Julia Caillet1,2,3, Bruno Pereira4, Romain Courtot1,2,3, Isabelle Barthélémy1,2,5, Laurent Devoize1,2,3,5, Arnaud Depeyre6,7. 1. Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont Ferrand, 1 Place Lucie Aubrac, 63003, Clermont Ferrand Cedex 1, France. 2. Faculty of Medicine, Université D'Auvergne, 63001, Clermont Ferrand cedex 1, France. 3. Odontology Department, Estaing Hospital, CHU Clermont Ferrand, 63003, Clermont Ferrand, France. 4. Biostatistics Unit, Department of Clinical Research and Innovation, CHU Clermont Ferrand, 63000, Clermont Ferrand, France. 5. Inserm U1107 Neuro-Dol, Trigeminal Pain and Migraine, Faculty of Dental Surgery, 63100, Clermont-Ferrand, France. 6. Oral and Maxillofacial Department, Estaing Hospital, CHU Clermont Ferrand, 1 Place Lucie Aubrac, 63003, Clermont Ferrand Cedex 1, France. depeyrearnaud@gmail.fr. 7. Hôpital Privé de La Loire, Ramsay Générale de Santé, 39 boulevard de la Palle, 42100, Saint Etienne, France. depeyrearnaud@gmail.fr.
Abstract
OBJECTIVES: To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis. MATERIALS AND METHODS: A surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: "Ectopic teeth", "Third molar", "Mandibular". One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles. RESULTS: From the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p < 0.001). In the meta-analysis, an extra-oral approach was only indicated when a cutaneous fistula was present (90% vs. 35.9%; p = 0.002), irrespective of ETMM location. In the questionnaire and meta-analysis, the presence of a cyst did not change the approach (p < 0.05). The indications for a graft or osteosynthesis were a condylar location (p < 0.001), while a cutaneous fistula decreased the indication (p = 0.04) and a cyst (p = 0.009) was only associated with a graft. CONCLUSIONS: The preferential approach was intra-oral, except when the ETMM was condylar or a cutaneous fistula was present when an extra-oral approach was preferred. Osteosynthesis or a graft were more likely when the ETMM was in the condyle. CLINICAL RELEVANCE: This study will help to orientate surgeons vis-à-vis ETMM treatment.
OBJECTIVES: To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis. MATERIALS AND METHODS: A surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: "Ectopic teeth", "Third molar", "Mandibular". One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles. RESULTS: From the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p < 0.001). In the meta-analysis, an extra-oral approach was only indicated when a cutaneous fistula was present (90% vs. 35.9%; p = 0.002), irrespective of ETMM location. In the questionnaire and meta-analysis, the presence of a cyst did not change the approach (p < 0.05). The indications for a graft or osteosynthesis were a condylar location (p < 0.001), while a cutaneous fistula decreased the indication (p = 0.04) and a cyst (p = 0.009) was only associated with a graft. CONCLUSIONS: The preferential approach was intra-oral, except when the ETMM was condylar or a cutaneous fistula was present when an extra-oral approach was preferred. Osteosynthesis or a graft were more likely when the ETMM was in the condyle. CLINICAL RELEVANCE: This study will help to orientate surgeons vis-à-vis ETMM treatment.