Pathological sequelae of “neglected” impacted third molars

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Abstract
An NIH conference on "Removal of Third Molars" debated the need for removal of asymptomatic impacted teeth with no evidence of pathology but stressed the need for long-range studies. The assumption is that "neglected" impacted third molars (ITMs) will sometime cause serious pathology. Examination of panoramic radiographs of 11,598 patients revealed 1,756 patients with 3,702 impacted teeth; average age 47 years, and an average retention period approximately 27 years. Dentigerous cystic changes occurred in about 30 ITMs (0.81%), internal resorption in 16 (0.43%), periodontal ligament damage and bone loss distal to the 2nd molar 166 times (4.48%), and pressure resorption of the 2nd molar 113 times (3.05%). No great surge in pathology occurred with increasing age. Some type of pathological change can be expected eventually in approximately 12.0% of an impacted 3rd molar population and 1.82% of the general population. A reappraisal of routine removal of ITMs might be indicated.

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