Towards Global Guidelines for Mandibular Third Molar Extraction

Management of mandibular third molars (M3Ms) remains a persistent area of clinical uncertainty in oral and maxillofacial surgery, particularly regarding prophylactic extraction in asymptomatic or minimally symptomatic patients. Clinicians must balance the potential benefits of removal, such as prevention of future pathology, against procedure-related risks, including inferior alveolar nerve injury, infection, pain, and postoperative morbidity. Conversely, retention can be associated with pericoronitis, second molar caries, periodontal defects, cystic change, and other complications, with risk profiles that vary by patient age, tooth position, and comorbidities. Despite extensive research, practice remains heterogeneous across countries and healthcare systems, reflecting differences in training, medicolegal context, access to care, and interpretation of the evidence base.

This Research Topic aims to advance toward evidence-informed, internationally applicable guidance for decision-making in M3M management. The central problem is the absence of broadly accepted, clinically actionable criteria that integrate patient-specific risk, procedural complexity, and long-term outcomes. To address this gap, the collection will synthesise current evidence and promote methodological rigour in evaluating indications for extraction versus retention, including prognostic factors for disease development and complications. Recent advances offer an opportunity to improve risk stratification and shared decision-making, including improved imaging-based assessment of surgical difficulty and nerve proximity, standardised definitions of “asymptomatic” and “pathology-free” M3Ms, and data-driven predictive models that incorporate clinical, radiographic, and patient-reported variables. By bringing together high-quality clinical evidence, consensus-building approaches, and implementation perspectives, the Topic seeks to support consistent patient care and reduce both unnecessary surgery and preventable morbidity.

We welcome submissions that clarify indications, outcomes, and decision pathways for M3M extraction and retention across diverse clinical settings. Topics of interest include:
(i) epidemiology and natural history of retained M3Ms;
(ii) predictors of pathology (pericoronitis, caries, periodontal disease, cystic lesions) and time-to-event risk;
(iii) surgical outcomes and complications, including nerve injury and quality-of-life impact;
(iv) imaging, classification systems, and objective measures of surgical complexity;
(v) comparative effectiveness studies and health-economic analyses;
(vi) shared decision-making, patient-reported outcomes, and ethical considerations;
(vii) guideline development methods and implementation strategies.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Policy Brief
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Mandibular third molar, Prophylactic extraction, Asymptomatic impacted teeth, Risk stratification, Inferior alveolar nerve injury, Clinical practice guidelines

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.