The removal of embedded third molars constitutes a large proportion of oral surgery procedures in the dental office. There are reports from studies worldwide suggesting a recent increase in the incidence of third molar impactions. The radiolucent area (namely follicular tissue) around these teeth has a potential to develop pathological conditions. However, there has been no internationally accepted consensus in dental literature to date on clinical criteria to differentiate between normal and pathological conditions of follicular tissue based on the radiographic features around impacted third molars. Previous studies suggest that normal pericoronal radiolucency is in the range of 2-3 mm although there is limited scientific data attesting the validity of this assumption. Several recent studies have demonstrated considerable pathosis in cases with clinically normal radiolucency. These recent studies have indicated that the incidence of pathosis in follicular tissues is higher than generally perceived from radiographic examination alone. This is especially notable since important pathological conditions such as ameloblastomas, odontogenic keratocysts or dentigerous cysts have been observed in the follicles which have the potential to develop into more serious complications. Despite recommendations from the National Institutes of Health (NIH) Consensus Development Conference on wisdom tooth removal indications, many authors have questioned the routine removal of impacted third molars attributing it to the current lack of knowledge about incidence and/or odds of pathosis in normal pericoronal tissues. There seems to exist some degree of perplexity among dental professionals in dealing with asymptomatic and radiographically normal impacted wisdom teeth.
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