Does Prophylactic Removal of Mandibular Third Molar Affect Outcomes and Postoperative Complications in Bilateral Sagittal Split Osteotomy in Young Adults?

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Abstract Aim: Does prophylactic removal of mandibular third molar affect outcomes and postoperational problems in bilateral sagittal split osteotomy (BSSO) in young adults? Materials and Methods: Searches were conducted using MEDLINE via PubMed, LILACS, Cochrane Central, and Scopus. In this systematic review, 18 articles were chosen, of which 16 were included in the meta-analysis. The review focused on a population (P) of individuals undergoing bilateral sagittal split osteotomy (BSSO). The intervention (I) was the prophylactic removal of mandibular third molars in patients undergoing BSSO, while the comparator (C) was patients with retained mandibular third molars undergoing BSSO. The outcome (O) assessed included unfavorable splits, neurosensory damage, surgical site infections, risk of relapse, symptomatic removal of osteosynthesis material, and other postoperative complications. Results: The meta-analysis revealed significant heterogeneity ( I ² = 57%), necessitating the use of a random effects model. The incidence of unfavorable split was almost similar across both the groups (2.44% among the comparator group and 2.37% among subjects of the intervention group). The odds ratio was 1.38 (95% confidence interval) which was nonsignificant among both ( P = 0.24). Conclusion: The study indicates that preemptive extraction of third molars does not reduce undesired mandibular fractures or postsurgical problems in BSSO. No statistically significant link is found between prophylactic third molar removal and complications such as neurosensory issues, infections, surgical material removal, or bad splits. There was no evidence that patient age, third molar presence, or the surgical technique affects bad split incidence. Well-designed randomized control trials are wanted to define if specific methods and previous surgery of third molar extraction reduce bad split and complications.

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