The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs.

Mylena Ranieri Libdy,Leandro Silva Marques,David Normando,Nicole Melres Rabello

doi:10.1590/2177-6709.25.4.068-074.oar

Abstract

ABSTRACTObjective: To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. Methods: 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). Results: The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). Conclusions: Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.

Highlights

Third molars are the most often impacted teeth,[1,2,3,4] with a prevalence ranging from 9.5% to 39% among various populations[5]
The objective of this study is to evaluate the skills of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis for spontaneously erupted M3M by longitudinal monitoring through panoramic radiographs
The present findings showed that when mandibular third molars erupt spontaneously, about 42% of orthodontists and 44.5% of OMFS indicated the extraction when evaluating a single panoramic radiograph taken at the end of orthodontic treatment (Table 2)

Summary

Introduction

Third molars are the most often impacted teeth,[1,2,3,4] with a prevalence ranging from 9.5% to 39% among various populations[5]. Prophylactic removal of third molars has been adopted under the assumption of preventing future damage,[19] such as pericoronitis,[2] osteitis, osteomyelitis,[20] dentigerous cysts,[21] caries in the distal of the second molar[22], or root resorption in neighboring teeth.[23] the tertiary crowding in adults[24,25,26] and the risk of relapse after orthodontic treatment[26] have been associated to the presence of third molars, most studies have demonstrated that third molars have a negligible influence on the long-term changes occurring in the mandibular arch.[27,28]

Methods

Results

Discussion

Conclusion