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 Table of Contents  
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 34-37

Radiographic evaluation of third molar impaction: A digital panoramic stud

1 Department of Dental Education, Marat General Hospital, Ministry of Health, Riyadh, Saudi Arabia
2 Restorative Dental Sciences, Marat General Hospital, Ministry of Health, Riyadh, Saudi Arabia
3 Department of Dental, Marat General Hospital, Ministry of Health, Riyadh, Saudi Arabia
4 Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
5 Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
6 Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Date of Submission05-Oct-2020
Date of Decision31-Jan-2021
Date of Acceptance05-Feb-2021
Date of Web Publication02-Apr-2021

Correspondence Address:
Abdul Khabeer
Room 3038, Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_221_20

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Background: The impaction of third molar can compromise adjacent teeth by increasing the risk of developing dentoalveolar lesions. Aims: The aim of this study was to evaluate the prevalence of impacted third molar in association to patients' demographics and its angulation among patients who visited dental clinics at the College of Dentistry, Imam Abdulrahman Bin Faisal University. Settings and Design: Retrospective radiographic study of patients visiting Dental Hospital. Subjects and Methods: Data were obtained from the dental records and digital orthopantomogram (OPG) of included study sample. Statistical Analysis: The Chi-square test was used to determine the association of impacted third molars with sex and nationality, whereas another two methods, analysis of variance, and Tukey post hoc test were applied, respectively, to establish the association of impacted third molars with the age of the patients. Results: A total of 1286 OPGs were collected and analyzed for the suitability of the study. Of these 1068 patients fulfilled the criteria for inclusion in the study, among them, 206 (19.3%) had at least one impacted third molar. Female population had a significantly high prevalence of third molars compared to male (P = 0.02). Similarly, the age of the patients was found to be significantly associated with impacted teeth (P < 0.001); also, the vertical and mesioangular impactions were found in 46.5% and 32.2% of the patients, respectively. Conclusion: The study found a low female predilection for the prevalence of third molar impaction with highest inclination at the young age that decreases with the growing age. Vertical impaction had the highest prevalence followed by mesioangular angulation.

Keywords: Angulation, impacted, Saudi Arabia, third molar

How to cite this article:
Khan SQ, Khabeer A, Alyousef NI, Benrashed MA, AlMaimouni Y, Al-Thobity A, Gad MM, Akhtar S. Radiographic evaluation of third molar impaction: A digital panoramic stud. Saudi J Health Sci 2021;10:34-7

How to cite this URL:
Khan SQ, Khabeer A, Alyousef NI, Benrashed MA, AlMaimouni Y, Al-Thobity A, Gad MM, Akhtar S. Radiographic evaluation of third molar impaction: A digital panoramic stud. Saudi J Health Sci [serial online] 2021 [cited 2021 Jul 23];10:34-7. Available from: https://www.saudijhealthsci.org/text.asp?2021/10/1/34/312899

  Introduction Top

Tooth eruption is a natural process which takes its normal course with the growth of children and young adults. However, there may be some variations in any individual when a tooth fails to erupt to its functioning position turning it into a pathological condition for that individual.[1] Studies have found third mandibular molar to be the most common impacted tooth,[2] the prevalence of which ranges from 27.3% to 72%.[3],[4] There may be several reasons for impaction including inadequate space,[4],[5] presence of other teeth blocking their eruption,[4] amount and direction of mandibular growth, and rate of third molar maturation.[5] The third molar impaction can compromise growth and health of its adjacent teeth that might lead to some pathological changes, for example,[6],[7] they may also have associated multiple lesions involving odontogenic keratocyst, dentigerous cyst, and unicystic ameloblastoma.[8] The management of mandibular third molar impaction is among the common problems faced by the dental professionals,[9],[10],[11] due to anticipated variations in anatomical position and angulation.[12] However, its extraction still remains a common procedure performed by oral surgeons[13] despite these variations and any associated pathologies.

Several studies have been conducted regarding the prevalence of impacted third molars in different cities of Saudi Arabia, one study conducted in the central region of the country found 19.2% prevalence as 768 out of 4000 participants were found to have at least 1 impacted third molar.[14] Another study, conducted in the northern region of the country, analyzed 2550 orthopantomograms (OPGs) of which 1551 (60.8%) patients demonstrated 2650 impacted third molars.[1] In another study with a sample size of 4000 participants, 2240 were found to have impacted molars, among these, 1014 had a higher impaction rate in the mandible than maxilla.[15] The studies concluded that impaction was more prevalent in the mandible than maxilla, with vertical impaction being the highest.[1] Teeth impaction is classified according to the angulation of the third molar, level of impaction, and its relation to the anterior border of the ramus of the mandible.[16]

This study was conducted at Imam Abdulrahman Bin Faisal University which aimed to assess the following: (i) prevalence of third molar impaction, (ii) association of impaction with age, (iii) association of impaction with gender of the patients, and (iv) type of impaction based on Winter's classification.[17] It was hypothesized that the prevalence of third molar impaction is inversely related to age with a female predilection.

  Subjects and Methods Top

This retrospective study was conducted at a dental college located in Eastern Province of Saudi Arabia, during the period from April to September 2018. Ethical approval was obtained from the scientific committee of the College of Dentistry, IAU. Patients were selected according to the inclusion criteria, which includes the following: (i) Saudi citizens having medical record at the dental hospital of the College, (ii) availability of patients OPG, (iii) absence of pathological dentoalveolar conditions; any craniofacial anomaly or syndrome, and (iv) patients who visited the restorative and prosthetic clinics during 2016–2017. Patients' age, nationality, and gender were recorded from their medical records, where patients who were younger than 21 years old or had an orthodontic treatment (according to dental record) were excluded from the study. Digital OPGs were evaluated to determine the frequency and location of impacted third molars using a MiPACS Dental Enterprise viewer (LEAD Technologies Inc, North Carolina, USA) by three examiners. Three examiners used line and measurement tools of the software for assessing Panoramic radio-graphs to find number of impacted third molar and their angulation. The inter-examiner reliability was checked by using statistical kappa analysis which was found to be 0.74. The angle between the long axis of the third molar in relation to the long axis of adjacent second molar, using Winter's classification is seen in [Table 1].[17]
Table 1: Winter's classification of third molar impaction by angulation[17]

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Statistical analysis was applied using the Statistical Package for the Social Sciences software version 22. Averages, standard deviations, frequency distributions, bar, and line graphs were used to describe the characteristics of collected data. In inferential statistics, the association between the frequency of impacted third molar with gender was found through the test for independence (Chi-square test). Association between patients' age and frequency of impacted third molar was tested through the one-way analysis of variance in which age was an independent variable and frequency of impacted teeth was categorical variable and as there were more than 2 categorize in the categorical variable (1–4) Tukey post hoc test was used for pairwise comparison. P < 0.05 was considered statistically significant.

  Results Top

A total of 1286 OPG radiographs were reviewed and 1068 were included following the inclusion criteria. The demographic data of study sample had an age range of 21–109 years with an average age of 43.19 ± 15.24. Out of 1068 records, 672 (62.9%) were female and 396 (37.1%) were male. The analysis of the radiographs revealed that only 206 (19.3%) patients had impacted third molars, whereas 862 (80.7%) patients did not. A total of 472 impacted third molars were found in 206 patients. Out of 1068, 206 patients had impacted third molars, where 69 (6.5%) had one, 55 (5.1%) had two, 35 (3.3%) had three, and 47 (4.4%) had four impacted third molars.

A statistically significant association was found between the gender and frequency of impacted third molars (P = 0.02) [Table 2]. A higher number of impacted third molars were found among female patients with a P < 0.001 [Table 2]. Furthermore, the comparison of variable age with the frequency of impacted third molar provided significant results. An inverse relation was observed when age was compared with the number of impacted third molars with a significant association (P < 0.001) [Figure 1]. Post hoc analysis was summarized, which provided a pair-wise comparison of frequency of impacted teeth with age [Table 3]. The average age of patients with the number of impacted third molars classified as; one impacted third molar 37.6 ± 13.4, two impacted third molars 29.3 ± 8.9, three impacted third molars 27.1 ± 8.3, and four impacted third molars 25.9 ± 5.4. The angulation of impacted third molars is categorized in [Table 4].
Table 2: Distribution (percentage) of impacted third molars according to gender

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Figure 1: Trend of impacted third molar with respect to patients' age

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Table 3: Pairwise analysis showing the number of impacted third molar according to the age of the patient

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Table 4: Prevalence of impacted third molars according to the angulation

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  Discussion Top

Impacted third molars are common and have been reported in studies conducted throughout the globe. The knowledge of the prevalence and the angulation of impacted third molars may help identify the magnitude of suspected future patient in dental surgery clinics and the needed resources to perform and provide optimum oral care. The sample size used was similar to several national studies.[3],[15],[18] Selection criteria included patients older than 21 years old, as third molars erupt between the age group of 17 and 21 years.[15] In addition, confiding factors such as the presence of the pathological dentoalveolar condition, anomaly, syndrome, or history of orthodontic treatment, were excluded.

In the present study, 19.3% of the sample population had at least one impacted third molar, while the remaining 80.7% sample population did not have an impacted third molar. Moreover, female patients had a significantly higher prevalence compared to male patients [Table 2]. In contrast, two other studies conducted in Saudi Arabia[15],[18] revealed the absence of gender predilection. A study conducted in 2010 on a Turkish population revealed that 35.9% of the sample population had at least one impacted third molar, with a higher prevalence in female patients compared to male.[19] Another study conducted in the Western region of Saudi Arabia in 2010 showed a higher prevalence (40.5%) of impacted third molars compared to the present study.[16] However, the study found a lower prevalence of impacted third molars in female compared to male patients in the Western region of Saudi Arabia.[16]

The relation between age and impacted third molar was assessed in the present study which showed a higher prevalence of impacted third molars in younger patients compared to older patients group. In addition, a higher number of impacted third molars (three or four) had an inverse association with age, which is in agreement with other studies.[20],[21] This finding can be attributed to the extraction of third molar at an earlier age.

The most frequently observed impacted third molars were found in a vertical position (46.5%), followed by mesioangular position (32.2%). These findings are similar to the study conducted by Sandhu and Kaur[21] that included 354 teeth, which reported a 42% prevalence of vertically impacted third molars and 31% of mesioangular impactions. Furthermore, studies conducted by Celikoglu et al.[19] and Ventä et al.[22] reported a higher prevalence of vertical and mesioangular impactions. In the present study, distoangular impactions and horizontal impactions were observed in 14.7% and 7% of impacted third molars, respectively. These findings are similar to the study conducted by Celikoglu et al.[19] who reported 11.5% of mesioangular impactions and 8.1% of horizontal impactions among a sample of 368 OPGs. The mesial inclination of mandibular third molars maybe attributed to the difference in root growth between mesial and distal roots, where the underdevelopment of mesial is more common; leading to a higher prevalence of mesioangular position.[21] In the present study, only the angulation of impacted teeth was accessed without assessing the level of impaction, these limitations should be addressed in future studies.

  Conclusion Top

In the present sample of the study, low prevalence of impacted third molar was observed with a female predilection. Added to that, the incidence was higher in younger age than older age group. Moreover, vertical impaction was the most common angulation found, followed by mesioangular impaction.


The authors would like to thank the medical records department for providing information.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

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


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