Clinical indications and conditions of third-molar germectomy and early adolescent extractions: a retrospective analysis

This retrospective study evaluated third-molar (M3) germectomy/early adolescent extractions, focusing on clinical and radiographic characteristics, removal indications, and possible effects on adjacent second molars (M2s). Records of 112 adolescent patients (mean age, 16.10 ± 0.92 years; range, 12.92–17.00 years) who underwent M3 germectomy/early adolescent M3 extraction between 2017 and 2023 were reviewed. A total of 234 M3s were assessed on panoramic radiographs using established radiographic classification systems for positional, angulation, and developmental evaluation. Removal indications and M2 pathology, positional changes, and treatment needs were recorded. Statistical analyses included chi-square tests, multivariable logistic regression, and receiver operating characteristic (ROC) analysis, with significance set at p < 0.05. Among the 234 M3s, 73 (31.2%) had Demirjian stages C–E (germectomy subgroup), whereas 161 (68.8%) had stages F–H (early adolescent extraction subgroup). The leading removal indications were orthodontic space management (37.2%) and pericoronitis (34.2%). Jaw-based differences were largest for removal indication (Cramér’s V = 0.65) and Winter angulation (V = 0.52), followed by Archer position (V = 0.48) and Demirjian stage (V = 0.35). M2 pathology and treatment need showed small-to-medium effects (both V = 0.28), and M2 position showed a small effect (V = 0.20). Most adjacent M2s had no pathology (80.8%) and required no treatment (80.3%). No significant patient-level sex differences were observed. Jaw-related differences were observed in M3 removal clinical and radiographic characteristics, with the largest effects seen for removal indications and angulation patterns; orthodontic indications were more frequent in maxillary M3s, whereas pericoronitis and adjacent M2 treatment needs were more frequent in mandibular M3s. Overall, mandibular location and non-vertical M3 angulation emerged as the main factors associated with adjacent second molar pathology. The findings support consistent developmental-stage-specific terminology and individualised clinical and radiographic assessment when determining whether and when an adolescent M3 should be removed.