Background: Third molar extraction is one of the most common oral surgical procedures worldwide, with significant implications for patient quality of life during recovery. While clinical outcomes have been extensively studied, there is increasing recognition of the importance of patient-reported outcomes in evaluating the effectiveness of different surgical approaches.

Purpose: This review aims to comprehensively assess patient-reported outcomes following different approaches to third molar extraction, with particular focus on comparing coronectomy with complete extraction and evaluating the impact of various surgical technique modifications on patient experience.

Methods: A narrative synthesis of published literature was conducted, integrating findings from randomized controlled trials, systematic reviews, and prospective cohort studies that reported patient-centered outcomes following third molar surgery. Key outcomes of interest included pain, swelling, functional limitations, neurosensory disturbances, and overall quality of life.

Results: Coronectomy demonstrates advantages in reducing the risk of inferior alveolar nerve injury (risk ratio 0.11, 95% CI: 0.03-0.36) and associated sensory disturbances compared to complete extraction in high-risk cases, with many studies also reporting reduced early postoperative pain and swelling. However, the potential need for reoperation (0.6-6.9% of cases) represents an important consideration in treatment planning. Regarding surgical technique, triangular flaps show modest reductions in early postoperative pain compared to envelope flaps (mean difference -0.21 on a 0-10 scale, 95% CI: -0.32 to -0.10), while secondary wound closure demonstrates advantages in reducing pain (mean difference 0.79, 95% CI: 0.35 to 1.24) and swelling compared to primary closure. Advanced technologies like piezoelectric surgery show promise in improving patient-reported recovery. Patient factors, including age, gender, and psychological profile, significantly influence reported outcomes and should be considered in preoperative planning.

Conclusions: Different surgical approaches to third molar extraction offer distinct advantages regarding specific aspects of patient experience. Optimizing patient-reported outcomes requires an individualized approach that considers the specific anatomical situation, patient characteristics, and expressed preferences. Future research should focus on standardizing outcome measurement, extending follow-up periods, and developing personalized approaches based on individual risk profiles.