Distoangular Impaction Research Articles

Radiographic Assessment Regarding the Pattern of Third Molar Impaction and its Association with Gender in the Population of Islamabad

Abstract 
 Objective: To analyze and document the gender-specific incidence of impacted third molars and elucidate the specific patterns associated with impacted third molars.
 Methodology: This retrospective cross-sectional study analyzed orthopantomograms (OPG) data from 278 patients, covering a total of 445 impacted third molars. A convenient sampling technique was used and the study was completed in three months from September 2023 and December 2023, Inclusion criteria: OPGs of individuals aged 25 years or older with fully formed third molar roots, Exclusion criteria: OPGs of individuals younger than 25, with craniofacial anomalies, prior orthodontic treatment, erupted third molars, or incomplete root formation in third molars.
 Results: Both males and females were almost equal in number. The majority 73.2% of OPG showed mandibular third molar impaction while 26.8% showed maxillary third molar impaction. In the maxillary arch, the distoangular type of impaction was observed in the majority, accounting for 48.7%. In the mandibular arch, mesioangular impaction prevailed, comprising 41.7%. In the maxillary arch, a statistically significant correlation (p=0.006) was found between gender and impaction type, with females exhibiting a distinct and more prevalent impaction pattern than males. In the mandibular arch, there was no statistically significant association between gender and impaction type (p=0.23).
 Conclusion: In conclusion, our study reveals noteworthy gender variations in the prevalence and types of third molar impactions. Mandibular third molars exhibit a higher prevalence than maxillary counterparts, with mesioangular impaction prevailing in the mandibular arch and distoangular impaction in the maxillary arch.

Effect of impaction on third molar development and age estimation—A study in a Lebanese population

The effect of impaction on third molar development is disputable as the scientific literature is not uniform. In parallel, population-specific studies have been encouraged in dental age estimation. This study aimed to investigate the effect of impaction on third molar formation in a sample of Lebanese individuals. The sample consisted of 518 panoramic radiographs of females (n=229) and males (n=289) between 15 and 23.9 years. Mandibular third molars were classified based on their position as non-impacted and impacted (with horizontal, vertical, mesioangular, and distoangular impaction). Dental development was classified according to Demirjian's 8-level staging system. Most teeth presented mesioangular impaction (#38=29.7%, #48=33%). Developing third molars were predominantly distributed between stages D and G. The mean age of most developmental stages was higher among impacted teeth, meaning that third molar mineralization could be slower in the presence of impaction. In general, the delayed dental development did not have statistically significant effects (P<0.05). However, descriptive data pointed out differences between (impacted and non-impacted) mean ages of >12 months-suggesting a potential clinical significance (despite the lack of a statistical one). Furthermore, differences changed based on sex and side (#38/#48). Therefore, dental age estimation from third molars in the selected Lebanese population should preferably be performed in non-impacted third molars whenever available.

FREQUENCY OF PARESTHESIA DUE TO INFERIOR ALVEOLAR NERVE DAMAGE AFTER EXTRACTION OF MANDIBULAR THIRD MOLAR AMONG PATIENTS SHOWING DARKENING OF ROOT IN ORTHOPANTOMOGRAM

Background: Paresthesia is an abnormal dermal sensation with no apparent physical cause. One of the everyday practices in any oral surgery setup is the extraction of the impacted mandibular third molars surgically. Precise measurement of the bone present for support of the implant coronal to the inferior alveolar nerve (IAN) canal is the pertinent way to prevent IAN injuries.&#x0D; Objective: To assess the frequency of paresthesia due to IAN damage after mandibular third molar’s surgical extraction in patients with darkening of root on orthopantomogram.&#x0D; Material &amp; Methods: It was a descriptive case series study which took place in the department of Oral and Maxillofacial Surgery at Sharif Medical and Dental College, Lahore in a time frame of 6 months i.e. from December 2020 till May 2021. After meeting the inclusion/exclusion criteria, 200 patients were made part of the study program. Informed consent and demographic information was recorded. Surgical procedure of all these patients was done. Assessment was done post-operatively first after one week when patient came for suture removal by inquiring about the subjective perception of abnormal feeling or sensation on lower lip and chin area. Patients were then reappointed for a follow-up visit after 1 month as well.&#x0D; Results: Patients’ mean age was 28.05±3.94 years. There were 104 (52%) males and 96 (48%) females in the study population. There were 38 (19%) patients of distoangular impaction, 39 (19.5%) had horizontal impaction, 55 (27.5%) had mesioangular impaction while 68 (34%) had vertical impaction. The IAN paresthesia after 1st month of surgery was found in 13 (6.5%) patients.&#x0D; Conclusion: According to this study, the frequency of paresthesia after 1st month of surgery was 6.5% due to IAN injury after mandibular third molar surgery in patients with darkening of root as observed on orthopantomogram.&#x0D; Keywords: Inferior Alveolar Nerve, Orthopantomogram, Paresthesia, Third Molar Surgery.

Comparison between Partial Newmann Flap Versus Modified Partial Newmann Flap in Mandibular Third Molar Surgery

Aim: To compare the outcomes of two different flap techniques, namely the Partial Newmann Flap (FNP) and the Modified Partial Newmann Flap (MPNF), in surgical extraction of mandibular third molars. Methods: This randomised clinical study included 186 participants, 93 each group. The research comprised male and female patients aged 20–45 with lower mesioangular impacted third molar till 18–21. Patients with vertically impacted wisdom teeth, disto-angular impaction, horizontal impaction, pregnancy, trismus, pericoronitis, and oral submucous fibrosis were excluded. The student t-test compared mouth opening across groups, whereas the chi-square test compared discomfort and edoema. Results: The mean age of the participants was 32.17±8.30 years. On the first day, the MPNF group reported significantly less moderate pain (34.41%) compared to the NPF group (56.99%) (p=0.001). On the third day, the MPNF group reported significantly more mild pain (55.91%) and less severe pain (1.08%) compared to the NPF group, which reported less mild pain (49.46%) and more severe pain (7.53%) (p=0.028). Similarly, mouth opening was significantly higher in the MPNF group than the NPF group on the 1st, 3rd, and 7th day. Swelling was significantly less in the MPNF group than the NPF group on the 1st and 3rd day. Conclusion: The Modified Partial Newmann Flap may be a better alternative compared to the Partial Newmann Flap in terms of pain, swelling, and mouth opening during the disimpaction of lower third molars. Keywords: Partial Newmann Flap, Modified Partial Newmann Flap, Mandibular Third Molar

Prevalence of Impacted Teeth in a South Indian Population using Cone Beam Computed Tomography: A Retrospective Study

Localisation of impacted teeth is essential for surgical and orthodontic management. The study objective was to evaluate the prevalence and type of tooth impaction in the jaws using cone beam computed tomography (CBCT). The CBCT records of subjects between 2018 and 2020 were retrieved from our institution archives and examined by two oral radiologists. A total of 760 CBCT scans were evaluated, of which 140 (18.4%) scans had impacted teeth. From the 140 CBCT scans, 216 impacted teeth were identified. Maximum impactions were in the age group of 21–30 years. Third molars were the most commonly impacted teeth (66.2%), followed by canines (23.6%), supernumerary teeth (4.6%), premolars (3.2%), incisors (1.4%), and second molars (0.9%). Among the impacted canines, 53% were buccally impacted, 43% were palatally impacted and other impactions were 4%. Among the third molars, mesioangular impactions were the most frequent (41.2%), followed by horizontal (28%), vertical (16.7%) and distoangular impaction (4.1%). The most frequently impacted teeth were the third molars, followed by canines. Canine impactions were more frequent in the maxilla, while third molar impactions were thrice as common in the mandible compared to the maxilla. Mesioangular third molar impactions were the commonest, followed by horizontal, vertical and distoangular.

Is there any difference in the development of mandibular third molars according to the type of impaction: An orthopantomographic study in south Indian children and adolescents

Development of third molars and their influence on the dental arch is a major concern in clinical dentistry especially, orthodontics and oral surgery. Lately, their position, eruption potential and development has become a subject of interest in forensic practice. The present study was aimed to determine whether if there is any difference in the development of the mandibular third molars according to the impaction type. Orthopantomographs (n = 1112) from 478 males and 634 females between 15 and 22 years old were analysed. In each radiograph, impaction status and the developmental stage of mandibular third molars were determined. Descriptive statistics were performed at developmental stages D to H. For stage G, there was a delay by 0.74 and 0.62 years for mesioangular impaction, 0.89 and 0.33 years for horizontal impaction, 1.43 and 0.9 years for distoangular impaction and 1.74 and 1.1 years for vertical impaction, in males and females. For stage H, delay by 0.17 and 0.74 years, 0.05 and 0.06 years, 0.48 and 1.48 years and 0.62 and 0.62 years, respectively for all impaction variants in both sexes. Mean chronological age of the distoangular and vertically impacted mandibular third molars were higher in certain developmental stages than mesioangular and horizontal impactions. Our findings concluded that distoangular and vertical impaction variants mineralize more slowly than mesioangular and horizontal variants, however these differences were smaller. Therefore, no distinction is required between impaction types for dental age estimation especially in the prediction of the age of majority (18 years).

Prediction of post-traumatic neuropathy following impacted mandibular third molar removal

ObjectivesThe extraction of impacted mandibular third molars is a common surgical procedure often associated with complications including post-traumatic neuropathy. Previous work has focused on identifying confounding factors, but a robust preoperative risk prediction model remains elusive. MethodsUsing a dataset of 648 patients and 812 impacted mandibular third molars, we used least absolute shrinkage and selection operator (LASSO) to fit prediction models based on risk factors assessed at both the tooth and patient levels. In addition, we fitted multivariable logistic regression models with the Firth correction for generalized estimating equations (GEE). ResultsThe LASSO model for post-traumatic neuropathy identified distoangular impaction of ≥ 45° (odds ratio [OR] = 2.9), proximity to the inferior alveolar nerve of ≤ 3 mm (OR = 1.9), disadvantageous curving (OR = 1.4), and psychiatric conditions (OR = 2.1) as predictors [area under the receiving operator characteristic curve (AUC) = 0.75]. Among other complications analyzed, the LASSO model for bleeding identified deep embedding or full impaction (OR = 1.8), psychiatric conditions (OR = 1.3), and age (OR = 0.9) as predictors (AUC = 0.64). These associations between predictors and postoperative complications were fundamentally reinforced by the corresponding GEE models. ConclusionsOur findings point to the predictability of post-traumatic neuropathy and bleeding based on tooth anatomy and patient characteristics, overall suggesting that preoperatively identifiable factors can predict the risk of adverse outcomes in the extraction of impacted mandibular third molars. Clinical significanceMandibular third molar extraction is both a routine procedure and a leading cause of trigeminal neuropathy. Prevention of post-traumatic neuropathy, aided by individualized preoperative risk prediction, is of high clinical relevance.

FREQUENCY OF COMMON PATTERN OF IMPACTED MANDIBULAR THIRD MOLAR IN PATIENTS PRESENTED TO A TERTIARY CARE HOSPITAL IN PESHAWAR

Objective:&#x0D; To determine frequency of common patterns of impacted mandibular third molar impaction in patients presented to a tertiary care hospital in Peshawar.&#x0D; Materials and Methods:&#x0D; This descriptive cross-sectional study which is carried out on 195 patients at Oral and Maxillofacial Surgery department, MTI/HMC, Peshawar from 07 June 2018 to 07 December 2018. Detailed history and thorough clinical and radiographic (orthopantomogram) examination with informed consent of all patients were taken. Based on the collected data, the definitive diagnosis of third molar impaction was established.&#x0D; Results:&#x0D; As per common patterns, 85 (43.58%) patients were recorded with mesioangular impaction, 51 (26.15%) patients were recorded with horizontal impaction, 33 (16.92%) patients were recorded with vertical impaction, whereas only 26 (13.33%) patients were recorded with distoangular impaction.&#x0D; Conclusion:&#x0D; We concluded that the most prevalent pattern for Impacted Third mandibular is mesioangular position.

Appearance of Mandibular Para-radicular Third Molar Radiolucencies on Cone-Beam Computed Tomography.

Aims:Mandibular para-radicular third molar radiolucencies (MPRs) may be mistaken for pathological lesions, leading to misdiagnosis and mistreatment. This study sought to assess the appearance of MPRs on cone-beam computed tomography (CBCT).Settings and Design:This was a descriptive, cross-sectional study.Materials and Methods:This study evaluated 770 CBCT of patients presenting to the dental school of Hamadan University of Medical Sciences. Demographic information, unilateral or bilateral presence, shape and prevalence of MPRs observed on axial and sagittal sections, their density, thinning of cortical margin, internal trabeculation, bony expansion, and mean height and width of MPRs were all evaluated.Statistical Analysis Used:Data were analyzed using SPSS version 22.0 and descriptive statistics. Chi-square test was used.Results:Seventy (9.1%) patients had a total of 82 MPRs, including 51 (72.86%) females. The prevalence of MPRs in females was more than males (P = 0.011). The majority of MPRs were unilateral 58 (70.73%), mostly round in shape 48 (58.54%), and were mostly associated with third molars with distoangular impaction 47 (57.31%); this difference was statistically significant (P < 0.001). Furthermore, in 47 (57.32%) patients, MPRs had less density than the surrounding bone. MPRs were not associated with expansion or root resorption in any patient.Conclusion:Differentiation of MPRs from the pathological lesions is important to make a decision about further imaging or referral for surgical treatment. MPRs are often considered normal since they do not cause root resorption or bone expansion and do not affect the lamina dura. MPRs are more commonly found adjacent to third molars with distoangular impaction.

The association of mandibular third molar impaction with the dental and periodontal lesions in the adjacent second molars

It is a consensus that symptomatic impacted mandibular third molars (MTMs) need to be removed. Although the prophylactic extraction of asymptomatic impacted MTMs remains controversial. This study aims to investigate the effects of MTMs on themselves and adjacent teeth pathophysiology and provide the evidence for prophylactic extraction of impacted MTMs. A retrospective study of panoramic radiographs of patients visited the Affiliated Stomatology Hospital of Guangzhou Medical University from April 2014 to May 2018 was conducted to investigate the dental and periodontal lesions in MTMs and adjacent mandibular second molars (MSMs), as well as the correlation of tooth lesion severity with patient age. Among the 2650 impacted MTMs, 6.98% dental lesions and 37.81% periodontal lesions were found, as well as 24.63% dental lesions and 35.30% periodontal lesions in the distal of adjacent MSMs. 9.27%, 2.02%, 0.47%, and 13.33% dental lesions and 48.81%, 17.31%, 5.19%, and 10% periodontal lesions were observed in MTMs with mesioangular, horizontal, inverted and distoangular impaction types, respectively. For the adjacent MSMs, 31.98%, 11.82%, 1.94%, and 13.33% distal dental lesions and 45.74%, 16.95%, 2.91%, and 23.33% distal periodontal lesions were found in mesioangular, horizontal, inverted and distoangular impaction types, respectively. In mesioangular MTMs, the severity of the distal dental and periodontal lesions in the adjacent MSMs showed a high-positive correlation with patient age (P<0.05) CONCLUSION: Early prophylactic extraction of MTMs with mesioangular-impaction and close monitoring of MTMs with horizontal/inverted-impaction could prevent impacted MTMs-associated lesions in MTMs/MSMs.

Risk of lingual nerve injuries in removal of mandibular third molars: a retrospective case-control study

BackgroundThrough the analysis of clinical data, we attempted to investigate the etiology and determine the risk of severe iatrogenic lingual nerve injuries in the removal of the mandibular third molar.MethodsA retrospective chart review was performed for patients who had undergone microsurgical repair of lingual nerve injuries. The following data were collected and analyzed: patient sex, age, nerve injury side, type of impaction (Winter’s classification, Pell and Gregory’s classification). Ratios for the respective lingual nerve injury group data were compared with the ratios of the respective data for the control group, which consisted of data collected from the literature. The data for the control group included previous patients that encountered various complications during the removal of the mandibular third molar.ResultsThe lingual nerve injury group consisted of 24 males and 58 females. The rate of female patients with iatrogenic lingual nerve injuries was significantly higher than the control groups. Ages ranged from 15 to 67 years, with a mean age of 36.5 years old. Lingual nerve injury was significantly higher in the patient versus the control groups in age. The lingual nerve injury was on the right side in 46 and on the left side in 36 patients. There was no significant difference for the injury side. The distoangular and horizontal ratios were the highest in our lingual nerve injury group. The distoangular impaction rate in our lingual nerve injury group was significantly higher than the rate for the control groups.ConclusionDistoangular impaction of the mandibular third molar in female patients in their 30s, 40s, and 50s may be a higher risk factor of severe lingual nerve injury in the removal of mandibular third molars.

MANDIBULAR WISDOM TEETH;

Objectives: This study evaluated mandibular wisdom teeth impaction frequency, angulation and associated variables among patients visiting OPD at BibiAseefaDental CollegeLarkana. Study Design: Descriptive cross sectional studyinvolving patients of 18 to 40 years of age.Setting:Radiology Department at BibiAseefa Dental College for Orthopantomogram (OPG) Radiograph.Period:1 monthfrom01-03-2016 to 31-03-2016. Materials and Methods:The prevalence of impacted mandibular third molars, type of angulation, level of impaction (according to Winters classification) and relationship with ramus (according toPell &amp; Gregory classification) and inferior alveolar nerve canal were evaluated on the OPG radiograph as well as clinically.Results: A total of 162 patients participated in this study including 68 males (42.06%) and 94 Females (57.94%). The mean age of study participants was found to be 23.09 years.The total prevalence of mandibular third molar impaction in current study was 28.57%. Thehighest number of patients were withMesioangular impactions (13.49%), followed byVertical (9.52%) and Horizontal(5.56%) no any Distoangular impaction was found in present study. The level B (15.9%) was more common followed by level C (8.7%). Moreover, Class I ramus relationship was frequently found among study participants followed by Class II and Class III respectively.Conclusion: The female patients with mandibular wisdom teeth impaction outnumbered males.The most common was the mesioangular impaction with level B depth and class I ramus relationship.

ASSESSMENT ON RESULTS OF SURGICAL EXTRACTION OF&amp;NBSP; IMPACTED LOWER THIRD MOLARS WITH POSTOPERATIVE LOW - LEVEL LASER THERAPY

Background: The most frequently performed surgical procedure in dentistry is impacted third molar extraction with difficulty varies according to the location of the tooth. Laser therapy after surgery can accelerate cell and tissue reconstruction along with relieve post-operative pain. The objective of this study was to investigate the clinical and radiographic characteristics of impacted lower third molar and to evaluate the results of surgical extraction of impacted lower third molar with post-surgical low-level laser therapy (LLLT). Subjects and Methods: Clinical and radiographic data from 90 patients (average age 28.13 ± 5.38) subjected to a surgical extraction of lower third molar were pooled and divided randomly into 3 groups: group 1 received LLLT immediately after surgery intraorally, group 2 treated with LLLT immediately after the extraction extraorally. Patients received routine management with nonactivated laser were inserted in the control group. Assessments of pain, swelling and trismus level were carried out at 24, 48 hours and on the 7th day after surgery. Results: Correlation of wisdom teeth to ramus and adjacent teeth mainly type II (88.9%), type III accounted for 11.1%. Relative depth of wisdom teeth in the bone mainly position B (81.1%), position C (18.9%). Correlation of wisdom teeth axis to adjacent teeth: horizontal (58.9%), mesioangular impactions (40%) and distoangular impaction (1.1%). There were statistically significant decreases in the level of pain, edema and interincisal opening between the laser-treated groups and the control group on the 1st and 2nd postoperative day. Conclusions: Intraoral and extraoral post-surgical low-level laser therapy treatment was useful in reducing swelling, pain and trismus compared to placebo group in impacted third molar surgery. Key words: Impacted lower third molar, low- level laser therapy

Comparison of Prevalence and Angulation of Impacted Third Molar among Erbil Population with That of Iraq Neighboring Countries

Background and objectives: the problem of impacted teeth remain actual in all countries. Differences in ethnicity, culture and environment may play a role in its occurrence. The objective is to find the differences in prevalence of this problem between population of Erbil/Iraq and Iraqi neighboring countries. Patients and methods: primary data of Erbil population and secondary data of Iraqi neighboring countries were used. A retrospective analysis done for all orthopantomograms in college of dentistry, then compared to published data of those countries. Results: regarding the age and sex, there is no such significant differences between all included countries; considering dominant type of impaction, Kuwait was different from others by dominance of vertical impaction; Distoangular impaction in Erbil was twice of other countries. Conclusion: there is no significant differences between Erbil population and Iraqi neighboring countries regarding the prevalence and angulation of impaction.

Pathologies associated with impacted mandibular third molars in sub-saharan africans

Background: The prevalence of third molar pathology and problems associated with surgical extraction of impacted third molars has been extensively discussed in the literature; however, few have discussed the pathologies that can be associated with impacted third molar tooth. Aim: The aim of the current study, therefore, is to evaluate the types of associated pathologies with impacted third molars in Sub-Saharan Africans. Materials and Methods: This is a prospective study that was conducted in the Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria, between January and March 2012. Consented patients between ages 18 and 35 years were recruited into the study. Data were analyzed using IBM SPSS Statistics for Windows Version 20 (IBM Corp., Armonk, NY, USA). Statistical significance was set at P < 0.05. Results: A total of 135 mandibular third molar extractions was carried out during the study period from 72 (53.3%) females and 63 (46.7%) males (F:M = 1.1:1). Mesioangular impaction was the most frequent spatial relation of the impacted mandibular third molar to the lower second molar tooth (70 [51.9%]), followed by distoangular impaction (29 [21.5%]). Mesioangular impaction was mostly associated with pathology (70 [51.9%]), with a statistical significant difference of P = 0.000. Pathological pocket and caries on both impacted lower third molar and lower second molar tooth accounted for the highest number of associated pathologies (37 [27.4%]). Conclusion: Caries and pathological pockets were the most common associated pathology with impacted third molar.

Intra-alveolar extraction of impacted distoangular mandibular third molars: A novel technique.

Recent trends in maxillofacial surgery are to reduce the trauma to the adjacent soft tissue. The distoangular impaction presents a challenge to the maxillofacial surgeon and also results in more surgical morbidity. Here, we present a minimally invasive extraction technique for the distoangular mandibular third molar impaction.

A Cohort Study of the Patterns of Third Molar Impaction in Panoramic Radiographs in Saudi Population.

Objectives:To evaluate the epidemiological patterns of third molar impaction in a cohort of patients living in the north of Saudi Arabia.Materials and Methods:A retrospective cohort study comprised of analysing 2550 Orthopantomograms (OPGs) belonging to patients who attended Aljouf University College of Dentistry between September 2013 and December 2015. OPGs were examined to determine the frequency of third molar impaction, their levels of eruption and angulations. Mixed effects logistic regression analysis was performed to calculate adjusted odds ratios. Data were weighted by age and sex based on population regional estimates.Results:1551 patients (60.8%) with a mean age of 33.5 years-old (95%CI: 32.9 to 34) demonstrated 2650 impacted third molars. Third molars were more likely present in patients aged from 20 to 39 years-old (p<0.001); and in mandible more than maxilla (p<0.001). It showed highest vertical impaction and higher impaction rate in mandible than maxilla. Level A impaction was the most common among other levels by 1365 (53.5%). Vertical impaction was the most common pattern (1354 patients; 53.1%). Mesioangular impaction ranked second in mandible, while distoangular impaction ranked second in maxilla. There was no statistically significant difference between males and females concerning impaction frequency, depth levels and angulations.Conclusion:Impacted third molars is still a public health concern among youth and young adults. Vertically impacted mandibular third molars with their occlusal plane at the same level as the occlusal plane of adjacent tooth is the most prevalent pattern of third molar impaction in the northern region of Saudi Arabia.

Incidence of Trismus in Transalveolar Extraction of Lower Third Molar.

Background:Conventional mandibular third molar removal produces tissue trauma that induces an inflammatory reaction, leading to postoperative sequelae, the most common ones being trismus which influences the patient's quality of life in the postoperative period. Identifying the factors determining trismus after mandibular third molar extraction helps us to evaluate and correlate the incidence of trismus with morphological and surgical factors that are associated with its incidence in the postoperative period.Methodology:Patients referred to our institution for surgical removal of their impacted lower third molar between November 2014 and February 2015 were the participants of the study. Type of impaction, indication, and level of difficulty based on Pedersen criteria were obtained. Postoperative pain, swelling, and mouth opening (MO) limitations were evaluated at postoperative day (POD) 0, POD1, POD3, POD5, and POD7 and were analyzed. P < 0.05 was considered statistically significant.Result and Conclusion:In this study, out of fifty patients, only nine patients had experienced limited MO during postoperative period when the duration of procedure exceeded 30 min. However, it occurred as cumulative of pericoronitis and tooth sectioning done. The postoperative trismus was more significant in disto-angular impaction (P < 0.05) due to postoperative sequelae, swelling and pain.

Radiographic assessment of agenesis, impaction, and pararadicular radiolucencies in relation with third molar in Nashik City of Maharashtra

Introduction: The third molar develops entirely after birth and also it is the last tooth to erupt in all ethnic groups despite racial variations in the eruption sequence. Tooth development with effects on tooth size, shape, position, and total absence is affected due to environmental factors, systemic diseases, genetic polymorphisms, and teratogens. Aims and Objectives: The aim of this study was to assess the prevalence of agenesis, impaction, and pararadicular radiolucencies in relation with third molars. Materials and Methods: One hundred digital orthopantomograph (OPG) scans of patients of age ranging from 18 to 25 years were selected randomly from the digital OPG database of the Department of Oral Medicine and Radiology, and then assessment and analysis were carried out. Results: Overall agenesis rate was about 14.5%. Bilateral agenesis of maxillary and mandibular third molars was about 14% and 13%, respectively. Overall impaction rate was about 21.92%. Mesioangular impaction rate was about 57.33% whereas distoangular impaction rate was about 26.66%. Prevalence of pararadicular radiolucencies was only about 0.8% with mandibular predilection. Conclusion: As the agenesis of the third molars is increasing, they can be considered as vestigial. Prevalence of impaction of the third molars is increasing. Pararadicular radiolucencies are mostly seen with mandibular third molar.

Risk Factors for Permanent Injury of Inferior Alveolar and Lingual Nerves During Third Molar Surgery

The purpose of this study was to assess the incidence of and risk factors for permanent neurologic injuries to the inferior alveolar nerve (IAN) or lingual nerve (LN) after the removal of third molars. This report also describes the use of a Clinical Incident Review (CIR) process, allowing close monitoring of all patients with neurologic injuries as a result of dentoalveolar surgery. A database associated with a CIR process at the Royal Dental Hospital of Melbourne from January 2006 through December 2009 was assessed. Factors assessed included gender, age, operator class, method of anesthesia, spacial relation, depth of impaction, ramus relation, proximity of the IAN on orthopantomogram, cone-beam computed tomographic usage, and side of injury. During this 4-year period, 11,599 lower third molars were removed in 6,803 patients. The incidence of an IAN injury was 0.68%, and the incidence of an LN injury was 0.15%. Important risk factors for permanent IAN injury were increasing age, surgery performed by staff dentists, type of anesthesia, and mesioangular impactions. The mean time of complete resolution was 4.3 months. No factors were found to statistically increase the risk of LN injury, although most injuries were seen in patients with a distoangular impaction. The overall incidences of IAN and LN injuries were low. Some risk factors for permanent IAN nerve injury were identified. Important risk factors for permanent IAN injury were increasing age (≥25 yr old), surgery performed by staff dentists, surgery under general anesthesia, and mesioangular impaction. No factors were found to statistically increase the risk of LN injury.