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The Classification of Impacted Third Molar and Their Relationship with Caries on the Second Molar

Year 2025, Volume: 12 Issue: 1, 64 - 70, 21.04.2025

Halil Ayyıldız , Selinay Sari

https://doi.org/10.15311/selcukdentj.1488671

Abstract

Background: The eruption and positioning of teeth play crucial roles in dental health, with the third molars, commonly known as wisdom teeth, often prone to impaction. Impaction occurs when a tooth fails to emerge properly due to various factors, leading to potential complications such as caries, pericoronitis, and cystic lesions. Understanding the epidemiology and consequences of impacted third molars is essential for effective dental management. The aims of this study are to assess the frequency and positioning of impacted third molars and to examine their association with caries formation on the distal surface of adjacent second molars.
Methods: Panoramic radiographs of 705 patients meeting inclusion criteria were analyzed to assess the prevalence and positioning of impacted third molars. The study employed classification systems to categorize impacted teeth and examined their relationship with caries formation on the distal surface of adjacent second molars.
Results: Vertical angulation was predominant among impacted third molars, with position C being most prevalent. Statistical analysis revealed a significant association between horizontal angulation and position A with caries occurrence on the distal surface of second molars.
Conclusion: The study underscores the importance of evaluating impacted third molars and their relationship with caries development on adjacent teeth. Prophylactic removal of vertically and mesioangularly positioned third molars, particularly those in position A, may be advisable to mitigate the risk of caries formation on second molars.

Keywords

Dental caries Impacted teeth Panoramic radiography Third molar

Ethical Statement

The research protocol was approved by Kütahya Health Sciences University Non-Interventional Clinical Research Ethics Committee (decision date and approval number: 13.02.2024, 2024/02-27). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Since our research is a retrospective study, the informed consent form has not been taken.

Supporting Institution

Not applicable.

Thanks

Not applicable.

References

  • 1. Yesiltepe S, Kılcı G. Evaluation the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings of the second molar teeth with CBCT scans. Oral Radiol. 2022;38(2):269-277. doi:10.1007/s11282-021-00554-2
  • 2. Alsaegh MA, Abushweme DA, Ahmed KO, et. al. 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. BMC Oral Health. 2022;22(1):306. Published 2022 Jul 24. doi:10.1186/s12903-022-02338-4
  • 3. Al-Zoubi H, Alharbi AA, Ferguson DJ, et al. Frequency of impacted teeth and categorization of impacted canines: A retrospective radiographic study using orthopantomograms. Eur J Dent. 2017;11(1):117-121. doi:10.4103/ejd.ejd_308_16
  • 4. Khawaja NA, Khalil H, Parveen K, et al. A Retrospective Radiographic Survey of Pathology Associated with Impacted Third Molars among Patients Seen in Oral & Maxillofacial Surgery Clinic of College of Dentistry, Riyadh. J Int Oral Health. 2015;7(4):13-17.
  • 5. Al-Dajani M, Abouonq AO, Almohammadi TA, et al. A Cohort Study of the Patterns of Third Molar Impaction in Panoramic Radiographs in Saudi Population. Open Dent J. 2017;11:648-660. Published 2017 Dec 26. doi:10.2174/1874210601711010648
  • 6. Prajapati VK, Mitra R, Vinayak KM. Pattern of mandibular third molar impaction and its association to caries in mandibular second molar: A clinical variant. Dent Res J (Isfahan). 2017;14(2):137-142.
  • 7. Quek SL, Tay CK, Tay KH, et al. Pattern of third molar impaction in a Singapore Chinese population: a retrospective radiographic survey. Int J Oral Maxillofac Surg. 2003;32(5):548-552.
  • 8. Dodson TB, Susarla SM. Impacted wisdom teeth. BMJ Clin Evid. 2014;2014:1302. Published 2014 Aug 29.
  • 9. Zaman MU, Almutairi NS, Abdulrahman AM, et al. Pattern of Mandibular Third Molar Impaction in Nonsyndromic 17760 Patients: A Retrospective Study among Saudi Population in Central Region, Saudi Arabia. Biomed Res Int. 2021;2021:1880750. Published 2021 Aug 26. doi:10.1155/2021/1880750
  • 10. Chou YH, Ho PS, Ho KY, et al. Association between the eruption of the third molar and caries and periodontitis distal to the second molars in elderly patients. Kaohsiung J Med Sci. 2017;33(5):246-251. doi:10.1016/j.kjms.2017.03.001
  • 11. Hashemipour MA, Tahmasbi-Arashlow M, Fahimi-Hanzaei F. Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population. Med Oral Patol Oral Cir Bucal. 2013;18(1):e140-e145. Published 2013 Jan 1. doi:10.4317/medoral.18028
  • 12. Yıldırım H, Büyükgöze-Dindar M. Investigation of the prevalence of impacted third molars and the effects of eruption level and angulation on caries development by panoramic radiographs. Med Oral Patol Oral Cir Bucal. 2022;27(2):e106-e112. Published 2022 Mar 1. doi:10.4317/medoral.25013
  • 13. Polat HB, Ozan F, Kara I, et al. Prevalence of commonly found pathoses associated with mandibular impacted third molars based on panoramic radiographs in Turkish population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(6):e41-e47. doi:10.1016/j.tripleo.2008.02.013
  • 14. Xavier CRG, Dias-Ribeiro E, Ferreira-Rocha J, et al. Avaliação das posições dos terceiros molares impactados de acordo com as classificações de Winter e Pell & Gregory em radiografias panorâmicas. Revista de Cirurgia e Traumatologia Buco-maxilo-facial. 2010;10(2):83-90.
  • 15. Khouri C, Aoun G, Khouri C, et al. Evaluation of Third Molar Impaction Distribution and Patterns in a Sample of Lebanese Population. J Maxillofac Oral Surg. 2022;21(2):599-607. doi:10.1007/s12663-020-01415-x
  • 16. Santos KK, Lages FS, Maciel CAB, et al. Prevalence of Mandibular Third Molars According to the Pell & Gregory and Winter Classifications. J Maxillofac Oral Surg. 2022;21(2):627-633. doi:10.1007/s12663-020-01473-1
  • 17. Nakamori K, Tomihara K, Noguchi M. Clinical significance of computed tomography assessment for third molar surgery. World J Radiol. 2014;6(7):417-423. doi:10.4329/wjr.v6.i7.417
  • 18. Synan W, Stein K. Management of Impacted Third Molars. Oral Maxillofac Surg Clin North Am. 2020;32(4):519-559. doi:10.1016/j.coms.2020.07.002
  • 19. Matzen LH, Schropp L, Spin-Neto R, et al. Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT. Dentomaxillofac Radiol. 2017;46(1):20160330. doi:10.1259/dmfr.20160330
  • 20. Matzen LH, Wenzel A. Efficacy of CBCT for assessment of impacted mandibular third molars: a review - based on a hierarchical model of evidence. Dentomaxillofac Radiol. 2015;44(1):20140189. doi:10.1259/dmfr.20140189
  • 21. Falci SG, de Castro CR, Santos RC, et al. Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars. Int J Oral Maxillofac Surg. 2012;41(10):1270-1274. doi:10.1016/j.ijom.2012.03.003
  • 22. Pell GJ, Gregory BT. Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest. 1933;39:330-8.
  • 23. Winter GB. Impacted mandibular third molars. St Louis: American Medical Book Co. 1926:241–279.
  • 24. Tulloch JF, Antczak-Bouckoms AA, Ung N. Evaluation of the costs and relative effectiveness of alternative strategies for the removal of mandibular third molars. Int J Technol Assess Health Care. 1990;6(4):505-515. doi:10.1017/s0266462300004177
  • 25. Ateş Yıldırım E, Türker N, Göller Bulut D, et al. The relationship of the position of mandibular third molar impaction with the development of dental and periodontal lesions in adjacent second molars. J Stomatol Oral Maxillofac Surg. 2024;125(1):101610. doi:10.1016/j.jormas.2023.101610
  • 26. Ghaeminia H, Meijer GJ, Soehardi A, et al. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009;38(9):964-971. doi:10.1016/j.ijom.2009.06.007
  • 27. Jacques E, Ebogo M, Eng YC, et al. Radiographic Evaluation of Impacted Third Mandibular Molar According to the Classification of Winter, Pell and Gregory in a Sample of Cameroonian Population. Ethiop J Health Sci. 2023;33(5):851-858. doi:10.4314/ejhs.v33i5.15
  • 28. Salam S, Bary A, Sayed A. Prevalence of Impacted Teeth and Pattern of Third Molar Impaction among Kerala Population a Cross Sectional Study. J Pharm Bioallied Sci. 2023;15(Suppl 1):S354-S357. doi:10.4103/jpbs.jpbs_618_22
  • 29. Celikoglu M, Miloglu O, Kazanci F. Frequency of agenesis, impaction, angulation, and related pathologic changes of third molar teeth in orthodontic patients. J Oral Maxillofac Surg. 2010;68(5):990-995. doi:10.1016/j.joms.2009.07.063
  • 30. Toedtling V, Forouzanfar T, Brand HS. Parameters associated with radiographic distal surface caries in the mandibular second molar adjacent to an impacted third molar. BMC Oral Health. 2023;23(1):125. Published 2023 Feb 24. doi:10.1186/s12903-023-02766-w
  • 31. Prasanna Kumar D, Sharma M, Vijaya Lakshmi G, et al. Pathologies Associated with Second Mandibular Molar Due to Various Types of Impacted Third Molar: A Comparative Clinical Study. J Maxillofac Oral Surg. 2022;21(4):1126-1139. doi:10.1007/s12663-021-01517-0
  • 32. Chen Y, Zheng J, Li D, et al. Three-dimensional position of mandibular third molars and its association with distal caries in mandibular second molars: a cone beam computed tomographic study. Clin Oral Investig. 2020;24(9):3265-3273. doi:10.1007/s00784-020-03203-w
  • 33. Claudia A, Barbu HM, Adi L, et al. Relationship Between Third Mandibular Molar Angulation and Distal Cervical Caries in the Second Molar. J Craniofac Surg. 2018;29(8):2267-2271. doi:10.1097/SCS.0000000000004505
  • 34. Keskin Tunç S, Koc A. Evaluation of Risk Factors for External Root Resorption and Dental Caries of Second Molars Associated With Impacted Third Molars. J Oral Maxillofac Surg. 2020;78(9):1467-1477. doi:10.1016/j.joms.2020.04.041
  • 35. Kang F, Huang C, Sah MK, et al. Effect of Eruption Status of the Mandibular Third Molar on Distal Caries in the Adjacent Second Molar. J Oral Maxillofac Surg. 2016;74(4):684-692. doi:10.1016/j.joms.2015.11.024
  • 36. Marques J, Montserrat-Bosch M, Figueiredo R, et al. Impacted lower third molars and distal caries in the mandibular second molar. Is prophylactic removal of lower third molars justified?. J Clin Exp Dent. 2017;9(6):e794-e798. Published 2017 Jun 1. doi:10.4317/jced.53919

Gömülü Üçüncü Azı Dişlerinin Sınıflandırılması ve İkinci Azı Dişindeki Çürüklerle İlişkisi

Year 2025, Volume: 12 Issue: 1, 64 - 70, 21.04.2025

Halil Ayyıldız , Selinay Sari

https://doi.org/10.15311/selcukdentj.1488671

Abstract

Amaç: Dişlerin sürmesi ve konumlanması diş sağlığında önemli rol oynar. Yirmi yaş dişleri olarak da bilinen üçüncü azı dişleri, genellikle gömülü kalmaya eğilimlidir. Gömülülük, dişin çeşitli faktörlerden dolayı düzgün şekilde çıkmaması sonucu ortaya çıkar ve çürük, perikoronit ve kistik lezyonlar gibi potansiyel komplikasyonlara yol açabilir. Gömülü üçüncü azı dişlerinin epidemiyolojisini ve sonuçlarını anlamak, etkili diş tedavisi için çok önemlidir. Bu çalışmanın amacı, gömülü üçüncü azı dişlerinin sıklığını ve konumunu değerlendirmek ve bunların komşu ikinci azı dişlerinin distal yüzeyindeki çürük oluşumu ile ilişkisini incelemektir.
Gereç ve Yöntemler: Dahil etme kriterlerini karşılayan 705 hastanın panoramik radyografileri, gömülü üçüncü azı dişlerinin prevalansını ve konumunu değerlendirmek için analiz edildi. Çalışmada gömülü dişleri kategorize etmek için sınıflandırma sistemleri kullanılmış ve bunların komşu ikinci azı dişlerinin distal yüzeyindeki çürük oluşumuyla ilişkisi incelenmiştir.
Bulgular: Gömülü üçüncü azı dişleri arasında vertikal açılanma baskındı ve en yaygın olanı C pozisyonuydu. İstatistiksel analiz, ikinci azı dişlerinin distal yüzeyinde çürük oluşumu ile horizontal açılanma ve pozisyon A arasında anlamlı bir ilişki olduğunu ortaya çıkardı.
Sonuçlar: Çalışma, gömülü üçüncü azı dişlerinin ve bunların komşu dişlerdeki çürük gelişimi ile ilişkilerinin değerlendirilmesinin önemini vurgulamaktadır. Pozisyon A, vertikal ve mezioangular olarak gömülü üçüncü azı dişlerinin profilaktik olarak çekilmesi, ikinci azı dişlerinde çürük oluşumu riskini azaltmak için önerilebilir.

Keywords

Diş çürükleri Gömülü diş Panoramik radyografi Üçüncü azı dişi

References

  • 1. Yesiltepe S, Kılcı G. Evaluation the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings of the second molar teeth with CBCT scans. Oral Radiol. 2022;38(2):269-277. doi:10.1007/s11282-021-00554-2
  • 2. Alsaegh MA, Abushweme DA, Ahmed KO, et. al. 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. BMC Oral Health. 2022;22(1):306. Published 2022 Jul 24. doi:10.1186/s12903-022-02338-4
  • 3. Al-Zoubi H, Alharbi AA, Ferguson DJ, et al. Frequency of impacted teeth and categorization of impacted canines: A retrospective radiographic study using orthopantomograms. Eur J Dent. 2017;11(1):117-121. doi:10.4103/ejd.ejd_308_16
  • 4. Khawaja NA, Khalil H, Parveen K, et al. A Retrospective Radiographic Survey of Pathology Associated with Impacted Third Molars among Patients Seen in Oral & Maxillofacial Surgery Clinic of College of Dentistry, Riyadh. J Int Oral Health. 2015;7(4):13-17.
  • 5. Al-Dajani M, Abouonq AO, Almohammadi TA, et al. A Cohort Study of the Patterns of Third Molar Impaction in Panoramic Radiographs in Saudi Population. Open Dent J. 2017;11:648-660. Published 2017 Dec 26. doi:10.2174/1874210601711010648
  • 6. Prajapati VK, Mitra R, Vinayak KM. Pattern of mandibular third molar impaction and its association to caries in mandibular second molar: A clinical variant. Dent Res J (Isfahan). 2017;14(2):137-142.
  • 7. Quek SL, Tay CK, Tay KH, et al. Pattern of third molar impaction in a Singapore Chinese population: a retrospective radiographic survey. Int J Oral Maxillofac Surg. 2003;32(5):548-552.
  • 8. Dodson TB, Susarla SM. Impacted wisdom teeth. BMJ Clin Evid. 2014;2014:1302. Published 2014 Aug 29.
  • 9. Zaman MU, Almutairi NS, Abdulrahman AM, et al. Pattern of Mandibular Third Molar Impaction in Nonsyndromic 17760 Patients: A Retrospective Study among Saudi Population in Central Region, Saudi Arabia. Biomed Res Int. 2021;2021:1880750. Published 2021 Aug 26. doi:10.1155/2021/1880750
  • 10. Chou YH, Ho PS, Ho KY, et al. Association between the eruption of the third molar and caries and periodontitis distal to the second molars in elderly patients. Kaohsiung J Med Sci. 2017;33(5):246-251. doi:10.1016/j.kjms.2017.03.001
  • 11. Hashemipour MA, Tahmasbi-Arashlow M, Fahimi-Hanzaei F. Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population. Med Oral Patol Oral Cir Bucal. 2013;18(1):e140-e145. Published 2013 Jan 1. doi:10.4317/medoral.18028
  • 12. Yıldırım H, Büyükgöze-Dindar M. Investigation of the prevalence of impacted third molars and the effects of eruption level and angulation on caries development by panoramic radiographs. Med Oral Patol Oral Cir Bucal. 2022;27(2):e106-e112. Published 2022 Mar 1. doi:10.4317/medoral.25013
  • 13. Polat HB, Ozan F, Kara I, et al. Prevalence of commonly found pathoses associated with mandibular impacted third molars based on panoramic radiographs in Turkish population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(6):e41-e47. doi:10.1016/j.tripleo.2008.02.013
  • 14. Xavier CRG, Dias-Ribeiro E, Ferreira-Rocha J, et al. Avaliação das posições dos terceiros molares impactados de acordo com as classificações de Winter e Pell & Gregory em radiografias panorâmicas. Revista de Cirurgia e Traumatologia Buco-maxilo-facial. 2010;10(2):83-90.
  • 15. Khouri C, Aoun G, Khouri C, et al. Evaluation of Third Molar Impaction Distribution and Patterns in a Sample of Lebanese Population. J Maxillofac Oral Surg. 2022;21(2):599-607. doi:10.1007/s12663-020-01415-x
  • 16. Santos KK, Lages FS, Maciel CAB, et al. Prevalence of Mandibular Third Molars According to the Pell & Gregory and Winter Classifications. J Maxillofac Oral Surg. 2022;21(2):627-633. doi:10.1007/s12663-020-01473-1
  • 17. Nakamori K, Tomihara K, Noguchi M. Clinical significance of computed tomography assessment for third molar surgery. World J Radiol. 2014;6(7):417-423. doi:10.4329/wjr.v6.i7.417
  • 18. Synan W, Stein K. Management of Impacted Third Molars. Oral Maxillofac Surg Clin North Am. 2020;32(4):519-559. doi:10.1016/j.coms.2020.07.002
  • 19. Matzen LH, Schropp L, Spin-Neto R, et al. Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT. Dentomaxillofac Radiol. 2017;46(1):20160330. doi:10.1259/dmfr.20160330
  • 20. Matzen LH, Wenzel A. Efficacy of CBCT for assessment of impacted mandibular third molars: a review - based on a hierarchical model of evidence. Dentomaxillofac Radiol. 2015;44(1):20140189. doi:10.1259/dmfr.20140189
  • 21. Falci SG, de Castro CR, Santos RC, et al. Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars. Int J Oral Maxillofac Surg. 2012;41(10):1270-1274. doi:10.1016/j.ijom.2012.03.003
  • 22. Pell GJ, Gregory BT. Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest. 1933;39:330-8.
  • 23. Winter GB. Impacted mandibular third molars. St Louis: American Medical Book Co. 1926:241–279.
  • 24. Tulloch JF, Antczak-Bouckoms AA, Ung N. Evaluation of the costs and relative effectiveness of alternative strategies for the removal of mandibular third molars. Int J Technol Assess Health Care. 1990;6(4):505-515. doi:10.1017/s0266462300004177
  • 25. Ateş Yıldırım E, Türker N, Göller Bulut D, et al. The relationship of the position of mandibular third molar impaction with the development of dental and periodontal lesions in adjacent second molars. J Stomatol Oral Maxillofac Surg. 2024;125(1):101610. doi:10.1016/j.jormas.2023.101610
  • 26. Ghaeminia H, Meijer GJ, Soehardi A, et al. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009;38(9):964-971. doi:10.1016/j.ijom.2009.06.007
  • 27. Jacques E, Ebogo M, Eng YC, et al. Radiographic Evaluation of Impacted Third Mandibular Molar According to the Classification of Winter, Pell and Gregory in a Sample of Cameroonian Population. Ethiop J Health Sci. 2023;33(5):851-858. doi:10.4314/ejhs.v33i5.15
  • 28. Salam S, Bary A, Sayed A. Prevalence of Impacted Teeth and Pattern of Third Molar Impaction among Kerala Population a Cross Sectional Study. J Pharm Bioallied Sci. 2023;15(Suppl 1):S354-S357. doi:10.4103/jpbs.jpbs_618_22
  • 29. Celikoglu M, Miloglu O, Kazanci F. Frequency of agenesis, impaction, angulation, and related pathologic changes of third molar teeth in orthodontic patients. J Oral Maxillofac Surg. 2010;68(5):990-995. doi:10.1016/j.joms.2009.07.063
  • 30. Toedtling V, Forouzanfar T, Brand HS. Parameters associated with radiographic distal surface caries in the mandibular second molar adjacent to an impacted third molar. BMC Oral Health. 2023;23(1):125. Published 2023 Feb 24. doi:10.1186/s12903-023-02766-w
  • 31. Prasanna Kumar D, Sharma M, Vijaya Lakshmi G, et al. Pathologies Associated with Second Mandibular Molar Due to Various Types of Impacted Third Molar: A Comparative Clinical Study. J Maxillofac Oral Surg. 2022;21(4):1126-1139. doi:10.1007/s12663-021-01517-0
  • 32. Chen Y, Zheng J, Li D, et al. Three-dimensional position of mandibular third molars and its association with distal caries in mandibular second molars: a cone beam computed tomographic study. Clin Oral Investig. 2020;24(9):3265-3273. doi:10.1007/s00784-020-03203-w
  • 33. Claudia A, Barbu HM, Adi L, et al. Relationship Between Third Mandibular Molar Angulation and Distal Cervical Caries in the Second Molar. J Craniofac Surg. 2018;29(8):2267-2271. doi:10.1097/SCS.0000000000004505
  • 34. Keskin Tunç S, Koc A. Evaluation of Risk Factors for External Root Resorption and Dental Caries of Second Molars Associated With Impacted Third Molars. J Oral Maxillofac Surg. 2020;78(9):1467-1477. doi:10.1016/j.joms.2020.04.041
  • 35. Kang F, Huang C, Sah MK, et al. Effect of Eruption Status of the Mandibular Third Molar on Distal Caries in the Adjacent Second Molar. J Oral Maxillofac Surg. 2016;74(4):684-692. doi:10.1016/j.joms.2015.11.024
  • 36. Marques J, Montserrat-Bosch M, Figueiredo R, et al. Impacted lower third molars and distal caries in the mandibular second molar. Is prophylactic removal of lower third molars justified?. J Clin Exp Dent. 2017;9(6):e794-e798. Published 2017 Jun 1. doi:10.4317/jced.53919
There are 36 citations in total.

Details

Primary Language English
Subjects Oral and Maxillofacial Radiology
Journal Section Research
Authors

Halil Ayyıldız 0000-0001-8633-1764

Selinay Sari 0009-0000-1492-8430

Publication Date April 21, 2025
Submission Date May 23, 2024
Acceptance Date October 13, 2024
Published in Issue Year 2025 Volume: 12 Issue: 1

Cite

Vancouver Ayyıldız H, Sari S. The Classification of Impacted Third Molar and Their Relationship with Caries on the Second Molar. Selcuk Dent J. 2025;12(1):64-70.
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