Evolution of Decision-Making Models in Prophylactic Extraction of Asymptomatic Third Molars

Abstract

Objective This study identified the evolution of clinical decision-making models for prophylactic extraction of asymptomatic, healthy third molars (3MAS).

Methods A literature review (PubMed, LILACS, Cochrane; 1970–2025) used descriptors Third Molar, Asymptomatic, Prophylactic Extraction, and Decision-Making. From 360 records, 78 studies were selected, analyzed qualitatively, and grouped by decade to identify dominant theses and central arguments.

Results Prophylactic extraction evolved from routine practice (1970s), justified by prevention of future pathology, to a questioned approach in the 1980s due to surgical morbidity and cost-effectiveness. In the 1990s, evidence of low risk in monitored 3MAS strengthened active surveillance. From 2000 onward, risk predictors gave rise to the Selective Risk Model, reserving early extraction for high-risk cases. Between 2010 and 2020, refined diagnostics and quality-of-life assessments shaped the Decision Optimization Model. Since 2020, the Personalized Decision Model has prevailed, integrating AI-driven prediction and patient-centered shared decision-making.

Conclusion These models minimize costs and unnecessary surgeries, reduce morbidity, and prioritize active surveillance in low-risk cases, transforming 3MAS extraction from routine to an evidence-based exception.