A Cohort Study of the Patterns of Third Molar Impaction in Panoramic Radiographs in Saudi Population

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Abstract

Objectives:

To evaluate the epidemiological patterns of third molar impaction in a cohort of patients living in the north of Saudi Arabia.

Materials and Methods:

A retrospective cohort study comprised of analysing 2550 Orthopantomograms (OPGs) belonging to patients who attended Aljouf University College of Dentistry between September 2013 and December 2015. OPGs were examined to determine the frequency of third molar impaction, their levels of eruption and angulations. Mixed effects logistic regression analysis was performed to calculate adjusted odds ratios. Data were weighted by age and sex based on population regional estimates.

Results:

1551 patients (60.8%) with a mean age of 33.5 years-old (95%CI: 32.9 to 34) demonstrated 2650 impacted third molars. Third molars were more likely present in patients aged from 20 to 39 years-old ( p<0.001); and in mandible more than maxilla ( p<0.001). It showed highest vertical impaction and higher impaction rate in mandible than maxilla. Level A impaction was the most common among other levels by 1365 (53.5%). Vertical impaction was the most common pattern (1354 patients; 53.1%). Mesioangular impaction ranked second in mandible, while distoangular impaction ranked second in maxilla. There was no statistically significant difference between males and females concerning impaction frequency, depth levels and angulations.

Conclusion:

Impacted third molars is still a public health concern among youth and young adults. Vertically impacted mandibular third molars with their occlusal plane at the same level as the occlusal plane of adjacent tooth is the most prevalent pattern of third molar impaction in the northern region of Saudi Arabia.

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Most cited references 19

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Pattern of third molar impaction in a Singapore Chinese population: a retrospective radiographic survey.

S.L. Quek, C.K. Tay, K.H. Tay … (2003)

One thousand orthopantomograms (OPGs) of patients 20-40 years old were examined. Where impacted third molars were present, the angle and depth of impaction were recorded. Results were analysed using the Pearson chi2 test. 68.6% of OPGs showed at least one impacted third molar. The frequency was three-fold higher in the mandible (1024/1079=90%) than in the maxilla (306/1077=28%), with a significantly higher frequency (P<0.05) in females (56%) than males (44%). The mesioangular impaction was the most common, and 80% of all impacted third molars were partially buried in bone. Of the 429 bilateral occurrence of impacted third molars, 423 were in the mandible. It was concluded that the frequency of impacted third molars in the Singapore Chinese population studied was generally two to three times that reported in races of the Caucasian stock. There was also double the frequency of impacted third molars when compared to a previous study in a Chinese population published in 1932 with females being more frequently affected than males.

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Third molar outcomes from age 18 to 26: findings from a population-based New Zealand longitudinal study.

M. Thomson, P Konthasinghe, Monika Krüger (2001)

The purpose of this study was to describe the presence and impaction status of people's third molars at age 18 years, as well as the observed changes in their clinical status between ages 18 and 26 years. Eight hundred twenty-one participants in a prospective cohort study were dentally examined at ages 18 and 26 years, and panoramic radiographs were taken at age 18 years but not at 26 years. For each tooth, its radiographic impaction status at age 18 years was compared with the clinical status by age 26 years. Of the 2857 third molars assessed at age 18 years, 92.8% were able to be followed up clinically at age 26 years. Approximately 54.9% of the teeth that were not impacted by age 18 had erupted by 26 years. Of the teeth that were impacted by age 18, 33.7% had fully erupted by age 26, 31.4% had been extracted, and 13.1% remained unerupted. Of the maxillary teeth that were categorized as "impacted" at age 18 years, 36.2% had fully erupted by age 26, whereas only 25.6% of the mandibular teeth had done so (P <.01). Fewer mandibular teeth than maxillary teeth remained unerupted by the time the patient was 26 years old (27.4% and 41.4%, respectively; P <.01), but there was no significant difference between the jaws in the proportion of impacted teeth at age 18 years that had been extracted by age 26 years (29.6% and 30.3%, respectively). For mesioangularly impacted third molars, 39.3% of maxillary teeth and 20.4% of mandibular teeth had fully erupted by age 26. Of the third molars that were mesioangularly impacted at age 18 years, 39.3% of maxillary teeth and 20.4% of mandibular teeth had fully erupted by age 26 years, whereas almost one-third of each had been extracted. Of the distoangularly impacted third molars, 20.4% of the maxillary teeth and one-third of the mandibular teeth had erupted by age 26, with 21.6% of the maxillary teeth and 31.6% of the mandibular teeth having been extracted. Other than horizontally impacted third molars, a substantial proportion of other impaction types do erupt fully, and radiographically apparent impaction in late adolescence should not be sufficient grounds for their prophylactic removal in the absence of other clinical indications.