Factors influencing the prophylactic removal of asymptomatic impacted lower third molars

Prevalence and pattern of third molars impaction in a large Yemeni sample: a retrospective study

The prevalence of teeth impaction varies substantially between different populations, and the impaction of third molars is the most commonly recorded. This study aimed to explore the prevalence and pattern of the third molars impactions among Yemeni population. This was a retrospective radiographic study conducted in Yemen between 2022 and 2023. The digital panoramic radiographs were collected from two major X-ray centers in Yemen. The angular position and depth of the impacted third molars were assessed according to the classifications of Winter and of Pell and Gregory, respectively. All radiographs were evaluated twice by one investigator in a two-week interval, and Kappa test was used for intra-rater reliability. Gender-wise differences, differences between both sides, and differences between maxilla and mandible were analyzed using Chi-squared tes with odds ratio (OR) for the risk of impaction. A P-value < 0.05 was considered significant. Panoramic radiographs of 6338 individuals were included. Their mean age was 35.1 ± 13.3 years andand 63.9% were females. A total of 25,352 sites (quadrants) were screened for the presence of thirds molars. Among which, 14,003 third molars (55.3%) were present in one or more sites. There were 1440 individuals (23%) with a total of 2828 impacted third molars (20% of the existing third molars). Females were less likely to have third molar impaction (OR = 0.46, CI95% = 0.4-0.52). Impaction of the mandibular third molars was significantly more frequent than the maxillary ones (OR = 1.15, CI95% = 1.04-1.26; P = 0.005). Horizontal and mesioangular impactions were statistically more frequent in the lower molars compared to the upper ones (P < 0.001 each). Contrastingly, vertical (P = 0.015), distoangular, and other impactions (P < 0.001 each)were statistically more frequent in the maxilla. Levels A and B were more frequent in the lower third molars, while level C was predominating in the upper molars (P < 0.001 each). The prevalence of third molars impaction is more frequent in males and mandibular arch. The angulation and level of impaction seem to be more complicated in the maxillary arch.

AI-Driven localization of all impacted teeth and prediction of winter angulation for third molars on panoramic radiographs: Clinical user interface design

PURPOSE

Impacted teeth are abnormal tooth disorders under the gums or jawbone that cannot take their normal position even though it is time to erupt. This study aims to detect all impacted teeth and to classify impacted third molars according to the Winter method with an artificial intelligence model on panoramic radiographs.

METHODS

In this study, 1197 panoramic radiographs from the dentistry faculty database were collected for all impacted teeth, and 1000 panoramic radiographs were collected for Winter classification. Some pre-processing methods were performed and the images were doubled with data augmentation. Both datasets were randomly divided into 80% training, 10% validation, and 10% testing. After transfer learning and fine-tuning processes, the two datasets were trained with the YOLOv8 deep learning algorithm, a high-performance artificial intelligence model, and the detection of impacted teeth was carried out. The results were evaluated with precision, recall, mAP, and F1-score performance metrics. A graphical user interface was designed for clinical use with the artificial intelligence weights obtained as a result of the training.

RESULTS

For the detection of impacted third molar teeth according to Winter classification, the average precision, average recall, and average F1 score were obtained to be 0.972, 0.967, and 0.969, respectively. For the detection of all impacted teeth, the average precision, average recall, and average F1 score were obtained as 0.991, 0.995, and 0.993, respectively.

CONCLUSION

According to the results, the artificial intelligence-based YOLOv8 deep learning model successfully detected all impacted teeth and the impacted third molar teeth according to the Winter classification system.

Can the Position of the Impacted Third Molars Be an Early Risk Indicator of Pathological Conditions? A Retrospective Cone-Beam Computed Tomography Study

Objectives

The aim of this retrospective study was to evaluate the prevalence of pathologies associated with impacted third molars in relation to tooth position on cone-beam computed tomography images.

Material and Methods

In 348 cone-beam computed tomography images, the position of 640 impacted third molars (mesiodistal angulation, buccolingual inclination, impaction depth, and contact point localization) and the presence of pathologies (distal caries, external root resorption, marginal bone loss, and pathological follicular space) were evaluated. The data were analysed statistically with a significance level set at P < 0.05.

Results

Distal caries was mostly detected in relation to Class A (20.4%) and contact point at (12.5%) and above (10.5%) the cementoenamel junction (CEJ) (P = 0.000; P < 0.05). External root resorption and marginal bone loss were more common in mesioangular angulation (52.3% and 80.1%, respectively), Class C (53% and 73.8%, respectively), and contact point below the CEJ (53.2% and 73.3%, respectively) (P = 0.000; P < 0.05). Lingual inclination was identified as a new risk factor for associated pathologies (P < 0.05). Pathological follicular space was significantly more likely to occur in those with inverted angulation (100%) and absence of contact (31.5%) (P = 0.000 and P = 0.010, respectively; P < 0.05).

Conclusions

Pathologies arising in second molars in relation to impacted third molars are significantly associated with the three-dimensional position of impacted third molars, and watchful monitoring or prophylactic removal of impacted third molars should be considered, taking into account the relevant risk parameters for the related pathologies.

Maxillary and Mandibular Third Molars Impaction with Associated Pathologies in a North Cyprus Population: A Retrospective Study

This study aimed to find out the incidence of impacted third molars and associated pathologies in people who live in the North Cyprus population. Dr. Burhan Nalbantoglu State Hospital is the only hospital that has an oral and maxillofacial surgery department among the state hospitals in North Cyprus. Patients who were referred to this department during a one-year period due to the complaints regarding their third molar were included in our study. This retrospective study involved 550 patients aged 16 to 65 years (1752 third molars). Chi-square tests were done for bilateral comparison between age, gender, and third molar (p < 0.05). Among the groups included in the study, the highest number of third molars originated from the 20–29 age group (n = 1050). Among all 1752 third molars, 716 (40%) of them erupted, while 1036 (60%) were impacted molar teeth, with significant differences between genders (p > 0.05). The most often impacted position in the mandible was the mesioangular type (42%) and in the maxilla was the vertical type (62%). Partially and completely impacted mandibular third molars showed a significant difference between the left and right sides (p < 0.05). A huge proportion of third molars are impacted in the North Cyprus population. The degree of impaction of wisdom teeth and the problems they cause should be well evaluated, and the surgical approach should be considered according to the baseline of this data.

Third molar impaction in the Jazan Region: Evaluation of the prevalence and clinical presentation

Objective

To provide information on the prevalence and clinical features of impacted third molar teeth in the South-Western region of Saudi Arabia.

Material and methods

In this cross-sectional study, 1200 panoramic radiographs (50% males and 50% females) were retrieved from the electronic clinical records of patients at the College of Dentistry, Jazan University from December 2014 to December 2016, and impacted third molars were evaluated. Data on clinical and radiographic presentation were analyzed.

Results

Overall, there were 291 (24.3%) patients with impacted third molars among 1200 radiographs. The distribution of impacted third molars according to the number of impacted teeth was as follows: one impaction in 121 (41.6%); two impactions in 90 (30.9%); three impactions in 42 (14.4%); and four impactions in 38 (13.1%) patients. There was a high prevalence of all impaction types among females (54.5%). Maxillary vertical angulation was most common (50%) followed by mandibular mesioangular angulation (48.3%). The depth of impaction in maxillary teeth was higher than in mandibular teeth. Pain was uncommon (4.5% of patients).

Discussion

Clinically, vertical impaction in the maxilla was present in 50% of patients because of limited posterior space, and mesioangular angulation in the mandible was present in 48% of patients because of inadequate space between the ramus and the second molar. These findings are similar to other reports. Vertical impaction of the maxillary wisdom tooth is mostly related to the discrepancy between the mesiodistal size of the tooth crown and the limited retromolar space.

Conclusion

Noiseless presentation of an impacted third molar requires raising the population’s awareness about the need for diagnosis and treatment of the problem to avoid any further complications. The study can be to guide surgical procedures. This study documented the prevalence, pattern, and clinical features of impacted third molars in South Western region of Saudi Arabia.

Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above

BACKGROUND

The prophylactic extraction of asymptomatic impacted mandibular third molar is a contentious issue in dental practice.

OBJECTIVE

To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar.

METHODS

This was a prospective clinical study over a three-year period. The diagnosis of impacted mandibular third molar and their associated pathology was made by clinical and radiological examination. The data obtained were age, sex, type of impaction, reason for surgical extraction, and the clinical condition of the adjacent second molar.

RESULTS

Patients 50 years and above were 33.4%, and those with impaction 22.8%, while the symptomatic cases were in 18.4% patients. The age of the patients ranged from 52 to 84 years with male: female ratio, 2.3:1. In all the asymptomatic impactions, the adjacent second molars were disease-free, whereas 73.6% of the adjacent second molar related to symptomatic cases were asymptomatic (P=0.001).

CONCLUSION

This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical extraction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments.

Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study

Aim/Objective

The mandibular third molar is the most frequently impacted tooth with incidence varies from 9.5% to 68% in different populations. Hence, the aim was to study the prevalence and pattern of mandibular impacted third molar among Delhi-National Capital Region (NCR) population.

Materials and Methods

The study was conducted with data collected from registered hospitals and dental clinics of Delhi NCR region. The study represents a retrospective analysis of panoramic radiographs and intraoral periapical radiograph of patients at these centers from June 2014 to June 2016.

Results

Out of 960 patients with the third molar investigated, a total of 250 patients having impacted mandibular third molar (152 [60.8%] males and 98 [39.2%]) females between June 2014 and June 2016 were included in the study. The age ranged from 20 to 55 years, with a mean age of 27.6 years and the standard deviation was 5.8 years. The prevalence of impacted mandibular third molars for this study was 26.04%.

Conclusion

This study demonstrated that males (60.8%) were more likely to present with impacted mandibular third molars than females (39.2%). The prevalence of third molar impactions was almost the same on both the left (45.8%) and right (54.2%) sides. This study also noted that mesioangular impactions (49.2%) were the most common type of impaction. The least common form of impactions was the transverse types (2%). The prevalence of impacted mandibular third molars for this study was 26.04%.

Radiographic study of mandibular third molars: evaluation of the position and root anatomy in Brazilian population

OBJECTIVES

The root anatomy and position of mandibular third molars are important factors in assessing the level of difficulty of surgical removal procedures. In this light, this study aims to identify the most frequent position and the root anatomy of mandibular third molars.

METHODS

The study sample comprised 1205 mandibular third molars from 710 panoramic radiographs evaluated. Regarding the position, all of them were based on Pell and Gregory's and Winter's classifications. The root anatomy was classified according to the type and number of roots, as well as the presence of laceration, fusion, or divergence. Gender and the quadrant were also considered. Following an interexaminer analysis, a statistical analysis was performed using the Kappa test.

RESULTS

The results showed that the IA (40.3%) and mesioangular (53.8%) position was predominant in mandibular third molars. Regarding the anatomy, the most common were two roots (98.3%), of the conical simple type (88.9%), with absence of laceration (89.2%), divergence (84%), and fusion (80%).

CONCLUSION

The present study showed that the most prevalent mandibular third molar type in Brazilian patients was the IA and mesioangular position, with simple root anatomy. The result of this study can assist oral surgeons to better plan and assess the level of difficulty of surgical removal procedures.

Bilateral inverted and impacted maxillary third molars: A case report

Bilateral inverted third molar impaction is an extremely rare condition. We reported the case of a 50-year-old female patient with bilateral inverted and impacted maxillary third molars. Both were asymptomatic and pathology free clinically and radiographically. Surgical extraction of these inverted third molars with inaccessible positions requires an aggressive bone removal on the tuberosity bilaterally. Moreover, it contains a high risk of displacement of the inverted third molar into the maxillary sinus. Conservative management was the choice, with the patient’s agreement, and the inverted third molars were left in situ.

Key words:Bilateral inverted, maxillary third molar, upper impacted tooth.

Retained Third Molars Removal in a Severely Resorbed Edentulous Mandible. A Case Report

The presence of asymptomatic third molars can represent a potential problem in the mandible when these teeth are retained and the patient has lost all normally erupted teeth. Once the mandibular first and second molars are removed, the mandibular body becomes weaker with time, increasing the complexity, morbidity and incidence of complication in the surgical procedure to remove the retained third molar. This paper reports a case where the mandibular third molars retained in a severely resorbed mandible were removed in a 54-year-old female patient. The treatment plan was based on the safe surgical removal of the teeth and prosthetic rehabilitation with an implant-supported milled bar overdenture and a bone-mucous-supported complete denture in the mandibular and maxillary arch, respectively. If the removal of a retained third molar is indicated in a severely resorbed edentulous mandible, the treatment plan must involve not only preventive measures in order to avoid mandible fracture during or after tooth removal, but also alternatives that allow an adequate mandibular rehabilitation.

Does the Relationship between Retained Mandibular Third Molar and Mandibular Angle Fracture Exist? An Assessment of Three Possible Causes

The objective of this study is to discuss problems associated with dental retention through three clinical cases of mandible fractures related to the presence of retained lower third molars, emphasizing the possibility of mandible fractures resulting from this or from the extraction procedure. The three evaluated patients had a fracture in the mandible angle. The third molars were present in all the cases, as was the relationship of the fracture with the teeth. After evaluating the three cases and reviewing literature, it is believed that the presence of the retained lower third molars and the surgical procedures for their extraction increase the risk of mandible angle fractures.

Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population

Objectives: The aim of this study is to evaluate the position of impacted third molars based on the classifications of Pell & Gregory and Winter in a sample of Iranian patients. Study design: In this retrospective study, up to 1020 orthopantomograms (OPG) of the patients who were referred to the radiology clinics from October 2007 to January 2011 were evaluated. Data including the age, gender, the angulation type, width and depth of impaction were evaluated by statistical tests. Results: Among 1020 patients, 380(27.3%) were male and 640(62.7%) were female with the sex ratio was 1:1.7. Of the 1020 OPGs, 585 cases showed at least one impacted third molar, with significant difference between males (205; 35.1%) and females (380; 64.9%) (P = 0.0311). Data analysis showed that impacted third molars were 1.9 times more likely to occur in the mandible than in the maxilla (P =0.000). The most common angulation of impaction in the mandible was mesioangular impaction (48.3%) and the most common angulation of impaction in the maxilla was the vertical (45.3%). Impaction in the level IIA was the most common in both maxilla and mandible. There was no significant diffe-rence between the right and left sides in both the maxilla and the mandible. Conclusion: The pattern of third molar impaction in the southeast region of Iran is characterized by a high prevalence of impaction, especially in the mandible. Female more than male have teeth impaction. The most common angulation was the mesioangular in the mandible, and the vertical angulation in the maxilla. The most common level of impaction was the A and there was no any significant difference between the right and left sides in both jaws.

Key words:Third molar, impaction, incidence, Iran.

Quality of life following third molar removal under conscious sedation

AIM

The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction.

STUDY DESIGN

Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7.

RESULTS

Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9.

CONCLUSION

The removal of all third molars in a single appointment causes an important deterioration of the patient's QoL during the first postoperative week, especially due to local pain and eating discomfort.

Comparative evaluation of pre-emptive analgesic efficacy of intramuscular ketorolac versus tramadol following third molar surgery

Pre-emptive analgesia aims at preventing the central nervous system from reaching a hyper-excitable state known as central sensitization, in which it responds excessively to afferent inputs. The clinical implication would be more effective pain management, thereby reducing post-operative pain and analgesic requirements. This study aimed at investigating the existence of pre-emptive analgesia and to compare the pre-emptive analgesic efficacy of im ketorolac [NSAID] versus tramadol [SYNTHETIC OPIOD] for post-operative pain management following third molar surgery. Fifty patients under the age group of 16-25 years with asymptomatic, symmetrically impacted mandibular third molars were equally divided into 2 groups and underwent third molar surgery under local anesthesia. Ketorolac 30 mg and tramadol 50 mg were used in the study group, while sodium chloride 0.9 % was used in the control group. Study parameters included pain intensity scores for 12 post-operative hours, time to 1st rescue analgesia, total number of analgesics consumed during the 5 post-operative days and patients' self assessment of efficacy of the surgery with regardsto no pain. Statistically, the data are presented as the mean values with their standard deviations and a 95 % confidence interval [p is significant, if p < 0.05] for the mean are applicable. Incidences of adverse events like pain on injection of the study drug, local reactions, nausea and vomiting were noted. Patients in the study group significantly performed better than the control group in terms of all the parameters; while among the study group, ketorolac fared better than tramadol. All the drug related complications were mild and did not require any intervention. Pre-operative ketorolac or tramadol in comparison to placebo resulted in a significantly better post-operative pain management. However as against tramadol, ketorolac is a better choice as a pre-emptive analgesic agent for the post-operative pain management following third molar surgery.

Extrações de molares na Ortodontia

O tratamento ortodôntico com extração de molares em pacientes adultos é tecnicamente mais complexo, devido a inúmeros fatores. Em geral, o espaço a ser fechado é maior do que o espaço dos pré-molares e, por isso, a ancoragem é crítica e o tempo de tratamento mais longo. É comum esses casos apresentarem algum grau de comprometimento periodontal por causa da idade dos pacientes e, portanto, necessitam de maior controle da mecânica ortodôntica para reduzir os efeitos colaterais do fechamento do espaço. Por isso, bons resultados de finalização são mais difíceis de ser alcançados. Sendo assim, este artigo tem como objetivo apresentar as razões para a indicação de extração de molares nos tratamentos ortodônticos, as contraindicações, as diferentes fases da mecânica ortodôntica, esclarecer os fatores envolvidos nesse tipo de planejamento e tratamento e apresentar casos clínicos tratados com extração de molares.