Mandibular Third Molar Angulation Research Articles

The Clinical and Radiological Evaluation of Impacted Third Molar Position, Crown and Root Morphology.

This study aimed to analyze the crown and root morphology of maxillary and mandibular third molars, and assess their position in relation to adjacent anatomical structures using clinical examination and radiographic images. A total of 176 extracted impacted or partially impacted third molars were included in this study. Orthopantomogram images (OPG) were used to evaluate the number of roots, position, depth of impaction relative to the occlusal plane of the second molar, and angulation of maxillary and mandibular third molars. The extracted teeth were examined to determine the actual number of roots. The root morphology was classified using the Alavi classification system for maxillary third molars and the Machado classification for mandibular third molars. Additionally, the number of cusps, crown dimensions, and morphology were analyzed using digital and dental calipers. The extracted samples exhibited a significantly higher number of roots compared to the number assessed on OPG images (P<0.001). The majority of mandibular third molars had two fused roots (37.39%) and a five-cuspid crown (48.70%), while maxillary third molars had three fused roots (26.23%) and four cusps (42.62%). Both maxillary (60.66%) and mandibular third molars (61.74%) were predominantly vertically positioned. Regarding the depth of impaction, maxillary third molars were primarily classified as Class C (65.57%), while mandibular third molars were classified as Class B (47.83%). Differences in crown shape were observed, with maxillary crowns being mostly triangular (36.07%) and mandibular crowns being oval (38.26%). Maxillary third molars had shorter crowns compared to mandibular third molars (P<0.05). The root morphology of maxillary and mandibular third molars in the population of Bosnia and Herzegovina displays variability. Orthopantomogram imaging was found to be inadequate for accurate determination of the number of roots in third molars. The number of cusps on third molars cannot be relied upon as a predictor of the number of roots. The study's findings will have implications for dental practice, particularly for oral surgeons and restorative dentists.

Radiographic Evaluation of Impacted Third Mandibular Molar According to the Classification of Winter, Pell and Gregory in a Sample of Cameroonian Population

Background: The extraction of impacted third molars (M3) is a common surgical procedure in dentistry and oral surgery. Various  complications, including inferior alveolar nerve (IAN) damage, may occur during and after extraction of this tooth. Radiographic  examination should provide information about the M3 itself, but also about the surrounding bony structure and the relationship of the  roots to the IAN and the adjacent second molar, which is often traumatized during this extraction. The aim of our study was to evaluate  the depth and angulation of impacted mandibular third molars (M3) from panoramic radiographs, according to the classifications  proposed by Winter and Pell &amp; Gregory.&#x0D; Methods: Radiographic signs present on the orthopantomogram showing M3 depth, and retromandibular available space according to  the Pell &amp; Gregory classification were evaluated. Evaluation of the M3 angulation relative to the M2 according to Winter's classification  was also done. Student's t test was used to determine the association between side or sex and different variables.&#x0D; Results: The depth of  impaction of the M3 crown was level A accounting for 54.4% (n=260) of the PR while level B constituted 35.7% (n=171) of the images.  Regarding the availability of retromandibular space, Class I constituted 36.8% (n=176). The Class II accounted for 55.9% (n=267) of PR.  &#x0D; Conclusion: Our study showed that 54.4% of M3 were located at the same level as the occlusal plane of the second molar, while in 56% of  PR the space between the second molar and the ramus of the mandible is less than the mesiodistal diameter of the third molar. This  research showed that 23.1% of M3 had a level of vertical angulation, a level that allows for less painful luxation of the impacted molars.  These results seem to show a relatively high level of difficulty in mobilizing and extracting M3 from Cameroonian patients  

Three-dimensional relationship between the degree of bilateral impacted mandibular third molars angulation and the mandibular dental arch parameters: a cross-sectional comparative study.

The purpose of this study was to three-dimensionally evaluate the relationship between the degree of bilateral impacted mandibular third molar (IM3M) angulation and the mandibular dental arch parameters in normal skeletal and dental malocclusion patients. In this retrospective cross-sectional comparative study, 120 adult subjects' cone-beam computed tomography (CBCT) images were three-dimensionally analyzed. The sample included 120 adults aged 20-30years, with a gender distribution of 51 male and 69 female participants. The sample was divided into 100 adults with bilateral IM3M (study group) and 20 adults with normal bilateral erupted M3M (control group). The study group was sub-divided into three groups according to the degree of IM3M buccolingual angulation (BL°): group A, < 12° on the center of the ridge (N = 30), group B, 12-24° off-center of the ridge (N = 40), group C, > 24° off-center of the ridge (N = 30). The study group was also sub-divided into two groups according to IM3M mesiodistal angulation (MD°): group 1 from 10 to 45° (N = 36), group 2 > 45° (N = 64). Comparison within and between groups was performed using one-way ANOVA followed by Tukey's post hoc test. The correlation between IM3M, BL, and MD angulation and the mandibular arch parameter was calculated using Pearson's correlation coefficient. Statistically significant differences (P < 0.001) were found between the IM3M BL° and anterior teeth inclination, arch length (AL), and inter-second molar width (inter 2nd MW) as well as between the IM3M MD° with anterior crowding and the arch length (P < 0.001). A significant positive correlation was found between IM3M BL° and anterior teeth inclination and between IM3M MD° and anterior teeth crowding and inter 2nd MW. A significant negative correlation was observed between IM3M BL° and inter 1st MW and 2nd MW. The degree of buccolingual and mesiodistal angulation of the impacted mandibular third molars was related with mandibular dentoalveolar changes. Increased buccolingual angulation is generally associated with increased anterior teeth inclination and decreased 1st and 2nd inter-molar width. The increase in mesiodistal angulations was generally related with increased anterior teeth crowding and 2nd inter-molar width. Assessment of the relationship between the impacted mandibular third molars and the degree of arch discrepancy, and the position of mandibular incisors in the three planes of space might help in the decision-making process for the extraction of the impacted third molars in adult patients.

Effect of orthodontic extraction of mandibular premolars on third molar angulation after treatment with fixed appliances : Across-sectional study.

Orthodontic treatment involving premolar extractions might improve the angulation of lower third molars, which are the teeth most often impacted. This study analyzes the impact of first/second lower premolar extraction during orthodontic therapy on the angulation of mandibular third molars. A total of 120patients treated non-extraction (n = 40), with extraction of first (n = 40), or second lower premolars (n = 40) were included. The mesiodistal angulation of lower third molars relative to the adjacent tooth and their developmental stage were evaluated from posttreatment orthopantomograms. Between-group differences were statistically evaluated at asignificance level of 0.05. The orthopantomograms of 120patients (51% female) with amedian age of 15.2years at the time of debonding were evaluated after amean treatment duration time of 2.9years. No difference (P > 0.05) was seen between the average angulation of the lower third molars of the right (mean = 24.4°, standard deviation [SD] 13.6°) and the left side (mean = 23.6°, SD 14.1°). No differences in the angulation of the lower third molar were found between the non-extraction and extraction groups for the right (P = 0.44) or the left side (P = 0.22). Likewise, no differences were found when comparing the first and second premolars for the right (P = 0.26) or the left side (P = 0.10). Premolar extraction was associated with an advanced root development stage of the right third molar (odds ratio 7.1; 95% confidence interval 1.1-48.1; P = 0.04), with no differences between extraction of the first or second premolar (P = 0.10). Orthodontic treatment involving premolars extractions might be associated with asmall acceleration in root development, but not with the angulation, of lower third molars.

Prevalence and Angulation of Mandibular Third Molar Impaction in Zliten, Libya: A Retrospective Radiographic Study

Objectives: This retrospective study investigates the prevalence and angulation of impacted mandibular third molars and the most affected sex in a sample of Libyan patients between the ages of (19 and 84) who live in Zliten, Libya. Study Design: Sixty-nine patients between the ages of (19 and 84) referred to the Assalam Dental Centre were included in this retrospective study. Of the 69 patients, 30 females and 39 males were assessed for the prevalence and position of an impacted mandibular third molar on panoramic radiographs. Results: Out of 124 mandibular third molars, seventy-six were found to be impacted on both right and left sides, from which mesioangular impaction was the most common angulation in females. In contrast, vertical impaction was the most common in males. In addition, the prevalence of impacted mandibular third molars were more in females. Conclusion: The prevalence of impacted mandibular third molars is higher in females than males, and mesioangular impaction is the most common in females, while vertical angulation is frequently common in males.

270 A Retrospective Analysis of The Impaction Status of Mandibular Third Molars as A Risk Factor for Fractures of Angle or Condylar Region of The Mandible

Abstract Background the position and angulation of mandibular third molars have both been found to influence the angle and condylar fractures. Objective: To identify whether there is an association between the depth and angulation of third molar impaction and the relative risk of fracture of the mandibular angle and condyle. Method Four-hundred and eighty-two panoramic dental radiographs were assessed for the period from January 2012 to June 2020. The study variables included the presence of mandibular third molars, position and angulation. The outcome variables were angle and condylar fractures. Results the mean age was 28.5 years (range 15-89) and 93.2% (n = 499) were male. Angle fractures were significantly more frequent with an impacted wisdom tooth (M3) ( p = 0.023) whereas condylar fractures were more commonly associated with a fully erupted M3. The highest incidence of angle fractures was observed with wisdom teeth classified as class II ( p = 0.026) and position B ( p = 0.05). In contrast, class I wisdom molars were more frequently associated with condylar fractures. With regards to the angulation of wisdom teeth, angles between 80 o – 100 o were highly correlated with angle fractures ( p = 0.020) whereas M3 angulations of 60 o – 80 o were related to condylar injuries (p = 0.025). Conclusions fractures of the mandibular angle were significantly associated with Class II and position B wisdom teeth whereas class I third molars were associated with fracture of the condyles. The likelihood of angle and condylar fractures almost doubled when M3 angulations were (80-100) and (60-80) respectively.

Effects of Angle classII correction with the Forsus fatigue resistant device on mandibular third molars : Aretrospective study.

The goal was to evaluate the effects of Angle classII malocclusion treatment using the Forsus fatigue resistant device (FRD, 3M, St. Paul, MN, USA) on the position and angulation of mandibular third molars and retromolar space. In all, 58classII patients (mean age 13.6 ± 1.8years) treated with the FRD (FRD group) were compared with 51classI patients (mean age 13.5 ± 1.6years) who underwent orthodontic treatment (control group). A total of 109 mandibular third molars in the FRD group and 91in the control group were evaluated. Changes in the retromolar space, angulation of the second (ɣ) and third molars (β), and the angle between these teeth (α) were assessed with panoramic radiographs taken at the beginning and the end of the treatment. Data were statistically analyzed. At the end of the treatment, there were significant increases in ɣand βin the FRD group and ɣin the control group (p < 0.05). The decrease in αin the FRD group and increase in the control group were not significant (p > 0.05); however, this change led to asmall significant change between the groups (p < 0.05). The retromolar space significantly increased in the FRD group compared to the control group (p < 0.05). No significant correlation was found between retromolar space and third molar uprighting in any of the groups (p > 0.05). ClassII correction with FRD led to mesialization of the lower arch which provided an increase in the retromolar space. Little improvement in the uprighting of the third molars occurred.

Changes in Mandibular Third Molar Angulation in High-anchorage Extraction vs Non-extraction Orthodontic Treatment: A Prospective Study

The study aimed to compare the prospective changes in mandibular third molar angulation in high anchorage cases treated with first premolar extractions vs non-extraction orthodontic treatment. The sample consisted of 56 nongrowing patients: Group I had 26 patients with a high anchorage requirement who underwent first premolar extractions and group II had 30 patients who underwent non-extraction treatment. Pretreatment, mid-treatment, and posttreatment panoramic radiographs were obtained for group I and pretreatment and posttreatment for group II. Angle between M2 (second molar)-horizontal reference plane (HRP), M3 (third molar)-HRP, and M2-M3 were measured bilaterally. Data were analyzed using Student t test and ANOVA test (p value < 0.05). Statistically significant increase was found between the pretreatment, mid-treatment, and posttreatment values of M2-M3 in group I (p value = 0.02 R and p value = 0.049 L) and between pretreatment to posttreatment values of M2-HRP in group II bilaterally (p value = 0.001). Significant increase was found in the M2-M3 angulations in group II on the right side (p value = 0.036). M3-HRP decreased in group I without reaching statistical significance. No statistically significant intergroup differences were found between the two groups in relation to M2-HRP, M3-HRP, and M2-M3 angulations. M2-M3 angulations increased significantly bilaterally in group I and on the right side in group II, indicating worsening of third molar angulation. M3-HRP worsened in group I without reaching statistical significance. Extraction therapy in high anchorage cases does not lead to an improvement in third molar angulation. The extraction of first premolars in high anchorage cases does not lead to an improvement in the angulation of mandibular third molars; moreover, the angulation worsened with extraction therapy. Prospective orthodontic patients need to be cautioned against any improvement in mesioangular impaction of mandibular third molars in high anchorage premolar extraction cases.

A retrospective analysis of the impaction status of mandibular third molars as a risk factor for fractures of angle or condylar region of the mandible

BackgroundThe position and angulation of mandibular third molars (M3) have been found to influence the angle and condylar fractures. Due to variation in the results of relevant studies, this relationship remains not fully understood. ObjectiveTo identify the association between the depth and angulation of M3 and the risk of fracture of the mandibular angle and condyle. MethodologyA total of 527 patients were assessed from January 2012 to June 2020. Study variables included the presence, position and angulation of M3. The outcome variables were angle and condylar fractures. ResultsMean age was 28.5 years with 93.2% (n = 499) were male. Angle fractures were significantly more frequent with an impacted M3 (p = 0.023) whereas condylar fractures were more commonly associated with a fully erupted M3. The highest incidence of angle fractures was observed with M3 classified as class II (p = 0.026) and position B (p = 0.05). In contrast, class I M3 were more frequently associated with condylar fractures. With regards to the angulation, M3 between 80° – 100° were highly correlated with angle fractures (p = 0.020) whereas M3 angulations of 60° – 80° were related to condylar injuries (p = 0.025). ConclusionsFractures of the mandibular angle were significantly associated with Class II and position B wisdom teeth whereas class I were associated with fracture of the condyles. The likelihood of angle and condylar fractures almost doubled when M3 angulations were (80ᵒ-100ᵒ) and (60ᵒ-80ᵒ) respectively.

Pathological Abnormalities Due to Impaction of Third Molar Mandibular Horizontal and Mesioangular Angulation with Observation of Panoramic Radiography

Background: The lower third molar teeth are the most commonly impacted teeth due to a lack of place for an eruption. Impacted teeth affect the surrounding tissue and can lead to pathological abnormalities. The effect of impacted teeth results in various complaints such as pain, caries, pericoronitis, adjacent tooth root resorption, dentigerous cysts, and odontogenic tumors. The impacted mandibular third molars and associated pathological abnormalities were observed with panoramic radiography. Purpose: To determine the pathological abnormalities that accompany the molar impaction of horizontal and mesioangular angular mandibula with panoramic radiographic observation. Material&Methods: In this study, using the panoramic radiograph, consisting of 53 samples of radiographs were evaluated based on the mesioangular and horizontal angulation of mandibular impacted third molars and pathology abnormalities caused. The data were processed and analyzed by using the Friedman test and Chi-square test. Result: In impaction with mesioangular angulation, bone loss at the interalveolar between third molar and mandibular second molars by 33.3%, caries on the mandibular second molars and mandibular second molar’s root resorption had a similar percentage by 26.7% and caries in mandibular third molar impaction amounted to 13.3%. In impaction with horizontal angulation bone loss at interalveolar third molar and mandibular second molar by 59.1%, mandibular second molars of caries were 22.7%, caries in mandibular third molar impaction and mandibular second molar root resorption by 9.1%. Conclusions: The most common pathological abnormalities in mandibular third molar impaction of mesioangular and horizontal angulation are bone loss in the interalveolar third molar and the mandibular second molar.

Does the Angulation of an Impacted Mandibular third Molar Affect the Prevalence of Preoperative Pathoses?

Statement of the Problem: The removal of a third molar tooth associated with a pathological condition is usually an easy decision. However, it is necessary for clinicians to know about the prevalence of preoperative pathologies associated with impacted mandibular third molars to the identification of the prophylactic approach to be applied to symptom-free impacted third molars.Purpose: The objective was to investigate the effect of the angulation of impacted mandibular third molars on the prevalence of associated pathologies. Materials and Method: In this retrospective study, we examined the panoramic radiographs of 954 patients referred for impacted third molar surgery. A total of 1598 impacted mandibular third molar teeth were included in the study. Pathological conditions included the caries on distal surface of the adjacent second molar, caries on impacted mandibular third molars, bone loss distal to the adjacent second molar, the radiolucent area distal to the impacted mandibular third molar were determined. Results: Caries were observed more in the impacted third molar (18.9%) compared to the adjacent second molar (15.8%). The radiolucent area on distal surface of the impacted mandibular molar was 11%, while the periodontal bone loss distal to the adjacent second molar was 4.9%. Mesioangular-impacted mandibular third molars had high risk of caries development on second and third molar. The prevalence of periodontal tissue damage to the adjacent second molar was higher in horizontal and mesioangular angulation. Vertical and distoangular-impacted mandibular third molars had high risk for bone loss at distal aspect. Conclusion: The prevalence rate of pathological conditions in mesioangular impacted teeth was higher.

Preoperative Anatomic Evaluation of the Relationship Between Inferior Alveolar Nerve Canal and Impacted Mandibular Third Molar in a Population of Bhubaneswar, Odisha, Using CBCT: A Hospital-Based Study.

To evaluate the correlation between the position of inferior alveolar nerve canal and the angulation of impacted mandibular third molars using cone beam computed tomography (CBCT) in a hospital-based study in the state of Odisha, India. Three hundred cases of impacted third molars in 200 patients (154 males; 46 females) were included in the study, for whom an initial periapical or panoramic radiograph had revealed that the mandibular canal and the lower third molars were in close proximity. A CBCT scan of each patient was carried out to assess how the canal position influenced the class and position of impaction, angulation of impaction and bone contact. Class II position B impactions were found in 78.37% cases where the position of ID canal was approximate to the lingual plate and inferior to third molar (73.75%). The results were statistically significant (p = 0.00). 80% of the ID canals showed bone contact. Of these 73.75% ID canals showed lingual bone contact. Mesioangular impactions were most common in mandible and significantly associated with lingual and inferior positioning of the canal. The study mostly exhibited patients having mesioangular class II position B third molar impactions of the mandible. The position of the canal has a significant influence on the type of impaction and the bone contact.

Angulation, contact point, and cementoenamel junction distance of impacted mandibular third molars referred for extraction are probably associated with distal caries in the second molar

Angulation, contact point, and cementoenamel junction distance of impacted mandibular third molars referred for extraction are probably associated with distal caries in the second molar

Short-Term Evaluation of Gustatory Changes After Surgical Removal of Mandibular Third Molar—A Prospective Randomized Control Trial

The present study was carried out to prospectively determine the incidence and severity of suprathreshold taste changes after surgical removal of mandibular third molars. Sixty patients who required removal of impacted third molars were included in the study. Based on the Winter criteria of angulation of impacted mandibular third molars, 15 patients each with mesioangular, distoangular, horizontal, and vertical impacted third molars were selected. The chemo-gustometry chart in pentagon scheme was used to represent the results of gustometry and to establish a correlation between the difficulty index of impacted third molar removal and the incidence of gustatory changes. All patients underwent spatial taste testing preoperatively and 1week postoperatively. The highest incidence of taste changes was noted in category 3 (difficulty score, 7 to 8) and mostly for distoangular and vertically impacted teeth. In their extensive patient analysis of 4 different taste sensations, the authors found that suprathreshold taste changes do occur after surgical removal of an impacted mandibular third molar, with a high difficulty index score indicating the highest prevalence for altered taste sensations for distoangular and vertical impactions.

Is the angulation of mandibular third molars associated with the thickness of lingual bone?

To find out whether the angulation of mandibular third molars is associated with the thickness of the bone at the site of impaction, and if so, which particular angulation affects the protective mechanism of the nerve, we retrospectively studied the thickness of lingual bone at the sites of impaction of 200 mandibular third molars in 149 patients using coronal, sagittal, and axial slices of cone-beam computed tomograms (CT). We measured the bone at the cementoenamel junction of the mandibular second molar, at the mid-root of the third molar, and at the apex of the root. Bone less than 1mm thick was defined as “thinning”. We correlated these measurements with the angulation of the tooth based on the position of the second molar and the occlusal plane in 3 dimensions: vertical, mesiobuccal, and buccolingual. The primary outcome was the thickness of the bone around the third molar. A total of 102 teeth were on the left (51%), and 125 were angulated with an occlusal plane of <85° (63%). The mean (SD) thickness of bone at the cementoenamel junction of the second molar was 1.40 (0.87) mm, at mid-root 1.07 (1.03) mm, and at the apex 1.07 (1.30) mm. When the horizontal and mesioangular angulations of teeth were <85°, the thickness of bone at the mid-root differed significantly from that when the vertical and distoangular angulations were 85° or more (p<0.001). Correlations between the thickness of the bone and the buccolingual angulations were significantly associated with perforation of the bone at mid-root and apex (p<0.003). The bone around horizontal and mesioangular impactions was 3.6 times more likely to be “thin” than that at mid-root of vertical and distoangular third molars. A buccolingual angulation was also associated with perforation of the lingual cortex (p<0.003). As the bone was thinner at the mid-root of horizontally and mesioangularly impacted teeth, it seemed to compromise the integrity of the lingual plate, which is the natural protective barrier of the lingual nerve. These findings could be of prognostic value.

Prevalence of mandibular third molar impaction pattern in a private dental clinic of Sultanpur Lodhi

Background: Mandibular third molar is the most commonly impacted tooth, and its removal is a frequently performed dentoalveolar procedure. It is important to know the prevalence rate in a particular community.Objective: This article aims at evaluation of angulation, ramus relationship and depth of impacted mandibular third molars among patients visiting a private dental clinic in Sultanpur Lodhi.Methodology: 150 patients presenting with 228 cases of lower third molar impaction were included within this study. IOPAR and where necessary, OPG was used for radiographic assessment. Age, sex and tooth number were recorded in each patient on a specially designed performa. Angulation was determined using winter’s method whereas assessment of ramus relationship and depth was done using Pell and Gregory's method.Results and Conclusion: The age of patients ranged from 21-43 years with mean age of 26.6 years. Males showed preponderance to mandibular M3 impaction (54%) in our study, and right side was found more frequently involved (53%). Radiographic assessment revealed that mesioangular impaction (45.2%) was the most prevalent angular pattern followed by vertical, distoangular and horizontal types, and Class 2 Position A (29.4%) most common and Class 1 Position C the least common type of impaction depth and ramus relationship.

Evaluation of localisation of mandibular foramen in patients with mandibular third molar teeth using cone-beam computed tomography.

It is important to know the correct anatomical location of the mandibular foramen to obtain successful anaesthesia of inferior alveolar nerve and to prevent injury to the mandibular vessels and nerve, during a variety of oral and maxillofacial surgical procedures. The aim of this study is to evaluate localisation of the mandibular foramen in patients with the third molars using cone-beam computed tomography (CBCT). Cone-beam computed tomography was used to determine the location of the mandibular foramen in 67 patients (totally 99 sides) with unilateral or bilateral impacted mandibular third molars. The distance from the posterior border of the mandibular ramus to mandibular foramen did not differ significantly among the other angulations. But the difference between vertical and horizontal angulation of the impacted mandibular third molars according to 'fd' values (the shortest distance between mandibular foramen and the posterior border of mandibular ramus) was found to be statistically significant (p < 0.05). The present study provides new information to the literature concerning relationship between the location of the mandibular foramen and the mandibular third molars.

Difficulty index in extraction of impacted mandibular third molars and their post-operative complications

Background: Although the removal of impacted mandibular third molars is a common minor oral surgical procedure, the extraction of these teeth can present with certain post–operative complications. Koerner KR proposed a Difficulty Index Scale for removal of these teeth on the basis of local anatomy and radiographs, which were helpful in predicting the difficulty that would be encountered intra-operatively, as well as the post-operative complications. Objective: To study the different post-operative complications in the removal of impacted mandibular third molars calculating their difficulty index value. Method: A total of 119 patients, 79 females and 40 males who underwent extraction of their impacted third molars were selected over a one year period. Data were collected prospectively, according to the angulation, depth and position of the impacted mandibular third molars and their difficulty index calculated. This was further correlated with the postoperative complications encountered. Results: Mesio-angular impaction (43.7%), with level A (66.4%) and Class I (70.6%) impaction were the major type of impaction seen. The difficulty index showed that majority were in the moderately difficult category (51.2%), with swelling and trismus seen to increase as the difficulty index value increased. Females were affected more than males, with swelling (Odds ratio 2.206) and trismus (Odds ratio 2.570) seen to be significantly more. Conclusion: Surgical removal of impacted mandibular third molars causes post-operative complications and special care is required in their removal, especially in females. The Difficulty Index, as described by Koerner KR can be used as a tool for predicting the frequency of the post-operative complications, especially swelling and trismus. DOI: http://dx.doi.org/10.3126/jkmc.v3i1.10918  Journal of Kathmandu Medical College Vol. 3, No. 1, Issue 7, Jan.-Mar., 2014, Page: 14-20

Pre-operative assessment of relationship between inferior dental nerve canal and mandibular impacted third molar in Saudi population.

To study the correlation between the position of the inferior dental (ID) nerve canal and the angulation of impacted mandibular third molars using dental cone beam computed tomography (CBCT). The study considered 100 impactions in 85 patients (60 males, 25 females), for whom an initial panoramic radiographic assessment had revealed that the ID canal and the lower 3rd molar were in close proximity. A CBCT scan of each patient was carried out to assess how the ID nerve canal position influenced the class and position of impaction, angulation of impaction, and bone contact. Class I position B impactions were found in the majority of cases, where the position of the ID canal was approximate to the lingual plate and inferior to the 3rd molar (85.7%). The results were statistically significant (p=0.001). 96% of the ID canals showed bone contact. Of these, 77.1% of ID canals exhibited lingual bone contact, inferior to impaction. The results were statistically significant (p=0.001). Horizontally angulated impactions were most common in the mandible, and significantly associated with lingual and inferior positioning of the ID canal (76.2%). Our sample population most commonly exhibited horizontally angulated class I position B impactions of the mandible. The position of the ID canal significantly influenced the type of impaction and bone contact.

Impacted mandibular third molars and their influence on mandibular angle and condyle fractures – A retrospective study

BackgroundPrevious retrospective analyses prove that impacted mandibular third molars (M3s) increase the risk of angle fractures and decrease the risk of concomitant fractures to the condyle. Study designA retrospective cohort was designed for patients reported to the Department of Oral and Maxillofacial Surgery from January 2011 till June 2013. The study variables are presence or absence of third molar, if it is present, their position, classified using the Pell and Gregory system; angulation, classified using Shiller's method. The outcome variables were angle and condyle fractures. Materials and methodsHospital records and panoramic radiographs were used to determine and classify these variables.The study sample comprised of 118 mandibular angle and condyle fractures in 110 patients.Database was constructed and analysed using SPSS version 10.0. ConclusionThis present retrospective study concluded that the presence of impacted third molar predisposes the angle to fracture and reduces the risk of a concomitant condylar fracture. However absence of impacted third molar increases the risk of condylar fracture. The highest incidence of angle fracture was observed in position A impacted mandibular third molars. And there is no significant relationship, concerning ramus position and angulation of impacted mandibular third molars with the angle fracture.