Strategies for Assessment and Treatment of Third Molars

The management of third molars, especially those asymptomatic, represented a clinical challenge due to their variability in development and position, as well as the risk of underlying pathologies. These teeth, although not always showing obvious signs of disease, were associated with complications such as odontogenic cysts, infections and tooth resorption. Prophylactic extraction was proposed as a strategy to prevent future complications, although its relevance generated debate in the dental community.The pericoronary sac, a structure associated with impacted third molars, had the potential to develop cystic and tumour pathologies, which underlined the importance of its clinical and histopathological evaluation. NICE guidelines established specific criteria for extraction, limiting it to justified cases such as overt pathology or orthodontic needs. In the orthodontic setting, third molar extraction was justified in situations of dental crowding, interference with eruption of adjacent molars or as part of orthognathic surgery. However, the evidence did not support a direct relationship between these teeth and mandibular crowding. The decision to remove third molars required a comprehensive analysis of clinical, radiographic and preventive factors. Although some third molars erupted without complications, prophylactic extraction was recommended in specific cases to minimise risks and optimise the patient's oral health