Factors influencing prophylactic extraction of mandibular third molars in orthodontic practice: A cross-sectional study

Introduction: Prophylactic extraction of mandibular third molars remains controversial in orthodontics, with variability in clinical decision-making. This study aimed to identify the factors influencing prophylactic extraction among Israeli orthodontists. Methods: A cross-sectional survey was conducted using an online questionnaire distributed to 88 active orthodontic specialists and residents practicing in Israel. The questionnaire assessed the demographic characteristics and factors associated with prophylactic extractions. Statistical analyses included descriptive statistics, chi-square tests, Fisher exact test, Pearson's correlation, Cochran's Q test, and multivariate logistic regression. Results: Impaction characteristics were the most frequently considered factors for prophylactic extraction (35.2%), followed by mandibular arch crowding (26.1%). Only 4.5% of orthodontists routinely referred patients for prophylactic extractions. No significant correlations were found between the demographic factors and extraction practices. A marginally significant and weak positive correlation between age and consideration of mandibular arch crowding (r = 0.21; P = 0.049) was observed. Cochran's Q test indicated significant differences in the prioritization of factors (Q = 32.24; P <0.001), with impaction characteristics and mandibular arch crowding being considered significantly more prevalent than future pericoronitis. Conclusions: The decision to recommend prophylactic extraction of mandibular third molars is primarily influenced by impaction characteristics and concerns about mandibular arch crowding rather than demographic factors. This variability in decision-making highlights the need for evidence-based guidelines to support orthodontists in managing third molars during treatment.