Impacted Mandibular Third Molars Research Articles

Pattern of Impaction of Mandibular Third Molar and Its Relation with Caries in Mandibular Second Molar

Objective: To determine caries frequency in mandibular second molars in proportion to level of angulation and depth of impaction of mandibular third molars established on winters and Pell and Gregory classification system. Study Design: This was a Cross-sectional study. Place and Duration of Study: This study was regulated in Department of Oral and Maxillofacial Surgery at Islamic International Dental Hospital, Islamabad from 1 January 2018 to 30th June 2018. Materials and Methods: An overall 100 cases of caries were investigated on clinical and radiographic basis in mandibular second molars. Each panoramic radiograph was studied for the presence of carious lesion in lower second molars. The depth and angulation of impacted third molars was being assessed using Pell and Gregory and winter's grouping respectively. Chi square test was applied for analysis of data. Results: The participants in this study had age range from 18 to 60 years old. Mean age was 39.24 ±9.77 years. Majority of the patients 59 (59.0%) were between the ages 18 and 40. Among these patients, males were 83 (83.0%) and females 17 (17.0%) having a 4.9:1 male-to-female ratio. Caries at the distal aspect of mandibular second molars were seen in 39 percent of individuals with impacted lower third molars and mesioangularly impacted teeth most resulted in caries. Conclusion: This study concluded that 39% of the patients with impacted mandibular third molars caused distal cervical caries in second molars, with mesioangular impaction being the most prominent type causing caries. So, an attentive follow up of impacted mandibular third molars should be considered as health of lower mandibular second molar is influenced by pattern of impaction.

Postoperative Sequelae Following Surgical Extraction of Impacted Mandibular Third-Molar Extraction Using the Complete Closure Versus the Sutureless Techniques.

Wound closure techniques affect the severity of inflammatory complications that ensue following surgical extraction of the impacted mandibular third molar (M3). The choice of the technique remains a topic for discussion because reports regarding their associated sequelae are split. This study therefore compares the pain, swelling and trismus in the complete closure and the sutureless/non-closure techniques. This was a prospective, randomised clinical study carried out at the Dental and Maxillofacial Surgery department of a tertiary hospital. A total of 74 participants requiring impacted mandibular M3 extractions were randomised into a complete closure group and a sutureless technique group. They were subjected to the procedure under similar technique and conditions and followed up for a week to assess their experiences of pain, swelling and trismus. Variables were recorded and analysed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. The critical level of significance was set at P < 0.05. The sutureless group had statistically significantly higher postoperative pain on days 1, 3, 4 and 5 (P < 0.05) and lesser severity of trismus on day 7 (P < 0.05) than the complete closure group. There was no significant difference in swelling. Compared with the complete closure group, the sutureless group had similar severity of swelling, less trismus but had higher pain severity in the week following M3 surgery.

Evaluation of the Position and Incidence of Impaction of Mandibular Third Molars in Different Anteroposterior and Vertical Skeletal Patterns: A Retrospective Study

Aim: To evaluate the incidence of impacted mandibular third molar in different anteroposterior and vertical facial skeletal patterns and to evaluate the angle of impaction of mandibular third molar.&#x0D; Methodology: 207 Panoramic and lateral cephalometric radiographs for patients above 20 years old with impacted mandibular third molar were recruited from the orthodontic department clinics in multiple universities in Egypt and traced using WebCeph ™ software. From the lateral cephalograms, three anteroposterior measurements were taken which were termed as ANB, A-B difference and Wits appraisal and three vertical angles were measured which were SN/MP, MMPA and FMPA to determine different skeletal facial types. The angulation of mandibular third molar impaction was determined by β angle according to Winter’s classification from the orthopantomogram.&#x0D; Results: Among all 207 analyzed cases, impacted third molars were detected in (38.6%) cases&#x0D; unilaterally and (61.4%) bilaterally. Anteroposteriorly, the higher percentage of total impactions was found in subjects with a class 2 skeletal pattern (97.2%). Vertically, the higher percentage of total impactions was found in subjects with a mesocephalic facial pattern (45.9%). The most common type of impaction was mesioangular based on Winter’s classification.&#x0D; Conclusions: A higher incidence of lower third molar impaction was found in subjects with a class 2 skeletal pattern. A higher incidence of lower third molar impaction was found in subjects with a mesocephalic facial pattern. In almost all skeletal facial types, the mesioangular position of the impacted mandibular third molar was the most prevalent position.

The pattern of mandibular third molar impaction and its relationship with the development of distal caries in adjacent second molars among Emiratis: a retrospective study

ObjectivesThe purpose of this study was to investigate the pattern of mandibular third molar (MTM) impaction and associated carious lesions in adjacent mandibular second molars (MSMs) in a sample of Emirati individuals.MethodsThis retrospective study assessed 2000 orthopantomograms of Emirati patients who visited the Specialized Fujairah Dental Center between 2015 and 2020. The depth, ramus relation and angulation of the impacted MTMs were assessed according to the Pell and Gregory classification and Winter’s classification. In addition, carious lesions in adjacent MSMs associated with the evaluated parameters were identified.ResultsA total of 461 (23.05%) of the patients had at least one impacted MTM. The mean age of the study population was 26.24 years. Mesioangular, level B, and class II impactions were the most common, at 47.37% (χ2 = 382.134; p < 0.001), 45.48% (χ2 = 56.889; p < 0.001), and 74.05% (χ2 = 513.099; p < 0.001), respectively. There was a higher percentage of level C impaction among females than among males (χ2 = 19.178; p < 0.001). A total of 126 impacted teeth (18.36%) had associated carious lesions. These carious lesions were predominantly found in teeth with mesioangular impactions (χ2 = 59.430; p < 0.001), level A and B impactions (χ2 = 23.301; p < 0.001), and class II and I impactions (χ2 = 17.918; p = 0.006).ConclusionsIt is imperative to raise awareness of soft tissue mesioangular-impacted MTMs, as they are the most frequently associated with the development of carious lesions in adjacent MSMs. Approximately one quarter of evaluated Emiratis had at least one impacted MTM, with the most prevalent pattern being class II, level B, and mesioangular impactions. Furthermore, surgical removal is expected to be more challenging for females than for males.

Radiographic assessment of the prevalence and pattern of impacted teeth in Kanyakumari population using orthopantomogram- A retrospective study

Background: The present study was aimed to record the incidence of each distinctive impacted tooth by reviewing panoramic radiographs. Materials and methods: In present study 10-year records (2012 to 2021) of 4000 panoramic radiographs were obtained from the Department of Oral Medicine and Radiology, Sree Mookambika Institute of Dental Sciences (SMIDS), Kanyakumari. From the data collected, 442 patients` panoramic radiographs fulfilled the inclusion criteria and 627 impactions were detected and classified accordingly. The obtained results were tabulated and statistically analyzed. Results: A total of 627 impactions were found with 15.7% prevalence. Males had the higher number of impacted teeth than females with a small margin. Mandibular third molar (69.26%) was found to be the most commonly impacted teeth followed by canine (14.8%), maxillary third molar (9.39%), premolar (3.0%), supernumerary (2.1%) and incisors (1%). Horizontal pattern (69.9%) was the most commonly reported impaction of mandibular third molar. In maxilla, vertical impaction (63%) was the most common pattern. The results also revealed that higher portion of impacted teeth lies in mandible (78.3%) than in maxilla (21.6%). Conclusion: Impacted teeth and congenitally missing teeth are a common phenomenon nowadays. Many patients at their later age present to a dental surgeon due to pain and infection from impacted teeth. This study was designed to evaluate the prevalence of impacted teeth in patients in and around Kanyakumari district. With more than 15% prevalence of impactions in adults, it is wise to do panoramic imaging in suspected patients with missing teeth to prevent further complications like pain, infection and cystic transformation.

Relationship of Oral Pathologies Associated with Second Molars to the Patterns of Adjacent Impacted Third Molar

Objective: To assess the relationship of oral pathologies associated with second molars to the patterns of adjacent impacted third molar. Methodology: A cross sectional descriptive study was conducted on 385 Orthopantomograms (OPG) of patients. The study was conducted in the Institute of Dentistry, CMH Lahore Medical College, Lahore, Sharif Medical and Dental College (SMDC) and Services Institute of Medical Sciences (SIMS) over a period of three months from December 2020 to February 2021. The Pell and Gregory classification was used for depth of third molar impaction and ramus relationship of mandibular third molars. Winter`s classification was used for classifying the angle of impaction. Results: The association between presence of caries (p=≤0.001) and external resorption (p=≤0.001) in second mandibular molar with depth of impaction of adjacent an impacted third molar, ramus relationship of third molar with presence of external root resorption in second molar (p=≤0.001) and presence of caries (p=0.005), periapical radiolucencies (p=0.009) and external root resorption (p=≤0.001) in second molar with the angle of impacted third molar were significant. The association of presence of caries, pericoronal, periapical radiolucencies and external root resorption in the maxillary second molars with the depth and angle of adjacent impacted third molars was not significant. Conclusion: The carious lesions were the highest where the third molar had class A depth of impaction while the maximum external resorption was seen where the third molar had class C depth of impaction. Second mandibular molars adjacent to impacted third molars in class 2 ramus relationship had the most external root resorption. It was seen that second molars adjacent to the impacted third molars with mesioangular impactions had the highest percentage of caries and periapical radiolucencies while those adjacent to third molars with horizontal angle of impaction showed the maximum external root resorption. Keywords: Second molars, impacted third molars, pericoronal radiolucency, periapical radiolucency, external root resorption, caries

Effect of Photobiomodulation Therapy on Reducing Acute Pain and Inflammation Following Surgical Removal of Impacted Mandibular Third Molars: A Randomized, Split-Mouth Clinical Trial.

Objective: This study aimed to compare the effects of photobiomodulation therapy (PBMT) on analgesic and inflammatory reduction with that of ibuprofen following surgical removal of impacted mandibular third molars (IMTMs). Methods: A randomized, split-mouth clinical trial was performed on patients undergoing bilateral IMTM removal. PBMT [gallium aluminum arsenide (GaAlAs) laser] with specific parameters (wavelength of 810 nm, power of 0.5% ± 20% W, and energy density of 4 J/cm2) was applied randomly on one side of the mouth immediately after surgery and 1 and 2 days after surgery. The pain level was self-rated with a Likert scale at 2, 4, 6, 24, and 48 h postoperatively. Swelling and trismus were measured on the first and second day after surgery. Saliva was collected for measuring pre- and postoperative salivary immunoglobulin A (sIgA) concentrations with the sandwich ELISA test. Results: The study sample included 25 patients (average age of 22.88 years) with 50 bilateral symmetrical IMTMs. Pain level was highest at 2 h after surgery in both groups and gradually decreased over time (p < 0.01). Swelling and trismus at 48 h were higher than at 24 h (p < 0.01). Within the first 48 h postoperatively, pain level, swelling, and trismus were significantly lower in the PBMT group (p < 0.05). Postoperative sIgA was also significantly lower in the PBMT group (p < 0.05). Conclusions: In short-term and specific conditions of this study, it was found that PBMT helped promote postoperative pain relief and anti-inflammation after surgical removal of IMTMs. The results suggested that there may be a link between a decrease in salivary sIgA levels and decrease in inflammatory processes after PBMT. Trial Registration No. NCT04280809 at ClinicalTrials.gov.

CHARACTERISTICS OF FIRST DAY COMPLICATIONS AFTER ODONTECTOMY OF IMPACTED MANDIBULAR THIRD MOLAR IN GENERAL ANESTHESIA

Introduction: Odontectomy is the most common procedure performed by oral and maxillofacial surgeons. The consideration of odontectomy cases in general anesthesia with certain factors, such as patient anxiety, mental or physical disorders, degree of difficulty in impacted teeth, disoriented patients, number of teeth performed odontectomy, and duration of surgery. Some complications after odontectomy, including swelling, trismus, and paresthesia often occur from the first day after odontectomy. The purpose of this study was to determine the characteristics of the complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia at Dr. Hasan Sadikin General Hospital during January – June 2020. Methods: This study was a cross-sectional retrospective using medical record data of patients diagnosed with class I, II, and III mandibular molar impaction based on clinical and panoramic x-rays and performed odontectomy of mandibular third molar impaction in general anesthesia at Dr. Hasan Sadikin Hospital for the period January - June 2020. Results: The obtained data were 186 cases from 98 patients. Data were obtained from secondary data through medical records of mandibular third molar impaction odontectomy patients in general anesthesia who were treated at the inpatient installation of RSUP Dr. Hasan Sadikin for the period during January to June 2020 to determine the characteristics of complications on the first day after odontectomy of impacted mandibular third molar in general anesthesia based on age, gender, and the classification of mandibular third molar impactions. The percentage of complications on the first day after odontectomy of impacted mandibular M3 in general anesthesia at Dr. Hasan Sadikin General Hospital for the period during January - June 2020 showed that the largest number was found in complications of swelling as many as 41 people (54%), followed by trismus as many as 33 people (43%) and paresthesia were 2 patient (3%). Conclusion: The most common complications were swelling and trismus, where these complications were classified as mild and normal complications from odontectomy of impacted mandibular third molars. Meanwhile, the rarest complication was paresthesia. Keywords: Complications, Post-odontectomy, Impaction of mandibular third molar

Investigation of theexpression level of long non-coding RNAs in dental follicles of impacted mandibular third molars.

Dental follicle (DF) is made up of mesenchymal cells and fibers surrounding the enamel organ of a developing tooth. It has been shown that cystic and neoplastic lesions can develop from the pericoronal follicles of impacted third molars (ITMs). But themolecular transformation of DF tissues has not yetbeen uncovered and remains elusive. Accordingly, in the present study, we aimed to investigatethe differential expression of lncRNA genes in DF tissues associated with asymptomatic impacted mandibular third molars (IMTMs) that do not show pathological pericoronal radiolucency in radiographic examination. A total of 30 patients with unilateral mesioangular IMTMs were enrolled for the study. The expressions of lncRNA genes were determined in the DF and healthy gingival tissues obtained from study patients. For the determination of lncRNA expression levels, RNA was isolated from theobtained tissues, converted to cDNA samples, and analyzed by quantitative real-time PCR method. As a result, we found that thegene expression of MEG3 was increased about 10-fold in DF tissues compared to healthy gingival tissues (p < 0.0001). In addition, NORAD expression was found to be upregulated 4.2-fold (p = 0.0002) in DF tissues. Also, expression level of MALAT1 was found to be decreased 1.24-fold (p = 0.584) and TP73-AS1 increased 2.6-fold (p = 0.093) in DF tissues compared to healthy gingival tissues. Consequently, present findings suggest that differentially expressed lncRNAs in DFs might be associated with the various levels of cellular events including osteogenic differentiation, DNA damage, and the transformation into odontogenic pathology. Expression levels of MEG3 and NORAD lncRNA molecules may guide clinicians in the evaluation of asymptomatic ITM dental follicles that cannot be determined radiologically and during extraction of these teeth for prophylactic purposes.

A Case Report of Kissing Molars Class III

Kissing molars (KMs), first reported by Van Hoof in 1973, refer to molars with occlusal surfaces that contact each other in a single follicular space while their roots extend in opposite directions. This is a case of a 20-year-old male who presented with complaints of right mandibular molar pain with cold water contact and occlusion. Panoramic and cone-beam computed tomography (CBCT) images revealed impaction of the right mandibular third and fourth molars, with the occlusal surfaces contacting each other while the roots extended in opposite directions. KMs are classified according to the impaction of the mandibular first and second molars (Class I), second and third molars (Class II), and third and fourth molars (Class III). Our patient was considered Class III. Given the patient’s preference for surgical treatment, successful teeth extraction and extirpation were performed under intravenous sedation. The patient’s postoperative course was unremarkable. We describe a case of KMs Class III with a cystic variant assessed by panoramic and CBCT images. We additionally review all KMs Class III reported in the literature.

Effect of the local application of bupivacaine in early pain control following impacted mandibular third molar surgery: A randomized controlled study.

Postoperative pain is one of the main complications following impacted mandibular third molar (IMTM) surgery. The aim of this study was to assess the effect of the local application of bupivacaine on reducing early postoperative pain following IMTM surgery. A prospective, single-blinded, randomized controlled study was conducted on 40 patients who had undergone the surgical removal of an IMTM under local anesthesia. In the study group (n = 20), absorbable gelatin sponge (AGS) soaked in 3 mL of 0.5% plain bupivacaine hydrochloride was locally applied in the post-extraction socket. In the control group (n = 20), AGS soaked in 3 mL of normal saline was used. Pain intensity was assessed using a pain numerical rating scale (NRS) 4 and 12 h postoperatively. The variables were compared between the 2 groups and probability values <0.05 were considered statistically significant. The pain scores in the study group were significantly lower than those recorded in the control group at 4 h postoperatively (p = 0.003), whereas the difference in the pain scores between the 2 groups 12 h after surgery was not statistically significant (p = 0.443). The local application of bupivacaine is effective in reducing postoperative pain 4 h after the surgical extraction of IMTMs without any significant complications.

Radiographic Assessment of Impacted Mandibular Third Molar- An Ex-vivo study

Background: Mandibular third molars are the most commonly impacted teeth and frequently associated with various pathologies including infection, traumatic, inflammatory and cystic lesions necessitating their surgical removal. To avoid complications, clinical and radiographic evaluation of impacted teeth is essential to provide information about tooth anatomy, position and condition of the surrounding bone.&#x0D; Aim: To evaluate impacted mandibular third molars (IMTM) with the help of panoramic radiographs for the type of impaction, available third molar space, level of eruption, and relation to the inferior alveolar nerve (IAN).&#x0D; Materials and Methods: Total 600 patients were selected and were divided into three groups; group I (18-27 years), group II (28-37 years), and group III (&gt;38 years). Digital OPG were traced and evaluated for angulations, third molar space, level of eruption, and relation of third molar roots to IAN canal. The observations were subjected to statistical analysis using Chi-square test. Results: Out of 600 samples, 306 (51%) were males and 294 (49%) were females. Out of 1079 third molar sites, mesioangular impaction (40.22%) was the most common. Class II relation (84.24%) for third molar space and level A of eruption (45.69%) were most frequent. In true relation, interruption of the white line of the IAN canal (20.85%) was the most frequent relation of the IMTM roots to the IAN canal and others (false/no relation) was the most common in all relations.&#x0D; Conclusion: Panoramic radiography is a relatively safe, reliable, inexpensive, and readily accessible technique for preoperative evaluation of IMTM and their relation to IAN canal.

Comparison of Wound Healing Using Envelope and Triangular Flap for Impacted Mandibular Third Molar Surgery

Objective: To compare the wound healing with triangular flap versus envelope flap techniques among patients undergoing surgical removal of the impacted mandibular third molar (IMTM). Study Design: An open label randomized controlled trial. Place and Duration of the Study: The Department of Oral &amp; Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan from January 2021 to June 2021. Material and Methods: A total of 70 patients (35 in each group) of both genders aged 20 to 50 years requiring surgical removal of IMTM were included. Patients were asked to follow up on third and seventh day while observations regarding wound healing and pain were noted on 7th day among all cases completing the final follow up. Chi square was applied to compare data between both study groups taking p-value below 0.05 as significant. Results: In a total of 70 patients, there were 42 (60.0%) female and 28 (40.0%) female. Majority of the patients, 36 (51.4%) were above 30 years of age while mean age was noted to be 32.4+9.1 years. Sixty two patients completed the follow up so they were included in the final analysis for the assessment of wound healing and pain. Overall, wound healing was observed to be in 55/62 (88.7%) patients while wound healing was found to be 30/32 (93.8%) patients in envelope flap group in comparison to 25/30 (83.3%) in triangular flap group (p=0.1953). Overall, there was no statistically significant difference in between both study group with regards to evaluation of pain (p=0.3271) Conclusion: Both envelop flap and triangular flap techniques resulted in similar outcomes regarding wound healing among patients undergoing surgical removal of IMTM. Both flap techniques resulted in relatively similar degrees of post-surgery pain. Keywords: Third molar, pain, wound healing.

Positive Predictive Value of Panoramic Radiography for Assessment of the Relationship of Impacted Mandibular Third Molars with the Mandibular Canal Based on Cone-Beam Computed Tomography: A Cross-Sectional Study.

The aim of the present study was to assess the positive predictive value (PPV) of panoramic radiographic signs in the assessment of the relationship between impacted mandibular third molars (IMTMs) and the mandibular canal (MC). This cross-sectional study was conducted by reviewing 102 cone-beam computed tomography (CBCT) and panoramic radiographs of patients with IMTMs and radiographic signs of the contact of the IMTMs with the MC on panoramic radiographs (i.e., root apex darkening and interference with the white line). A positive relationship of the IMTM roots with the MC based on CBCT findings was recorded as the gold standard. The PPV of panoramic radiographic signs was calculated for the detection of the relationship of the IMTM root with the MC. The IMTMs were in contact with the MC on CBCT scans in 90.1% of the cases. The PPV of root apex darkening and the interference with the white line was found to be 89.09% (95% CI: (77.75, 95.88)) and 91.48% (95% CI: (79.62, 97.63)), respectively. The MC had a buccal position in 63.7%, and a lingual position in 35.2%, of the cases. The contact of IMTMs with the MC was more commonly seen in patients with a lingual position (100% of the samples). The IMTM root apex darkening and interference with the white line of the MC on panoramic radiographs had a high PPV for determination of the contact of IMTMs with the MC. Thus, presence of the above-mentioned risk factors indicates the need for subsequent 3D radiographic assessments.

Pattern of Mandibular Third Molar Impaction in Nonsyndromic 17760 Patients: A Retrospective Study among Saudi Population in Central Region, Saudi Arabia.

The objective of this study was to study the incidence of type of impaction of mandibular third molars based on the classifications of Pell and Gregory and Winter, which included angulation of the tooth and level of the occlusal surface of the third molar with respect to the second molar, respectively, in a sample of Saudi population in central region. In this retrospective study, orthopantomograms (OPGs) of 17760 patients were examined, who were reported by the Dental University Hospital (DUH) at King Saud University, Riyadh, Saudi Arabia, between the years 2016 and 2020. Out of 17760 radiographs, 2187 (12.31%) patients presented with at least one impacted third molar. Out of which, 1337 (7.52%) patients had bilateral impaction and 850 (4.78%) patients had unilateral impaction (p < 0.001). No gender predominance was noted in the impaction status (p > 0.05). In bilateral impaction, 671 were male (50.2%) and 666 were female (49.8%). Among unilateral impaction, 394 (46.4%) were male and 456 (53.6%) were female. Mesioangular angulation was the most common pattern of impaction (65%) followed by vertical angulation in both bilateral and unilateral impactions. Level A impaction was found to be highest in both bilateral and unilateral impactions which are 48.02% and 54.0%, respectively (p < 0.05). Our study highlights mesioangular impaction and level “A” as the most frequently encountered angulation and level of impaction in impacted teeth. This study result provides us useful data regarding the radiographic status of mandibular third molars in the population of Saudi Arabia.

PREDICTION OF EXTRACTION DIFFICULTY FOR INFERIOR THIRD MOLAR

Inferior third molar impaction remains an actual topic of discussion in modern dentistry due to the frequent complications and treatment contraindications. According to Rock and Elsey inferior third mandibular molar impaction occurs in 73% of young people. Many theories of impaction of inferior 3rd molar have been proposed, but the most popular is the insufficient development of retromolar space. Some authors claim that M3 extraction should only be performed when complications may occur, others say that M3 should be extracted if there are no contraindications, but Martin Kunkel is the advocate of the prophylactic extraction of the inferior third molar. In order to achieve the proposed goal, the frequency of impaction of mandibular third molar and their relationship with neighboring anatomical structures was evaluated. There were statistically processed data of medical records and radiographic examination. This study was made based on 320 patients treated in the University Dental Clinic nr.2, SUMPh ,,Nicolae Testemițanu”. Of these, 147 patients were selected: 58 patients with impacted inferior 3rd molar and 89 patients with inferior 3rd molar apparently erupted in the correct position. The most common complication caused by M3 was pericoronitis, followed by second molar caries.

Analysis of Factors Related to Distal Proximal Caries on the Distal Surface of the Mandibular Second Molar Induced by an Impacted Mandibular Third Molar

ObjectiveTo analyze the factors related to distal proximal caries of the mandibular second molar (MSM) induced by an impacted mandibular third molar (MTM).MethodsA total 500 panoramic radiographs of patients with impacted MTMs who were treated in the Department of Stomatology of the Affiliated Hospital of Yanbian University between October 2017 and October 2019 were selected. Descriptive and bivariate analyses were conducted, and the diagnosis of caries in the MSM and the position of the MTM were evaluated.ResultsThe posterior margin space of the MSM was larger in males (13.5 mm) than females (11.1 mm, P < 0.001) and correlated with the MTM’s impacted depth and eruption degree (P < 0.001). The prevalence of distal proximal caries of the MSM was 37.6%, and a χ2 test showed that age, impacted depth, impacted direction, impacted angle, degree of occurrence, and CEJ distance were correlated with caries in the distal adjacent surface of the MSM (P < 0.001). Logistic multivariate analysis showed that the impacted depth was at position A or B, the impacted direction was mesioangular, and the impacted angle was <80°. Distal adjacent caries of MSMs were prone to occur when entirely or partially emergent. CEJ distance was not an independent factor for caries. The severity of caries in an MSM’s distal adjacent surface had statistical significance on the impacted depth and impacted angle (P < 0.001).ConclusionThe posterior margin space of the MSM influences the impacted condition of the MTM. Preventive extraction can be considered if the impacted angle is <80°, especially in the case of a fully or partially emergent MTM at position A or B and mesioangular impacted areas.

Surgical Difficulty Assessment in Patients Undergoing Impacted Mandibular Third Molar Extraction. A Single Center Evaluation in Najran, Kingdom of Saudi Arabia

Introduction: The evaluation of surgical difficulty preoperatively is important during mandibular third molar (MTM) extraction. This study aimed to evaluate the difficulty index for the removal of impacted MTM using Pederson difficulty index (PDI), Parant Scale (PS), and total operation time (TOT). Materials and Methods: This was a prospective study of patients referred for the extraction of impacted MTM between April, 2019 and July, 2020. Estimated level of difficulty was done before a standardized surgery using the PDI and classified as: Minimally difficult (I), moderately difficult (II), and very difficult (III). Intraoperatively, it was classified as extraction requiring ostectomy only (II); extraction requiring ostectomy and coronal section (III); and complex extraction requiring coronal and root sectioning (IV) using the Modified PS. TOT was recorded by a resident with stopwatch. Results: A total of 502 patients (203 [40.4%] males and 299 [59.6%] females) with an M:F of 1:1.5. The age ranged from 17 to 69 years with a mean age ± standard deviation (SD) (31.6 ± 9.6) years. The majority of the patients were in the age group of 21–40 years. TOT ranged from 10 to 35 min with mean TOT ± SD (15.35 ± 7.02) min. The mean TOT according to PDI was 11.30 ± 2.22, 12.74 ± 4.14, and 26.44 ± 4.39 min in I, II, and III, respectively, while according to PS were 10.91 ± 0.9, 19.60 ± 4.5, 28.82 ± 3.5 min in II, III, and IV, respectively. The observed correlation coefficients® for PDI and PS were 0.716 and 0.870, respectively. Conclusion: Analysis of the surgical difficulty of impacted MTM extraction is essential for treatment planning and patient satisfaction. PS has been found to be significantly associated with TOT.

The Frequency of Mandibular Third Molar Impaction in Different Types of Vertical Skeletal Faces

OBJECTIVE: To determine the frequency of mandibular third molar impaction in different vertical skeletal facial types. METHODOLOGY: Data was collected using pre-treatment records including orthodontic files, pre-treatment lateral cephalograms and OPGs of 90 orthodontic patients. Patients from both genders were included. The age group of selected patients was 18-30 years. Vertical skeletal malocclusion was measured using facial angle and mandibular plane angle on cephalogram to group the subjects into Mesiofacial, Brachyfacial and Dolichofacial patients. Third molar eruption status was assessed using OPG. RESULTS: Results showed that erupted third molars were mostly found in brachyfacial patients. Among 32 erupted mandibular third molars, 16 belong to brachyfacial, 11 belonged to mesiofacial and 5 belonged to dolichofacial group. Complete impaction of mandibular third molar was most common among dolichofacial patients. Among 29 completely impacted mandibular third molars, 14 belong to dolichofacial, 9 belonged to mesiofacial and 6 belonged to brachyfacial group. No significant difference was found for partially impacted third molars among the three groups of facial types. There was higher prevalence of mandibular third molar impaction in females as compared to males. CONCLUSION: Frequency of third molar impaction was found to be highest in dolichofacial patients and lowest in brachyfacial patients due to forward direction of mandibular growth contributing to greater resorption of the anterior border of ramus and the additional space required for third molar eruption.

Radiographic Position of Impacted Mandibular Third Molars and Their Association with Pathological Conditions.

Objectives This study aimed to assess the radiographic position of impacted mandibular third molars (IMTMs) and their association with pathological conditions. Materials and Methods The impaction depth, relationship with ramus, and angulation of 1600 IMTMs and their association with 2nd molar distal caries and root resorption, pathological conditions, and proximity to the mandibular canal were evaluated on panoramic radiographs. The IMTM position was determined based on the depth of impaction according to the Pell and Gregory classification, relationship with ramus according to the Pell and Gregory classification, and angulation according to the Winter's classification. The classical and Bayesian logistic regressions were applied to analyze the effect of IMTM position on the associated complications using the odds ratio (OR) and 95% confidence interval (credible interval for Bayesian models). Two-tailed P value < 0.05 was considered statistically significant. Results Of 1600 IMTMs evaluated in this study, 195 (12.2%), 252 (15.8%), and 119 (7.4%) had caused second molar distal caries, second molar root resorption, and pathological lesions, respectively, and 872 (54.5%) had contact with the mandibular canal. Impaction angulation was a risk factor for second molar distal caries (maximum OR = 5.01, 95% CI: 3.12–8.18). Changed angulation and greater impaction depth were the risk factors for second molar root resorption (minimum OR = 1.64, 95% CI: 0.58–4.02). Decreased distance between the ramus and distal side of the second molar was a risk factor for associated pathological lesions (minimum OR = 2.73, 95% CI: 1.79–4.25). Mesioangular and horizontal angulations and greater impaction depth were the risk factors for contact with the mandibular canal (maximum OR = 3.44, 95% CI: 2.6–4.57 and minimum OR = 1.3, 95% CI: 094–1.8). Conclusions The frequency of complications associated with IMTMs was low, but considerable. The occurrence of these conditions might be affected by the impaction position. Thus, regular follow-ups are recommended in order to be able to surgically intervene when the first signs of pathologies arise.