Objective: Third molar removal is a frequent surgical procedure. Common complications associated with third molar surgery are well-recognized and frequently explained to patients during the process of informed consent. The general dental practitioner, as well as the oral and maxillofacial surgeon, must be familiar with all possible complications. This systematic review serves as a reminder of the unusual complications of this routine procedure. Method and Materials: Studies were located using systematic searches in Medline and the Cochrane Library electronic databases, as well as hand searching of key texts, references, and reviews relevant to the field. Key words included third molar, wisdom tooth, complications, unusual, and rare. References from the relevant articles were also doublechecked. The review was limited to English- and German-language articles published within the last 18 years. Results: Frequently detected, well-known complications are permanent nerve damage and immediate or late mandibular fractures. Twenty-four other complications were identified in 22 articles. Among these complications were inflammatory processes, abscess formation, and displacement of teeth and instruments. Single case reports describe asphyxial death after postextraction hematoma, life-threatening hemorrhage, brain abscess, epidural abscess, benign paroxysmal positional vertigo, subcutaneous and tissue space emphysema, subdural empyema, and herpes zoster syndrome. Conclusion: To achieve good patient care, it is necessary to realize the variety of possible complications. Rare complications must be recognized early so that adequate therapy can be immediately ensured. Keywords: adverse effects, complications, extraction, rare, removal, third molar, unusual, wisdom tooth