Surgical Treatment of Impacted Mandibular Second Molars: A Systematic Review

Purpose: The evidence on surgical uprighting and surgical exposure for the management of impacted mandibular second molars is limited. This systematic review evaluated the efficacy of both of these surgical procedures in the management of impacted mandibular second molars. Methods: The authors conducted a systematic review without meta-analysis of English language articles on Pubmed and Embase databases without publication date restrictions. Additional studies were identified by searching reference lists and manually reviewing published literature in key journals. Potential included study types were cases series, cohort studies, and randomized clinical trials studying surgical uprighting or surgical exposure of impacted mandibular second molars. The outcomes studied were the positioning of the tooth in the dental arch, pulpal obliteration or calcification, infection, root resorption, and root fracture. Results: Of the 1,438 records identified, 8 were included in the review, representing a total of 433 molars. The age of study participants in the included studies ranged from 7 to 20 years. A total of 22 of 27 (81.5%) impacted mandibular second molars included in this study were reported to be successfully positioned in the dental arch after surgical exposure. A total of 374 of 408 (91.7%) mandibular second molars included in this study were successfully positioned in the dental arch after surgical uprighting. There were no reported cases of infection and root fracture of impacted mandibular second molars treated by surgical exposure. In surgical uprighting, the overall reported rates of pulpal obliteration or calcification, infection, root resorption, and root fracture were 27.1, 1.9, 14.9, and 1.0%, respectively. Conclusions: While there are few studies comparing treatment strategies for the management of impacted mandibular second molars, surgical uprighting appears to be a successful treatment option for these patients with few reported complications. (C) 2021 The American Association of Oral and Maxillofacial Surgeons.