The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth.
The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth.
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DOI：
10.3310/hta4150
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发表时间：
2000
影响因子：
3.6
通讯作者：
Fujian Song;S. O’Meara;P. Wilson;S. Golder;J. Kleijnen
中科院分区：
文献类型：
--
作者：
Fujian Song;S. O’Meara;P. Wilson;S. Golder;J. Kleijnen
在英国，智齿拔除是最常见的外科手术之一。当第三磨牙有感染、不可修复的龋齿、囊肿、肿瘤和邻近牙齿和骨骼的破坏等病理变化时，对第三磨牙的拔除几乎没有争议。然而，预防性拔除阻生第三磨牙的理由是不确定的，并且已经争论了很多年。目的总结现有的关于阻生智齿预防拔除的证据，包括预防拔除相关手术并发症的发生率和保留相关的发病率。方法对相关研究文献进行系统回顾。方法-数据来源：现有的综述构成了本报告的基础，并进行了额外的文献检索，包括电子数据库（MEDLINE, 1984-99； EMBASE, 1984-99；科学引文索引，Cochrane对照试验注册，国家研究注册；有效性评论摘要数据库），论文来源（包括临床证据）和网络资源的检索。我们联系了相关机构和专业团体以获取进一步信息。方法-研究选择：选择符合以下标准的研究：(1)设计-随机对照试验（rct）、文献综述或决策分析；(2)参与者-未萌出或阻生第三磨牙的人，或因预防或相关病理变化而接受手术切除第三磨牙的人；(3)报告的结果-第三磨牙保留相关的病理改变或拔牙后的术后并发症。在研究选择上没有语言限制。方法-数据提取和综合：纳入研究的数据被提取到结构化表格中，并根据方法学检查表评估个别研究的有效性。对数据进行描述性总结。有关研究选择、数据提取和效度评估的决定由两位独立的审稿人做出，分歧通过讨论解决。对于非英语论文，我们招募了翻译来协助研究选择和数据提取。结果：共纳入40项研究：2项随机对照试验、34篇文献综述和4项决策分析研究。英国的一项随机对照试验研究了保留第三磨牙对以前接受过正畸治疗的患者门牙拥挤（主要是美容问题）的影响。本试验结果提示，为了防止晚切牙拥挤而拔除第三磨牙是不合理的。丹麦的另一项正在进行的随机对照试验比较了预防性拔除第三磨牙和根据发病率拔除第三磨牙的效果和费用。到目前为止，这项试验已经招募了200名参与者，初步结果表明，观察等待可能是一种很有前途的策略。然而，需要更多的数据和更长的患者随访来确定哪种治疗策略最具成本效益。众所周知，美国正在进行一项试验，但到目前为止还没有结果。文献综述的方法学质量普遍较差，而且没有一篇综述是系统的。关于前牙拥挤的九篇综述的结论表明，第三磨牙固位与拥挤之间只有微弱的关联。21篇综述中有6篇的范围更广，也得出结论认为预防性拔除第三磨牙是不合理的。12篇综述没有对第三磨牙的治疗给出明确的结论。三篇综述建议预防性拔除第三磨牙是适当的，但这些综述的方法学质量比大多数其他综述差。四分之三的论文集中在手术管理表示
BACKGROUND Removal of wisdom teeth is one of the most common surgical procedures performed in the UK. Little controversy surrounds the removal of impacted third molars when they are associated with pathological changes such as infection, non-restorable carious lesions, cysts, tumours, and destruction of adjacent teeth and bone. However, the justification for prophylactic removal of impacted third molars is less certain and has been debated for many years. OBJECTIVES To provide a summary of existing evidence on prophylactic removal of impacted wisdom teeth, in terms of the incidence of surgical complications associated with prophylactic removal, and the morbidity associated with retention. METHODS A systematic review of the research literature was undertaken. METHODS - DATA SOURCES: An existing review formed the basis of this report, and additional literature searches were undertaken, including searches of electronic databases (MEDLINE, 1984-99; EMBASE, 1984-99; Science Citation Index, Cochrane Controlled Trials Register, National Research Register; Database of Abstracts of Reviews of Effectiveness), paper sources (including Clinical Evidence), and web-based resources. Relevant organisations and professional bodies were contacted for further information. METHODS - STUDY SELECTION Studies were selected for inclusion if they met the following criteria: (1) design - randomised controlled trials (RCTs), literature reviews, or decision analyses; (2) participants - people with unerupted or impacted third molars, or those undergoing surgical removal of third molars either as prophylaxis or due to associated pathological changes; (3) reported outcomes - either the pathological changes associated with retention of third molars, or post-operative complications following extraction. There were no language restrictions on study selection. METHODS - DATA EXTRACTION AND SYNTHESIS: Data from included studies were extracted into structured tables and individual study validity was assessed against methodological checklists. Data were summarised descriptively. Decisions relating to study selection, data extraction and validity assessment were made by two independent reviewers, and disagreements were resolved by discussion. For non-English papers, translators were recruited to assist with study selection and data extraction. RESULTS Forty studies were included in the review: two RCTs, 34 literature reviews, and four decision analysis studies. One RCT in the UK focused on the effects of retained third molars on incisor crowding (predominantly a cosmetic problem) in patients who had previously undergone orthodontic treatment. The results of this trial suggested that the removal of third molars to prevent late incisor crowding cannot be justified. Another on-going RCT in Denmark compares the effects and costs of prophylactic removal of third molars with removal according to morbidity. So far, this trial has recruited 200 participants, and preliminary results indicate that watchful waiting may be a promising strategy. However, more data and longer follow-up of patients are needed to conclude which treatment strategy is the most cost-effective. It is also known that a trial is on-going in the USA but no results are available so far. The methodological quality of the literature reviews was generally poor, and none of the reviews was systematic. Conclusions from nine reviews on anterior crowding suggested that there was only a weak association between retention of third molars and crowding. Six out of 21 reviews with a more general scope also concluded that the prophylactic removal of third molars was unjustified. Twelve general reviews did not conclude with a clear message about the management of third molars. Three reviews suggested that prophylactic removal of third molars is appropriate, but these reviews were of poorer methodological quality than the majority of other reviews. Three out of four papers focusing on surgical management expressed