Assessment of Third Molar Impaction Pattern and Associated Clinical Symptoms in a Central Anatolian Turkish Population

Abstract

Objectives: The purpose of this study was to assess the pattern of third molar impaction and associated symptoms in a Central Anatolian Turkish population.

Material and methods: A total of 2,133 impacted third molar teeth of 705 panoramic radiographs were reviewed. The positions of impacted third molar teeth on the panoramic radiographs were documented according to the classifications of Pell and Gregory and of Winter. The presence of related symptoms including pain, pericoronitis, lymphadenopathy and trismus was noted for every patient. Distributions of obtained values were compared using the Pearson χ2 test. Nonparametric values were analyzed using the Mann-Whitney U test and Kruskal-Wallis test.

Results: The mean age of the subjects was 30.58 ± 11.98 years (range: 19-73); in a review of the 2,133 impacted third molar teeth, the most common angulation of impaction in both maxillaries was vertical (1,177; 55%). Level B impaction was the most common in the maxilla (425/1,037; 39%), while level C impaction was the most common in the mandible (635/1,096; 61%). Pain (272/705; 39%) and pericoronitis (188/705; 27%) were found to be the most common complications of impaction. Among 705 patients (335 males, 370 females), pericoronitis was more prevalent in males (101; 30%) and usually related to lower third molars (236; 22%). The retromolar space was significantly smaller in females (p < 0.05). Moreover, there was a significant difference in retromolar space for the area of jaw (maxillary: 11.3 mm; mandibular: 14.2 mm) and impaction level (A: 14.7 mm; B: 11.1 mm; C: 10.3 mm; p < 0.05).

Conclusion: The pattern of third molar impaction in a Central Anatolian Turkish population was characterized by a high prevalence rate of level C impaction with vertical position. Pain and pericoronitis were the most common symptoms usually associated with level A impaction and vertical position.

Fig. 1

Pell and Gregory classification. Level A: the occlusal plane of the impacted tooth is at the same level as the occlusal plane of the second molar (the highest portion of the impacted third molar is on a level with or above the occlusal plane); level B: the occlusal plane of the impacted tooth is between the occlusal plane and the cervical margin of the second molar (the highest portion of the impacted third molar is below the occlusal plane but above the cervical line of the second molar); level C: the impacted tooth is below the cervical margin of the second molar (the highest portion of the impacted third molar is below the cervical line of the second molar).

Fig. 2

Winter's classification. Vertical impaction: the long axis of the third molar is parallel to the long axis of the second molar (from 10 to −10°); mesioangular impaction: the impacted tooth is tilted toward the second molar in a mesial direction (from 11 to 79°); horizontal impaction: the long axis of the third molar is horizontal (from 80 to 100°); distoangular impaction: the long axis of the third molar is angled distally/posteriorly away from the second molar (from −11 to −79°); others (from 101 to −80°).

Fig. 3

Retromolar space measurements on panoramic radiography (red double-headed arrows; colors in the online version only): a = line from the anterior limit of the mandibular ramus; b = line from the posterior limit of the maxillary second molar; c = line from the posterior limit of the mandibular second molar.