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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 1-3

Assessment of impaction pattern of mandibular third molars: A radiographic survey


Department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance20-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. C Deepak
Reader, Sri Ramachandra Dental College and Hospital, Porur, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_6_21

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  Abstract 


Introduction: Third molars are known as wisdom teeth as they erupt after 18 years of age. In a lot of individuals, they fail to erupt onto the oral cavity owing to a variety of reasons, the most common being lack of space in the dental arch. The aim of this study is to assess the pattern of Mandibular third molar impactions using the orthopantomograph (OPG). Materials and Methods: OPGs of 150 patients (91 female and 59 male) who were between 18 and 25 years of age and had impacted mandibular third molars were assessed for gender, side of the mandible having greater frequency of impaction, and the pattern of impaction of the third molars. Results: Bilateral imapction (26.66%) was more common when compared with than and particular left (23.33%) or right (19.33%) unilateral impactions. The mesioangular pattern of impaction was more common in both male and female and was followed by distoangular, vertical, and horizontal patterns. Conclusion: The study showed that there was no gender predilection in the presence of impacted mandibular third molars and that the mesioangular pattern of impaction was more common.

Keywords: Gender predilection, impacted teeth, mandibular third molars, mesioangular impaction, orthopantomograph


How to cite this article:
Preethi M, Deepak C. Assessment of impaction pattern of mandibular third molars: A radiographic survey. Int J Soc Rehabil 2021;6:1-3

How to cite this URL:
Preethi M, Deepak C. Assessment of impaction pattern of mandibular third molars: A radiographic survey. Int J Soc Rehabil [serial online] 2021 [cited 2022 Dec 9];6:1-3. Available from: https://www.ijsocialrehab.com/text.asp?2021/6/1/1/331481




  Introduction Top


Impaction is defined as a completely or partially unerupted tooth and positioned against another tooth, bone, or soft tissue so that its further eruption would be unlikely.[1] Third molars are also known as wisdom teeth as they erupt in the late adolescence or even in adulthood. Since they are the last teeth to erupt, they are frequently impacted due to the lack of space in the dental arch. Impacted wisdom teeth are teeth that do not fully erupt into the mouth because of blockage from other teeth (impaction).

Owing to the fact that at least one impacted third molar can be traced in 33% of the general population,[2],[3] impacted third molars, especially the mandibular third molars, constitute a common cause of pain and inflammation in the oral region. The high prevalence of their impaction has been attributed to a remarkable variety of factors, among which are inadequate retromolar space, unfavorable path of eruption, malposition of the tooth germ, and hereditary reasons.[4]

Impacted third molars are associated with numerous complications, such as pericoronitis, periodontal pathology or root resorption of the adjacent tooth, caries, cystic or neoplastic lesions, orthodontic or prosthetic problems, and temporomandibular joint symptoms.[5],[6] Majority of patients who undergo a surgical extraction of an impacted third molar suffer from pain, swelling, trismus, and general oral discomfort during the first postoperative days. The other less frequent complications are alveolitis, infection, hemorrhage, and nerve injury.[7] The aim of the study is to assess the pattern of impaction of the mandibular third molars.

Various classifications have been given on impacted teeth such as Winter's classification, Pell and Gregory's classification, Killey and Kay classification, and Archer's classification of impacted maxillary teeth. Winter's classification is classified based on the inclination of the impacted tooth to the long axis of the second molar into distoangular, mesioangular, horizontal, vertical, and transverse. This classification is used for the study as it is simple and easily understandable.[8] The aim of this study is to evaluate the position of impacted third molars and also to evaluate the most common sex affected using the Winter's classification.[9]

Impacted third molars can also be classified according to their angular relationship to the adjacent second molar. Angulation of the impacted third molar can be determined by evaluating the angle formed between the intersected longitudinal axes of the impacted third molar and the adjacent second molar, as described by Winter, either visually or by using an orthodontic protractor.


  Materials and Methods Top


The impaction pattern of the mandibular molars was studied using orthopantomograph (OPG). OPGs of 150 patients who had impacted mandibular third molars were used for the study. The patients included in the study were between 18 and 25 years of age, with a mean age of 21.5 years. The pattern of impaction is derived by measuring the angles formed between the lines intersecting the long axis of the second and third molar. The angle formed is used to determine the mesial, distal, horizontal, and vertical inclination in relation to the second molar.

The radiographs were interpreted for the following:

  1. Unilateral or bilateral impaction of the mandibular third molar
  2. Pattern of impaction of the mandibular third molar
  3. Gender difference.



  Results Top


The results are tabled in [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6].
Table 1: Gender distribution

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Table 2: Distribution of mandibular impaction in the sample

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Table 3: Gender distribution pattern of impaction on right quadrant in female patients

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Table 4: Gender distribution pattern of impaction on right quadrant in male patients

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Table 5: Gender distribution pattern of impaction on left quadrant in female patients

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Table 6: Gender distribution pattern of impaction on left quadrant male patients

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  Discussion Top


Out of a total number of 150 OPGs used in the study, 59 were of male (33.33%) patients and 91 were of female (66.66%) patients [Table 1]. A significant difference was seen in unilateral and bilateral distribution of third molar impaction. Unilateral impaction was found in 64 radiographs which accounted for 43% of the total and bilateral impaction was seen in 40 people which accounted for 26.6% of the sample [Table 2].

The mesioangular pattern of impaction was more common and was followed by distoangular, vertical, and horizontal patterns. Third molar impactions were more common in the right quadrant (34% for the males and about 39% for the females) than in the left quadrant (23.3% in females and 33% in males). There is no sexual predominance seen in impaction pattern or agenesis [Table 3], [Table 4], [Table 5], [Table 6]. These findings are similar to other studies done in different populations.[10],[11],[12],[13]

The main factor for third molar impaction is the lack of space for eruption. The early man ate coarse uncooked food that resulted in attrition of teeth on the occlusal and proximal surfaces of the teeth. This attrition and tendency of mesial drifting of the teeth provided the space required for the eruption of the third molars, whereas in modern man, the attrition of teeth does not take place due to cooked and soft textured food and hence as a result, the space required for third molars eruption by attrition and mesial drifting of teeth is lost.[14],[15],[16],[17]

Other causes of impaction of teeth includes impactions include the growth of the face, size of jaw, tooth size and food habits, overlying bone or soft tissue or with the host having systemic diseases etc. A properly positioned third molar erupts between the ages of 18 and 24. The other complications seen with late eruption of the third molar and third molar impaction include incisor crowding, resorption of roots of adjacent tooth, inflammatory process, and Temporomandibular joint (TMJ) dysfunction.

The distribution of angulation and depth of impaction in the impacted lower third molars seen in this study is similar to that noted by Kramer and Williams.[18],[19] They reported that 75% of impacted lower third molars were in mesioangular and horizontal angulation. The angulation of an impacted tooth against the second molar has potential clinical implications, as outlined by Yamaoka et al.[20],[21]


  Conclusion Top


The following are the conclusions derived from the study,

  • Bilateral impaction of mandibular third molar was more common than unilateral impaction
  • Mesioangular impaction was the most common type of impaction and it was more common in males than in females followed by horizontal and vertical impaction
  • Agenesis was more common in females than in males.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Kapoor V. Textbook of Oral and Maxillofacial Surgery. Vol. 1. New Delhi: Arya (Medi) Publishing House; 1996. p. 45-71.  Back to cited text no. 1
    
2.
Rosa AL, Carneiro MG, Lavrador MA, Novaes AB. Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:404-7.  Back to cited text no. 2
    
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Arta SA, Pourabbas Kheyradin R, Mesgarzadeh AH, Hassanbaglu B. Comparison of the influence of two flap designs on periodontal healing after surgical extraction of impacted third molars. J Dent Res Dent Clin Dent Prospects 2011;5:1-4.  Back to cited text no. 3
    
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Juodzbalys G, Daugela P. Mandibular third molar impaction: Review of literature and a proposal of a classification. J Oral Maxillofac Res 2013;4:e1.  Back to cited text no. 4
    
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Farish SE, Bouloux GF. General technique of third molar removal. Oral Maxillofac Surg Clin North Am 2007;19:23-43, v-vi.  Back to cited text no. 5
    
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Cetinkaya BO, Sumer M, Tutkun F, Sandikci EO, Misir F. Influence of different suturing techniques on periodontal health of the adjacent second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:156-61.  Back to cited text no. 6
    
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Charan Babu HS, Reddy PB, Pattathan RK, Desai R, Shubha AB. Factors influencing lingual nerve paraesthesia following third molar surgery: A prospective clinical study. J Maxillofac Oral Surg 2013;12:168-72.  Back to cited text no. 7
    
8.
Santhosh Kumar MP, Shamara Aysha. Angulations of impacted mandibular third molar: A radiographic study in Saveetha Dental College. J Pharm Sci Res 2015;7:981-3.  Back to cited text no. 8
    
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Sldv RM, Das MC, Vijayaraghavan R, Shanmukha I. Incidence of agenesis, impactions, angular positions and pathologies related to third molar teeth. Natl J Physiol Pharm Pharmacol 2017;7:486-90.  Back to cited text no. 9
    
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Santhosh Kumar MP, Aysha S. Angulations of impacted mandibular third molar: A radiographic study in Saveetha Dental College. J Pharm Sci Res 2015;7:981-3.  Back to cited text no. 10
    
11.
Harsha SS. Incidence of mandibular third molar impaction in patients visiting a private dental college. IOSR J Dent Med Sci 2014;13:01-2.  Back to cited text no. 11
    
12.
Obuekwe ON, Enabulele JE. Gender variation in pattern of mandibular third molar impaction. J Dent Oral Disord Ther 2017;5:1-4.  Back to cited text no. 12
    
13.
Kramer RM, Williams AC. The incidence of impacted teeth. A survey at Harlem Hospital. Oral Surg Oral Med Oral Pathol 1970;29:237-41.  Back to cited text no. 13
    
14.
Bolender CJ. Attritional occlusion, the basis of the Begg technic. Orthod Fr 1985;56:409-16.  Back to cited text no. 14
    
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Bjork A, Jensen E, Palling M. Mandibular growth and third molar impaction. Acta Odontol Scand 1956;14:231-72.  Back to cited text no. 15
    
16.
Obiechina AE, Arotiba JT, Fasola AO. Third molar impaction: Evaluation of the symptoms and pattern of impaction of mandibular third molar teeth in Nigerians. Odontostomatol Trop 2001;24:22-5.  Back to cited text no. 16
    
17.
Hattab FN, Rawashdeh MA, Fahmy MS. Impaction status of third molars in Jordanian students. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:24-9.  Back to cited text no. 17
    
18.
Neelakantan P, Sharma S, Shemesh H, Wesselink PR. Influence of primary and secondary closure of surgical wound after impacted mandibular third molar removal on postoperative pain and swelling – A comparative and split mouth study. J Endod 2015;41:1108-11.  Back to cited text no. 18
    
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Subathra Devi V, Gnanavel BK. Prophylactic removal of third molars. Procedia Eng 2014;9:95-104.  Back to cited text no. 19
    
20.
Danda AK, Krishna Tatiparthi M, Narayanan V, Siddareddi A. Influence of primary and secondary closure of surgical wound after impacted mandibular third molar removal on postoperative pain and swelling – A comparative and split mouth study. J Oral Maxillofac Surg 2010;68:309-12.  Back to cited text no. 20
    
21.
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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