The letter by Dr. Szalma replying to our article reveals his substantial and important work in this area, which further highlights the early extraction of lower third molars in order to avoid nerve injury. In our article ‘Early extraction: a silver bullet to avoid nerve injury in lower third molar removal?’, we evaluated the effects (particularly nerve injury) of early extraction of immature third molars in a limited clinical sample (only 808 lower third molar, 518 patients ≤23 years) and emphasized the role of a team consultation before early extraction of third molar. This concept of ‘team consultation’ included an individual systematic assessment of the patient in cooperation with other departments. However, we only described the clinical complications in the limited sample and did not discuss this point in depth. Our next research focus will be elaborating the deeper mechanism of this phenomenon. Thus, to date, we completely agree with Dr. Szalma’s view concerning the prediction of inferior alveolar nerve (IAN) injury requiring an individual estimation.

According to Dr. Szalma’s experience, approximately 12–15% of IAN exposures occur in patients below the age of 23 years. Sighting an exposed intact IAN bundle during third molar surgery carries a 20% risk of paresthesia. The incidence rate of paresthesia after surgery is fairly low in previous reports. In addition, according to Dong Lin Zeng’s statistics, the mean age of third molar apical closing is <23.5 years in Han in southern China. The reason for the zero occurrence of reversible paresthesia may be that there was possible negligence in the investigation or that we truly did not find nerve injury in the limited sample.