What are the risks of operative intervention?

Purpose: The purpose of this article is to conduct a literature review, identify the studies with the highest level of evidence, and summarize the complications associated with operative treatment of impacted third molars (M3s).

Materials and methods: To address the research purpose, a search of PubMed, Scopus, and the Cochrane Database was performed, using the Medical Subject Headings search terms "third molars" or "wisdom teeth," "complications," "periodontal complications," "temporomandibular joint," "nerve involvement," "sinus communication," and "mandibular fracture." Individual case reports and anecdotal reports were excluded from review.

Results: Relevant studies for the following complications were identified and are reported: 1) periodontal, 2) temporomandibular joint, 3) nerve injury, 4) sinus, and 5) other.

Conclusions: Quality-of-life studies have indicated that around 10% of patients undergoing M3 removal may have a complication. However, most complications are mild and self-limited and undergo complete resolution. Most patients are back at work or school after 2 to 3 days, and long-term complications are rare. Clinicians advocating M3 removal should review in detail the risks of operative intervention in conjunction with the benefits of removal and should be prepared to prevent, anticipate, and manage these complications.