Abstract
Background/Objectives: Germectomy is the surgical removal of a developing third molar, usually before one-third of its root has formed. In children and adolescents, it is performed mainly for orthodontic reasons, without an established advantage over retention or later removal. This review summarizes clinical studies published in 2016–2026. Methods: English-language studies from PubMed, Scopus and Web of Science were synthesized narratively, graded with the Strength of Recommendation Taxonomy (SORT) and assessed for risk of bias. Results: Of the 77 records, 14 studies with 654 germectomies were included, and four of them were randomized trials; none reached SORT level 1, and no comparative study was at low risk of bias. The definitions and the staging criteria varied; five studies did not report the developmental stage. The indications were mostly orthodontic, but in the only randomized comparison with retention, germectomy did not shorten the uprighting of impacted second molars. Delayed-onset infection, the most frequent complication, followed 9.2% of 218 germectomies in the largest series and appeared 2–8 weeks after surgery, when seven studies had ended follow-up. Three other studies reported complications after 3.6–4.5% of germectomies; where specified, none was a nerve injury. Pain and oral health-related quality of life were assessed only in the first postoperative week, when pain peaked in the first days. Two maxillary case reports described germ displacement and late partial tooth formation. Conclusions: Germectomy rarely causes serious complications, but its orthodontic benefit is unproven. Families should expect pain in the first days and possible infection weeks later. Prospective comparisons of germectomy and monitoring of the germ, with standardized staging and follow-up of at least one year, should test the orthodontic indication.