Incidence of Caries and Pathological Findings in Different Positions of Impacted Third Molars: A Retrospective Analysis

Abstract

Impacted third molars(3M), commonly known as wisdom teeth, are prone to caries and pathological formations depending on their position in the jaw. This study aimed to determine and compare the incidence of caries, pathological formations, and the superposition of the roots of the mandibular impacted third molar over the mandibular canal in different positions of impacted 3Ms. This retrospective study was conducted on orthopantomographs of patients who presented with 3M complaints at the Tokat Gaziosmanpaşa University Oral and Maxillofacial Surgery Department between 2019 and 2023. The 3M were classified according to their position by two researchers independently and were evaluated for caries, pathology, and nerve superposition. The position of the 3Ms classified using Pell and Gregory and Winter's classifications. The primary outcome variable was the presence of caries in the 3M. The secondary outcome variable was the presence of pathological formations around the 3M. The tertiary outcome variable was the superposition of the roots of the mandibular 3M over the mandibular canal. A total of 7,038 patients were included in the study, with 53.74% being female. The mean age was 32.15±7.2 years. The highest incidence of caries was associated with the vertical position in both maxillary and mandibular 3Ms (right maxillary: 9.98%, P<0.001; left maxillary: 12.74%, P<0.001; left mandibular: 11.66%, p=0.003; right mandibular: 11.69%, p=0.031). Pathological formations were most commonly observed in the vertical position, but the highest incidence was found in the horizontal or mesioangular positions (right maxillary: 36.84%, p<0.001; left maxillary: 40%, p<0.001; left mandibular: 62.04%, p<0.001; right mandibular: 62.25%, p<0.001). Nerve superposition was most common in the vertical position but was highest in the distoangular position (left mandibular: 74.69%, p<0.001; right mandibular: 76.66%, p<0.001). The position of 3Ms plays a critical role in the development of complications such as caries and pathological formations. Prophylactic extraction may be considered more seriously in cases where the position of the tooth poses a higher risk of complications.