: 10.1016/j.forsciint.2007.04.218.
Venta I, Murtomaa H, Turtola L, et al. Clinical follow-up study of third molar eruption from ages 20 to 26 years. Oral Surg Oral Med Oral Pathol 1991;72(2):150–153. DOI: 10.1016/0030-4220(91)90154-5.
Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 2007;19(1):117–128, vii. DOI: 10.1016/j.coms.2006.11.013
Osborn TP, Frederickson G, Jr, Small IA, et al. A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg 1985;43(10):767–769. DOI: 10.1016/0278-2391(85)90331-3.
Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg 2003;61(12):1379–1389. DOI: 10.1016/j.joms.2003.04.001.
Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: Postoperative complications and their risk factors. J Can Dent Assoc 2007;73(4):325. PMID: 17484797.
Sayed N, Bakathir A, Pasha M, et al. Complications of third molar extraction: A retrospective study from a tertiary healthcare centre in Oman. Sultan Qaboos Univ Med J 2019;19(3):e230–e235. DOI: 10.18295/squmj.2019.19.03.009.
Chen YW, Chi LY, Lee OK. Revisit incidence of complications after impacted mandibular third molar extraction: A nationwide population-based cohort study PLoS One 2021;16(2):e0246625. DOI: 10.1371/journal.pone.0246625.
Schwartz-Arad D, Lipovsky A, Pardo M, et al. Interpretations of complications following third molar extraction. Quintessence Int 2017;49(1):33–39. DOI: 10.3290/j.qi.a39334.
Avellaneda-Gimeno V, Figueiredo R, Valmaseda-Castellon E. Quality of life after upper third molar removal: A prospective longitudinal study. Med Oral Patol Oral Cir Bucal 2017;22(6):e759–e766. DOI: 10.4317/medoral.21781.
Osunde OD, Saheeb BD, Bassey GO. Indications and risk factors for complications of lower third molar surgery in a nigerian teaching hospital. Ann Med Health Sci Res 2014;4(6):938–942. DOI: 10.4103/2141-9248.144919.
Werkmeister R, Fillies T, Joos U, et al. Relationship between lower wisdom tooth position and cyst development, deep abscess formation and mandibular angle fracture. J Craniomaxillofac Surg 2005;33(3):164–168. DOI: 10.1016/j.jcms.2005.01.011.
Baensch F, Kriwalsky MS, Kleffmann W, et al. Third molar complications in the elderly – A matched-pairs analysis. J Oral Maxillofac Surg 2017;75(4):680–686. DOI: 10.1016/j.joms.2016.11.021.
Kunkel M, Kleis W, Morbach T, et al. Severe third molar complications including death-lessons from 100 cases requiring hospitalization. J Oral Maxillofac Surg 2007;65(9):1700–1706. DOI: 10.1016/j.joms.2007.04.014.
Kunkel M, Morbach T, Kleis W, et al. Third molar complications requiring hospitalization. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102(3):300–306. DOI: 10.1016/j.tripleo.2005.09.010.
Berge TI. Incidence of infections requiring hospitalization associated with partially erupted third molars. Acta Odontol Scand 1996;54(5):309–313. DOI: 10.3109/00016359609003543.
Berge TI. Incidence of large third-molar-associated cystic lesions requiring hospitalization. Acta Odontol Scand 1996;54(5):327–331. DOI: 10.3109/00016359609003546.
Garcia AG, Sampedro FG, Rey JG, et al. Pell-Gregory classification is unreliable as a predictor of difficulty in extracting impacted lower third molars. Br J Oral Maxillofac Surg 2000;38(6):585–587. DOI: 10.1054/bjom.2000.0535.
Almendros-Marques N, Berini-Aytes L, Gay-Escoda C. Evaluation of intraexaminer and interexaminer agreement on classifying lower third molars according to the systems of Pell and Gregory and of Winter. J Oral Maxillofac Surg 2008;66(5):893–899. DOI: 10.1016/j.joms.2007.09.011.
McGrath C, Comfort MB, Lo EC, et al. Changes in life quality following third molar surgery--the immediate postoperative period. Br Dent J 2003;194(5):265–268. DOI: 10.1038/sj.bdj.4809930.
Ruta DA, Bissias E, Ogston S, et al. Assessing health outcomes after extraction of third molars: The postoperative symptom severity (PoSSe) scale. Br J Oral Maxillofac Surg 2000;38(5):480–487. DOI: 10.1054/bjom.2000.0339.
White RP, Jr, Shugars DA, Shafer DM, et al. Recovery after third molar surgery: Clinical and health-related quality of life outcomes. J Oral Maxillofac Surg 2003;61(5):535–544. DOI: 10.1053/joms.2003.50106.
Moghadam HG, Caminiti MF. Life-threatening hemorrhage after extraction of third molars: Case report and management protocol. J Can Dent Assoc 2002;68(11):670–674. PMID: 12513934.
Ramchandani PL, Sabesan T, Peters WJ. Subdural empyema and herpes zoster syndrome (Hunt syndrome) complicating removal of third molars. Br J Oral Maxillofac Surg 2004;42(1):55–57. DOI: 10.1016/s0266-4356(03)00209-2.
Sigron GR, Pourmand PP, Mache B, et al. The most common complications after wisdom-tooth removal: Part 1: A retrospective study of 1,199 cases in the mandible. Swiss Dent J 2014;124(10):1042–1046, 1052–1056. PMID: 25342545.
Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: A prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92(4):377–383. DOI: 10.1067/moe.2001.118284.
Chiapasco M, Crescentini M, Romanoni G. Germectomy or delayed removal of mandibular impacted third molars: The relationship between age and incidence of complications. J Oral Maxillofac Surg 1995;53(4):418–422. DOI: 10.1016/0278-2391(95)90715-7.
Kaposvari I, Kormoczi K, Csurgay K, et al. Delayed-onset infections after lower third molar surgery: A Hungarian case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;132(6):641–647. DOI: 10.1016/j.oooo.2021.04.052.
Figueiredo R, Valmaseda-Castellon E, Berini-Aytes L, et al. Delayed-onset infections after lower third molar extraction: A case-control study. J Oral Maxillofac Surg 2007;65(1):97–102. DOI: 10.1016/j.joms.2005.10.063.
Goldberg MH, Nemarich AN, Marco WP, 2nd. Complications after mandibular third molar surgery: A statistical analysis of 500 consecutive procedures in private practice. J Am Dent Assoc 1985;111(2):277–279. DOI: 10.14219/jada.archive.1985.0098.
Monaco G, Cecchini S, Gatto MR, et al. Delayed onset infections after lower third molar germectomy could be related to the space distal to the second molar. Int J Oral Maxillofac Surg 2017;46(3):373–378. DOI: 10.1016/j.ijom.2016.09.011.
Cho H, Lynham AJ, Hsu E. Postoperative interventions to reduce inflammatory complications after third molar surgery: Review of the current evidence. Aust Dent J 2017;62(4):412–419. DOI: 10.1111/adj.12526.