journal1 ›› 2016, Vol. 24 ›› Issue (1): 11-14.doi: 10.12016/j.issn.2096-1456.2016.01.002

Special Issue: 11

• Expert Forum • Previous Articles     Next Articles

The influence of the impacted mandibular third molar extraction on the distal periodontal tissue of the mandibular second molar

XU Jing   

  1. Department of Oral and Maxillofacial Surgery, Guangdong Provincial Stomatological Hospital & the Affiliated Stomatological Hospital of Southern Medical University, Guangzhou 510280, China
  • Received:2015-05-29 Online:2016-01-20 Published:2016-01-20
  • Contact: XU Jing, Email:, Tel: 0086-20-84426974

Abstract: The periodontal bone defect might be formed on the distal surface of the second molar root followed the extraction of the mandibular third molar. The occurrence and prognosis of the complication would be influenced by the age of extraction, the impaction level of the third molar, local inflammation, health state of adjacent tooth, etc. The periodontal bone defect of the second molar would be severer and had poorer prognosis in the case of extraction for the older patients, deeper impaction of the third molar, local inflammation, food impaction, adjacent tooth caries. From the prophylactics, it was beneficial for the prevention of the complication or reducing severity of the complication when the extraction of lower third molar was performed before the age of 25 years old. The periodontal bone defect could be effectively repaired by transplanting bone graft.

Key words: Extraction of impacted molar, Impacted mandibular third molar, Mandibular second molar, Periodontal bone defect, Guided bone regeneration

CLC Number: 

  • R782.1
[1] Kugelberg CF. Impacted lower third molars and periodontal health. An epidemiological, methodological, retrospective and prospective clinical study[J]. Swed Dent J, 1990,68(Supp 1):1-52.
[2] Leung WK, Corbet EF, Kan KW, et al. A regimen of systematic periodontal care after removal of impacted mandibular third molars manages periodontal pockets associated with the mandibular second molars[J]. J Clin Periodontol, 2005,32(7):725-731.
[3] Chuang SK, Perrott DH, Susarla SM, et al. Age as a risk factor for third molar surgery complications[J]. J Oral Maxillofac Surg, 2007,65(9):1685-1692.
[4] Hattab FN. Positional changes and eruption of impacted mandibular third molars in young adults. A radiographic 4-year follow-up study[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1997,84(6):604-608.
[5] Hattab FN, Alhaija ES. Radiographic evaluation of mandibular third molar eruption space[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999,88(3):285-291.
[6] Krausz AA, Machtei EE, Peled M. Effects of lower third molar extraction on attachment level and alveolar bone height of the adjacent second molar[J]. Int J Oral Maxillofac Surg, 2005,34(7):756-760.
[7] Hausmann E, Raisz LG, Miller WA. Endotoxin: stimulation of bone resorption in tissue culture[J]. Science, 1970,168(3933):862-864.
[8] Norton LA, Proffit WR, Moore RR. In vitro inhibition in the presence of histamine and endotoxins[J]. J Periodontol, 1970,41(1):153-157.
[9] Blakey GH, Marciani RD, Haug RH, et al. Periodontal pathology associated with asymptomatic third molars[J]. J Oral Maxillofac Surg, 2002,60(11):1227-1233.
[10] Elter JR, Cuomo CJ, Offenbacher S, et al. Third molars associated with periodontal pathology in the Third National Health and Nutrition Examination Survey[J]. J Oral Maxillofac Surg, 2004,62(4):440-445.
[11] Elter JR, Offenbacher S, White RP, et al. Their molars associated with periodontal pathology in old Americans[J]. J Oral maxillofac Surg, 2005,63(2):179-184.
[12] 邬继东,曹之强,孙世光.下颌牙拔除对第二磨牙牙周的影响[J].口腔颌面外科杂志,1994,4(3):151-153.
[13] Schofield ID, Kogon SL, Donner A. Long-term comparison of two surgical flap designs for third molar surgery on the health of the periodontal tissue of the second molar tooth[J]. J Can Dent Assoc, 1988,54(9):689-691.
[14] Summers L. Lateral trepanation of lower third molar[J]. Aust Dent J, 1974,19(3):149-151.
[15] Urbani G. Surgical technic fot extraction of the 3d lower molar while maintaining the integrity of the periodontal ligament distal and vestibular to the 2d molar[J]. Minerva stomatol, 1983,32(6):865-874.
[16] Kan KW, Liu JKS, Corbet EF, et al. Residual periodontal defects distal to the mandibular second molar 6-36 months after impacted third molar extraction. A retrospective cross-sectional study of young adults[J]. J Clin Periodontol, 2002,29(11):1004-1011.
[17] Kugelberg CF, Ahlstrom U, Ericson S, et al. The influence of anatomical,pathophysiological and other factors on periodontal healing after impacted lower third molar surgery: a multiple regression analysis[J]. J Clin Periodontol, 1991,18(1):37-43.
[18] Dodson TB. Management of mandibular third molar extraction sites to prevent periodontal defects[J]. J Oral Maxillofac Surg, 2004,62(10):1213-1224.
[19] Peng KY, Tseng YC, Shen EC, et al. Mandibular second molar periodontal status after third molar extraction[J]. J Periodontol, 2001,72(12):1647-1651.
[20] 黄桂林,程贤书,姜群,等.牙拔除后羟基磷灰石恢复牙槽骨高度的临床研究[J].口腔颌面外科杂志,2005,15(4):357-359.
[21] Montero J, Mazzaglia G. Effect of removing an impacted mandibular third molar on the periodontal status of the mandibular second molar[J]. J Oral Maxillofac Surg, 2011,69(11):2691-2697.
[22] Allegrini S Jr, Koening B Jr, Allegrini MR, et al. Alveolar ridge sockets preservation with bone grafting- review[J]. Ann Acad Med Stetin, 2008,54(1):70-81.
[23] Becker W, Becker BE, Berg LE. Periodontal treatment without maintenance.A retrospective study in 44 patients[J]. J Periodontol, 1984,55(9):505-509.
[24] Coceancig PL. Alveolar bone grafts distal to the lower second molar[J]. J Maxillofac Oral Surg, 2009,8(1):22-26.
[25] Osborne WH, Snyder AJ, Tempel TR. Attachment levels and crevicular depths at the distal of mandibular second molars following removal of adjacent third molars[J]. J Periodontol, 1982,53(2):93-95.
[26] Motamedi MH. Preventing periodontal pocket formation after removal of an impacted mandibular third molar[J]. J Am Dent Assoc, 1999,130(10):1482-1484.
[27] Rosa AL, Carneiro MG, Lavrador MA, et al. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002,93(4):404-407.
[28] Suarez-Cunqueiro MM, Gutwald R, Reichman J, et al. Marginal flap versus paramerginal flap in impacted third molar surgery: a prospective study[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003,95(4):403-408.
[29] KirtiloAɡˇlu T, Bulut E, Sümer M, et al. Comparison of 2 flap designs in the periodontal healing of second molars after fully impacted mandibular third molar extractions[J]. J Oral Maxillofac Surg, 2007,65(11):2206-2210.
[30] Kirk DG, Liston PN, Tong DC, et al. Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radial Endod, 2007,104(1):e1-e6.
[31] Nageshwar. Comma incision for impacted mandibular third molars[J]. J Oral Maxillofac Surg, 2002,60(12):1506-1509.
[32] Jakse N, Bankaoglu V, Wimmer G, et al. Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002,93(1):7-12.
[33] Guida L, Cuccurullo GP, Lanza A, et al. Orthodontic-aided extraction of impacted third molar to improve the periodontal status of the neighboring tooth[J]. J Craniofac Surg, 2011,22(5):1922-1924.
[34] 陈志方.骨组织工程支架材料充填下颌阻生智牙拔牙窝的临床效果[J].上海口腔医学,2011,20(1):93-96.
[35] Dodson TB. Is there a role for reconstructive techniques to prevent periodontal defects after third molar surgery[J]. J Oral Maxxilofac Surg, 2005,63(7):891-896.
[36] Sammartino G, Tia M, Bucci T, et al. Prevention of mandibular third molar extraction-associated periodontal defects: a comparative study[J]. J Periodontol, 2009,80(3):389-396.
[37] Hassan KS, Mari HF, Alagal AS. Does grafting of third molar extraction sockets enhance periodontal measures in 30-to 35-year-old patients?[J]. J Oral Maxillofac Surg, 2012,70(4):757-764.
[38] d’Aquino R, De Rosa A, Lanza V, et al. Human mandible bone defect repair by the grafting of dental pulp stem/progenitor cells and collagen sponge biocomlexs[J]. Eur Cell Mater, 2009,12(18):75-83.
[39] Nazaroglou I, Stavrianos C, Kafas P, et al. Radiographic evaluation of bone regeneration after the application of plasma rich in growth factors in the lower third molar socket: a case report[J]. Cases Journal, 2009,2N:9134.
[40] Sammartino G, Tia M, Marenzi G, et al. Use of autologous platlet-rich plasma (PRP) in periodontal defect treatment after extraction of lower mandibular third molars[J]. J Oral Maxillofac Surg, 2005,63(6):766-770.
[41] Karapataki S, Hugoson A, Kugelberg CF. Healing following GTR treatment of bone defects distal to mandibular 2nd molars after surgical removal of impacted 3rd molars[J]. J Clin Periodontol, 2000,27(5):325-332.
[42] 许竞.2种术式拔除下颌阻生第三磨牙术后干槽症及其发生机制探讨[J].广东牙病防治,2011,19(1):37-39.
[1] XING Huiyan,HU Yuping,JIANG Wenqiong,ZHANG Ran,WEI Fangyuan,TAN Yanning,DENG Min,LI Shufang. CBCT study of the root and root canal morphology of mandibular second molars in a population in western Guangxi [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(12): 836-842.
[2] REN Lizhi,SUN Rui. New progress in the clinical application of GBR membrane materials [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2020, 28(6): 404-408.
[3] WANG Yamin,ZHOU Zhen,DAO Junfeng,CHEN Qiyue,LIU Wenjing,SONG Guangbao. Evaluation of the effect of concentrated growth factor in guided bone regeneration in maxillary anterior tooth defects [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2020, 28(4): 236-240.
[4] LI Ning,YANG Liu,WANG Hongning,WANG Tiejun. Clinical application of molar uprighting for impacted mandibular second molars [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2020, 28(10): 641-645.
[5] LIU Fang,GU Yongchun,GUO Hong,TANG Ying,LIU Chao,SHEN Yifen. Anatomical morphology of the root and root canal system of the second permanent molar in the Uygur people [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2019, 27(8): 522-526.
[6] Tao LUO, Ling ZOU. Research progress in applications used for guided tissue regeneration in endodontic surgery [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(3): 189-194.
[7] Juan ZHANG, Yaxin WANG, Chao SUN, Guangchao ZHOU, Lianfeng YANG, Daming WU. Cone-beam computed tomography evaluation of the distance between the root apex of mandibular molars and the inferior alveolar nerve canal in adults [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(3): 175-179.
[8] Haibin LU, Lei WAN, Mingdeng RONG, Xueyang ZHANG, Yuan SU. Clinical effects of combined application of Er: YAG laser and guided bone regeneration in treatment of peri-implantitis [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2017, 25(7): 430-434.
[9] Hai-tao WANG,Min YU,Zeng-quan WANG,Shao-qin TU,Si-yuan WU. The investigation of the perpendicular occlusal condition of the mesially impacted mandibular third molars and its relationship with TMD [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2016, 24(2): 94-97.
Full text



[1] ZHU Song-song, HU Jing. The application of distraction osteogenesis in the temporomandibular joint ankylosis and secondary dentofacial deformities[J]. journal1, 2016, 24(1): 6 -10 .
[2] ZHONG Jiang-long, PAN Ji-yang, CHEN Wei-liang. The evaluation of Eagle syndrome treatment by surgery combined with antidepressant therapy[J]. journal1, 2016, 24(1): 26 -28 .
[3] CHEN Xi, SUN Qin-zhou. The study of colorimetric board of porcelain fused to metal restoration for moderate to severe dental fluorosis[J]. journal1, 2016, 24(1): 33 -36 .
[4] OUYANG Ke-xiong1, LIANG Jun, ZOU Rui, LI Zhi-qiang, BAI Zhi-bao, PIAO Zheng-guo, ZHAO Jian-Jiang.. Ion Torrent RNA-Seq detection and analysis of the long non-coding RNA in tongue squamous cell carcinoma[J]. journal1, 2016, 24(1): 15 -19 .
[5] YU Pei, XUE Jing, ZHANG Xiao-wei, ZHENG Cang-shang. The influence of the roughness of zirconia ceramic surface on microbial attachment[J]. journal1, 2016, 24(1): 20 -25 .
[6] LIU Fang. Clinical assessment of two fissure sealant techniques in children’s dental caries prevention[J]. journal1, 2016, 24(1): 44 -45 .
[7] . [J]. journal1, 2016, 24(1): 49 -52 .
[8] LU Jian-rong, BAN Hua-jie, WANG Dai-you, ZHOU Hui-hui, LONG Ru, QIN Shu-hua. Clinical observation of sternocleidomastoid muscle flaps combined with artificial biological membrane reparing the defects after parotidectomy[J]. journal1, 2016, 24(1): 29 -32 .
[9] LI Bin, HE Xiao-ning, GAO Yuan, HU Yu-ping. Clinical analysis of pain after two kinds of apical stop preparation[J]. journal1, 2016, 24(1): 40 -43 .
[10] Man-wen YE,Wei FANG,Yong SHI,Jie PAN,Shu-guang ZENG. Preparation and characterization of genipin-crosslinked silk fibroin/chitosan sustained release microspheres[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2016, 24(2): 79 -86 .
This work is licensed under a Creative Commons Attribution 3.0 License.