image missing

Timisoara Medical Journal

(ISSN: 1583-526X) Open Access Journal
Rss Feed:

Timisoara_Med 2024, 2023(2), 1; doi:10.35995/tmj20230201

Article
Assessment of the Third Molar Using Panoramic Radiographs in a Sample of Syrian Patients
Ali Yusuf Shqera 1,*, Afraa Samee Ali 2 and Radwan Aziz Haffaf 3
1
Oral and Maxillofacial Surgery MSc, Teaching Assistant, Faculty of Dentistry, Manara University, Latakia, Syria
2
Bachelor of Science in Nursing, Latakia, Syria; afraasaliiiii@gmail.com
3
Orthodontics Phd Student, Faculty of Dentistry, Tishreen University, Latakia, Syria; radwan.haffaf@yahoo.com
*
Correspondence: aliyshqera@gmail.com; Tel.: +963-949588876
How to cite: Shqera, A.Y.; Ali, A.S.; Haffaf, R.A. Assessment of the Third Molar Using Panoramic Radiographs in a Sample of Syrian Patients. Timisoara Med. 2023, 2023 (Issue 2), 1; doi:10.35995/tmj20230201.
Received: 1 July 2023 / Accepted: 21 December 2023 / Published: 15 January 2024

Abstract

:
Purpose: To study the characteristics of the third molar by panoramic radiography in a sample of Syrian patients. Materials and methods: We analyzed 335 panoramic radiographs of Syrian patients with at least one third molar. The sample consisted of 169 males (50.5%) and 166 females (49.5%). Third molars were classified according to Pell and Gregory’s classification and Winter’s classification. Results: The incidence of impaction was higher among females than males. The most common pattern was of vertically mandibular third molars at level A and class II, followed by vertically maxillary third molars at level B. Conclusions: The early diagnosis of impacted third molars by panoramic radiographs is useful for determining the position and depth of these molars and for proper planning for extraction.
Keywords:
third molar; impacted tooth; panoramic radiography

Introduction

A tooth is termed impacted when its eruption path is interrupted by a physical barrier that prevents it from reaching its normal position and occlusal level within a certain time range [1]. The most frequently impacted teeth are the mandibular third molar, followed by the maxillary third molar, the maxillary canine, and the mandibular premolars [1].
Impaction can result from a variety of factors, such as genetics, jaw size and growth, lack of available space, quality of surrounding tissues, physical or mechanical interference, failure to induce the underlying mesenchyme, presence of pathological lesions such as cysts and tumors, and diet or artificial feeding of infants and children [2,3,4,5,6].
The analysis of third molar eruption confirmed that third molars with large angulation have a weak chance of eruption compared with those with little angulation [7].
The third molar is placed laterally within the dental arch, which reduces the reach of the toothbrush to it, causing plaque accumulation and predisposing the occurrence of caries in this area [8].
Racial and ethnic groups can have different third-molar impactions [9,10,11,12]. To the best of our knowledge, this is the first study to assess the pattern of third molar impaction in Syria. Panoramic radiographs are typically used to assess impacted teeth for their angulation, depth, the amount of bone covering them, and relationship to anatomical structures. This study was conducted to assess the third molar pattern in a sample of Syrians using panoramic radiographs and dental support.

Materials and Methods

A retrospective study of 335 panoramic radiographs for Syrian patients with at least one third molar was performed; there were 169 males (50.5%) and 166 females (49.5%). All of the panoramic radiographs were performed at the same panoramic radiology center, in order to preserve the same radiological parameters.
The pattern of third molars was evaluated by Pell and Gregory’s classification and the Winter’s classification, in addition to the site, caries of the second and/or third molar, and relationship with adjacent anatomical structures.
Data for categorical variables are expressed in frequencies and percentages and were statistically analyzed in Microsoft Excel 2019 and Jamovi 2.3.18 using the chi-square test at a significance level of 0.05. Demographic variables were calculated as simple descriptive statistics.

Results

We evaluated 937 third molars: 431 (46%) were maxillary third molars and 506 (54%) were mandibular third molars; 466 (49.8%) were right third molars, and 471 (50.2%) were left third molars (Table 1 and Table 2).
Table
Table 1. Maxillary third molars’ distribution (X2 = 0.43, p-value = 0.805).
Table 1. Maxillary third molars’ distribution (X2 = 0.43, p-value = 0.805).
BilateralUnilateralTotal
RightLeft
Male832923218
Female842421213
Total1675344431
Table
Table 2. Mandibular third molars’ distribution (X2 = 1.16, p-value = 0.559).
Table 2. Mandibular third molars’ distribution (X2 = 1.16, p-value = 0.559).
BilateralUnilateralTotal
RightLeft
Male1091726261
Female982227245
Total2073953506
The number of third molars differed between males (479/937; 51.1%) and females (458/937; 48.9%). The impaction rate was 41.7% overall (391/937); 47.6% in females (218/458) and 36.12% in males (173/479) (X2 = 12.6928, p-value = 0.000367). Bilateral distribution was more frequent. Unilateral right maxillary third molars and left mandibular third molars were more common.
The impaction rates of the maxillary third molar were 32.9% overall (142/431), 50.7% on the right side (72/142), 49.3% on the left side (70/142), 37.3% in males (53/142), and 62.7% in females (89/142). The most common impaction pattern was the vertical position and level B (10.9%), followed by the distoangular position and level B (6.3%) (Table 3, Table 4 and Table 5).
Table
Table 3. Frequency of maxillary third molars’ angulation (X2 = 9.69, p-value = 0.021).
Table 3. Frequency of maxillary third molars’ angulation (X2 = 9.69, p-value = 0.021).
VerticalDistoangularMesioangularHorizontal
Male189 (43.9%)23 (5.3%)6 (1.4%)0 (0%)
Female165 (38.3%)30 (7%)14 (3.2%)4 (0.9%)
Table
Table 4. Frequency of maxillary third molars’ depth (X2 = 18.6, p-value = 0.00009).
Table 4. Frequency of maxillary third molars’ depth (X2 = 18.6, p-value = 0.00009).
Level ALevel BLevel C
Male172 (39.9%)31 (7.2%)15 (3.5%)
Female128 (29.7%)51 (11.8%)34 (7.9%)
Table
Table 5. Frequencies of maxillary third molars’ patterns (X2 = 22.79, p-value = 0.011).
Table 5. Frequencies of maxillary third molars’ patterns (X2 = 22.79, p-value = 0.011).
AngulationDepthMalesFemalesCounts% of Total
VerticalA16512428967.1 %
VerticalB19284710.9 %
DistoangularB1017276.3 %
VerticalC513184.2 %
DistoangularC79163.7 %
MesioangularC39122.8 %
DistoangularA64102.3 %
MesioangularB2571.6 %
HorizontalC0330.7 %
MesioangularA1010.2 %
HorizontalB0110.2 %
Total 218213431100%
The impaction rates of the mandibular third molar were 49.2% overall (249/506), 46.6%v on the right side (116/249), 53.4% on the left side (133/249), 48.2% in males (120/249), and 51.8% in females (129/249). The most common impaction pattern was the vertical position, level A, and class II (17.8%), followed by the mesioangular position, level A, and class II (5.1%) (Table 6, Table 7, Table 8 and Table 9).
Table
Table 6. Frequency of mandibular third molars’ angulation (X2 = 5.35, p-value = 0.253).
Table 6. Frequency of mandibular third molars’ angulation (X2 = 5.35, p-value = 0.253).
VerticalMesioangularDistoangularHorizontalInverted
Male198 (39.1%)33 (6.5%)16 (3.2%)13 (2.6%)1 (0.2%)
Female182 (36%)33 (6.5%)24 (4.7%)6 (1.2%)0 (0%)
Table
Table 7. Frequency of mandibular third molars’ depth (X2 = 4.44, p-value = 0.109).
Table 7. Frequency of mandibular third molars’ depth (X2 = 4.44, p-value = 0.109).
Level ALevel BLevel C
Male221 (43.7%)35 (6.9%)5 (1%)
Female191 (37.7%)50 (9.9%)4 (0.8%)
Table
Table 8. Frequency of mandibular third molars’ class (X2 = 1.01, p-value = 0.603).
Table 8. Frequency of mandibular third molars’ class (X2 = 1.01, p-value = 0.603).
Class IClass IIClass III
Male151 (29.8%)107 (21.1%)3 (0.6%)
Female139 (27.5%)105 (20.8%)1 (0.2%)
Table
Table 9. Frequencies of mandibular third molars’ patterns (X2 = 28.93, p-value = 0.049).
Table 9. Frequencies of mandibular third molars’ patterns (X2 = 28.93, p-value = 0.049).
AngulationDepthClassMalesFemalesCounts% of Total
VerticalAI14111625750.8 %
VerticalAII50409017.8 %
MesioangularAII1313265.1 %
MesioangularBII1213254.9 %
VerticalBII617234.5 %
DistoangularAII77142.8 %
DistoangularBII77142.8 %
DistoangularAI210122.4 %
MesioangularAI6391.8 %
HorizontalBII6391.8 %
VerticalBI1671.4 %
MesioangularBI1340.8 %
VerticalCII0330.6 %
HorizontalAII2130.6 %
HorizontalBIII2130.6 %
HorizontalCII3030.6 %
MesioangularCII1120.4 %
HorizontalAI0110.2 %
InvertedCIII1010.2 %
Total 261245506100%
Caries were found in 52.2% of the maxillary third molars and in 62.1% of the mandibular third molars, with statistical significance between jaws (p = 0.006), but with no statistical significance in each jaw alone (maxilla: p = 0.543, mandible: p = 0.087) (Table 10).
Table
Table 10. Frequency of caries by third molars’ location (X2 = 12.4, p-value = 0.006).
Table 10. Frequency of caries by third molars’ location (X2 = 12.4, p-value = 0.006).
Caries1828Maxillary3848Mandibular
+118107225 (52.2%)152162314 (62.1%)
-102104206 (47.8%)10884192 (37.9%)
Total 431 (100%) 506 (100%)
A percentage of 46.6% of the maxillary third molars were closed to the maxillary sinus, while 39.7% of the mandibular third molars were closed to the inferior alveolar canal (Table 11 and Table 12).
Table
Table 11. Relationship between maxillary third molar and maxillary sinus (X2 = 6.97, p-value = 0.008).
Table 11. Relationship between maxillary third molar and maxillary sinus (X2 = 6.97, p-value = 0.008).
MaleFemaleTotal
+88113201 (46.6%)
-130100230 (53.4%)
Table
Table 12. Relationship between mandibular third molar and inferior alveolar canal (X2 = 12.8, p-value = 0.0003).
Table 12. Relationship between mandibular third molar and inferior alveolar canal (X2 = 12.8, p-value = 0.0003).
MaleFemaleTotal
+84117201 (39.7%)
-177128305 (60.3%)

Discussion

According to earlier studies, the reported prevalence of impacted third molars differs among various racial and ethnic groups [9,10,11,12].
Impacted third molars were at a prevalence of 41.7% (32.9% of maxillary third molars and 49.2% of mandibular third molars) in this report. However, lower prevalence rates have been reported in research carried out on Chinese (27.8% [13]), Indian (27% [14]), Saudi (24.3% [15], 12.31% [9]), and Emirati (23.05% [16]) populations, and higher prevalence rates have been reported in Indians (76% [17]), Malaysians (73.5% [18], 67.6% [19]), Saudis (70% [20]), Singaporeans (68.6% [21]), and Omanis (54.3% [22]).
A percentage of 55.75% of impacted third molars were in females and 44.25% in males. The majority of studies stated that the frequency of impacted third molars was noticeably higher in females [2,15,16,23,24,25,26,27,28,29], whereas other studies reported more frequent impaction in males than females [8,10]. However, some studies have claimed that there was no difference between gender and the prevalence of impacted third molars [5,9,20,30,31,32].
A fascinating finding of the current study is that female impaction is deeper than male impaction (60.5% of level B impactions and 65.5% of level C impactions). Previous studies with comparable findings have been reported [5,15,18]. This is due to the difference in the growth rate, as the size of the jaws is smaller in females and their third molars often erupt after the growth of the jaws has been completed, whereas they erupt in males with the continued growth of the jaws [33].
Another significant finding of the current study was the higher distoangular impaction rates in females (58.1% of distoangular impactions). Females were found to impact distoangularly more frequently than males in earlier studies [15,16,18]. Given that females experience distoangular and deeper impaction, it is likely that impacted third molars in females will be harder to surgically remove than those in males.
In the current study, level B was the most frequent depth for impacted maxillary third molars (57.7%) and level A was the most frequent depth for impacted mandibular third molars (62.2%). According to the results of several earlier studies [2,4,6,9,10,25,28,34,35], level A was the most frequent impaction level. Earlier studies [1,5,15,16,20,26,27,36,37] found a higher level of impaction, even though level B was the most prevalent. Level C came at a lower frequency in the current study, while it was found to be the most frequent in Malaysian [18] and Turkish [38] samples.
The prevalence of bilateral impaction was higher in the present study. Similar results have been noted in earlier studies [9,20,21]. The prevalence of unilateral and bilateral impactions was nearly equal in previous studies [16,36]. Another study reported a lower rate of bilateral impaction [13].
Unilateral right maxillary and left mandibular impactions were more common. These results agreed with previous studies [8,25,27,28] in terms of the frequency of mandibular impaction on the left side, but differed from the results of Kalaiselvan, where the impaction is repeated equally between the two sides, and from Hekmatian, where the impaction was more frequent on the right side [10,29].
Many studies, including the one we conducted, found that the mandible and maxilla both exhibit the highest rates of vertical angulation [1,4,8,10,23,25,26,27,28,29,34,38,39,40,41], while numerous studies found that mesioangular impaction was the most typical pattern of angulation [2,5,6,9,13,15,16,18,20,31,36,42,43,44].
In the current report, the class II relationship with the ramus predominated (85.1% of impacted mandibular third molar), followed by class I and class III. Class II was more common in other studies, too [2,4,5,10,20,26,28,36].
In this study, caries were detected in 57.5% of impactions (52.2% of maxillary third molars and 62.1% of mandibular third molars). Other previous studies have shown different percentages of 12.2% [36], 14.86% [16], 18.75% [4], and 24.63% [42]. In addition, we found that vertical third molars were associated with more caries, followed by mesioangular impaction. Previous studies found that caries were more prevalent in mesioangular impaction followed by horizontal impaction [4,16,44], and in distoangular impaction [13,42]. Moreover, we found that caries were more prevalent in level A and in class I. Earlier studies support this finding [16,44].

Conclusions

Based on these results, the prevalence of impacted third molars in Syrian patients was 41.7%. This may be of considerable value because the possible related complications are costly and problematic. Moreover, the prevalence of impacted third molars was higher in the mandible than maxilla, and higher in females than in males. The most common impaction pattern of the maxillary third molar was a vertical position at level B, and the most common impaction pattern of the mandibular third molar was a vertical position at level A and Class II.
Regular monitoring of the third molar’s status should become an integral part of appropriate oral health care due to considerable differences. We recommend the use of panoramic radiographs for their usefulness in diagnosing the angulation and depth of the third molar, as well as in planning a proper surgical removal if needed.

Author Contributions

Conceptualization, A.Y.S., A.S.A. and R.A.H.; Methodology, A.Y.S., A.S.A. and R.A.H.; Validation, A.Y.S., A.S.A. and R.A.H.; Formal Analysis, A.Y.S., A.S.A. and R.A.H.; Investigation, A.Y.S., A.S.A. and R.A.H.; Resources, A.Y.S., A.S.A. and R.A.H.; Data Curation, A.Y.S., A.S.A. and R.A.H.; Writing—Original Draft Preparation, A.Y.S., A.S.A. and R.A.H.; Writing—Review & Editing, A.Y.S., A.S.A. and R.A.H.; Visualization, A.Y.S., A.S.A. and R.A.H.; Supervision, A.Y.S., A.S.A. and R.A.H.; Project Administration, A.Y.S., A.S.A. and R.A.H.

Funding

This study received no external funding.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Alfergani, S.M.; Latif, K.; Alanazi, Y.M. Pattern of Impacted Mandibular Third Molars in a Saudi Population. Pak. Oral Dent. J. 2017, 37, 407–410. [Google Scholar]
  2. Jaroń, A.; Trybek, G. The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population. Int. J. Environ. Res. Public Health 2021, 18, 6016. [Google Scholar] [CrossRef] [PubMed]
  3. Ayrancı, F.; Omezli, M.; Sivrikaya, E.; Rastgeldi, Z. Prevalence of Third Molar Impacted Teeth: A Cross-Sectional Study Evaluating Radiographs of Adolescents. JCEI 2017, 8, 50–53. [Google Scholar]
  4. Kumar, V.R.; Yadav, P.; Kahsu, E.; Girkar, F.; Chakraborty, R. Prevalence and Pattern of Mandibular Third Molar Impaction in Eritrean Population: A Retrospective Study. J. Contemp. Dent. Pract. 2017, 18, 100–106. [Google Scholar] [CrossRef]
  5. Padhye, M.N.; Dabir, A.V.; Girotra, C.S.; Pandhi, V.H. Pattern of mandibular third molar impaction in the Indian population: A retrospective clinico-radiographic survey. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2013, 116, e161–e166. [Google Scholar] [CrossRef] [PubMed]
  6. Byahatti, S.; Ingafou, M.S.H. Prevalence of eruption status of third molars in Libyan students. Dent. Res. J. (Isfahan) 2012, 9, 152–157. [Google Scholar] [CrossRef] [PubMed]
  7. Vranckx, M.; Ockerman, A.; Coucke, W.; Claerhout, E.; Grommen, B.; Miclotte, A.; Van Vlierberghe, M.; Politis, C.; Jacobs, R. Radiographic prediction of mandibular third molar eruption and mandibular canal involvement based on angulation. Orthod. Craniofac. Res. 2019, 22, 118–123. [Google Scholar] [CrossRef] [PubMed]
  8. Syed, K.B.; Alshahrani, F.S.; Alabsi, W.S.; Alqahtani, Z.A.; Hameed, M.S.; Mustafa, A.B.; Alam, T. Prevalence of distal caries among mandibular second molar due to impacted third molar teeth in Saudi population. J. Clin. Diagn. Res. 2017, 11, ZC28–ZC30. [Google Scholar] [CrossRef]
  9. Zaman, M.U.; Almutairi, N.S.; Abdulrahman Alnashwan, M.; Albogami, S.M.; Alkhammash, N.M.; Alam, M.K. 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. [Google Scholar] [CrossRef]
  10. KalaiSelvan, S.; Ganesh, S.K.N.; Natesh, P.; Moorthy, M.S.; Niazi, T.M.; Babu, S.S. Prevalence and Pattern of Impacted Mandibular Third Molar: An Institution-based Retrospective Study. J. Pharm. Bioallied. Sci. 2020, 12, S462–S467. [Google Scholar] [CrossRef]
  11. Jain, S.; Debbarma, S.; Prasad, S.V. Prevalence of impacted third molars among orthodontic patients in different malocclusions. Indian J. Dent. Res. 2019, 30, 238–242. [Google Scholar] [CrossRef] [PubMed]
  12. Sarica, I.; Derindag, G.; Kurtuldu, E.; Naralan, M.E.; Caglayan, F. A retrospective study: Do all impacted teeth cause pathology? Niger. J. Clin. Pract. 2019, 22, 527–533. [Google Scholar] [CrossRef] [PubMed]
  13. Ye, Z.-X.; Qian, W.-H.; Wu, Y.-B.; Yang, C. Pathologies associated with the mandibular third molar impaction. Sci. Prog. 2021, 104, 00368504211013247. [Google Scholar] [CrossRef] [PubMed]
  14. Venu, K.; Reddy, G.; Prasad, K. Prevalence of Third Molar Impactions in Urban Population of Age 22-30 Years in South India—An Epidemological Study. J. Indian Dent. Assoc. 2022, 5, 609–611. [Google Scholar]
  15. Idris, A.M.; Al-Mashraqi, A.A.; Abidi, N.H.; Vani, N.V.; Elamin, E.I.; Khubrani, Y.H.; Alhazmi, A.S.; Alamir, A.H.; Fageeh, H.N.; Meshni, A.A.; et al. Third molar impaction in the Jazan Region: Evaluation of the prevalence and clinical presentation. Saudi Dent. J. 2021, 33, 194–200. [Google Scholar] [CrossRef]
  16. Alsaegh, M.A.; Abushweme, D.A.; Ahmed, K.O.; Ahmed, S.O. 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, 306. [Google Scholar] [CrossRef]
  17. Sandhu, S.; Kaur, T. Radiographic evaluation of the status of third molars in the Asian-Indian students. J. Oral Maxillofac. Surg. 2005, 63, 640–645. [Google Scholar] [CrossRef]
  18. Mahdey, H.M.; Arora, S.; Wei, M. Prevalence and Difficulty Index Associated with the 3rd Mandibular Molar Impaction among Malaysian Ethnicities: A Clinico-Radiographic Study. J. Clin. Diagn. Res. 2015, 9, ZC65–ZC68. [Google Scholar] [CrossRef]
  19. Kanneppady, S.K.; Balamanikandasrinivasan; Kumaresan, R.; Sakri, S.B. A comparative study on radiographic analysis of impacted third molars among three ethnic groups of patients attending AIMST Dental Institute, Malaysia. Dent. Res. J. (Isfahan) 2013, 10, 353–358. [Google Scholar]
  20. Hatem, M.; Bugaighis, I.; Taher, E.M. Pattern of third molar impaction in Libyan population: A retrospective radiographic study. Saudi J. Dent. Res. 2016, 7, 7–12. [Google Scholar] [CrossRef]
  21. Quek, S.L.; Tay, C.K.; Tay, K.H.; Toh, S.L.; Lim, K.C. Pattern of third molar impaction in a Singapore Chinese population: A retrospective radiographic survey. Int. J. Oral Maxillofac. Surg. 2003, 32, 548–552. [Google Scholar] [CrossRef] [PubMed]
  22. Al-Anqudi, S.M.; Al-Sudairy, S.; Al-Hosni, A.; Al-Maniri, A. Prevalence and Pattern of Third Molar Impaction. Sultan Qaboos Univ. Med. J. 2014, 14, e388–92. [Google Scholar] [PubMed]
  23. 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, e106–e112. [Google Scholar] [CrossRef] [PubMed]
  24. Sejfija, Z.; Koҁani, F.; Macan, D. Prevalence of Pathologies Associated with Impacted Third Molars in Kosovar Population: An Orthopanthomography Study. Acta Stomatol. Croat. 2019, 53, 72–81. [Google Scholar] [CrossRef]
  25. Taghain, S.M.; Maboudi, A.; Goli, M.; Sameie, A.; Sadri, L. The Prevalence of Impacted Third Molar, Impaction Angulation, and Impaction Depth in Patients Visiting Dental Clinics and Private Offices in Ghaemshahr, Iran, in 2016. J. Res. Appl. Basic Med. Sci. 2022, 8, 83–89. [Google Scholar] [CrossRef]
  26. Zafar, E.; Rahim, M.; Hanif, M. Frequency & pattern of mandibular third molar impactions. A cross sectional study. Pak. Oral Dent. J. 2021, 41, 165–168. [Google Scholar]
  27. Abdorazzaghi, M.; Aida, M.; Hamid, A. The prevalence of impacted teeth in patients referred to selected dental clinics in Qom city, 2013, Iran. QOM Univ. Med. Sci. J. 2014, 8, 69–73. [Google Scholar]
  28. Hashemipour, M.A.; 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, e140. [Google Scholar] [CrossRef]
  29. Hekmatian, E.; Rahimmalek, A. ‪Prevalence of Impacted Mandibular Third Molars and Their Angulations on Panoramic Radiographs of Patients Referring to The Department of Radiology in Esfahan Faculty of Dentistry. J. Isfahan Dent. Sch. 2016, 140–148. [Google Scholar]
  30. Ventä, I.; Vehkalahti, M.M.; Huumonen, S.; Suominen, A.L. Prevalence of third molars determined by panoramic radiographs in a population-based survey of adult Finns. Community Dent. Oral Epidemiol. 2020, 48, 208–214. [Google Scholar] [CrossRef]
  31. Alfadil, L.; Almajed, E. Prevalence of impacted third molars and the reason for extraction in Saudi Arabia. Saudi Dent. J. 2020, 32, 262–268. [Google Scholar] [CrossRef]
  32. Bayoumi, A.; Baabdullah, R.; Bokhari, A.; Nadershah, M. The Prevalence Rate of Third Molar Impaction among Jeddah Population. Int. J. Dent. Oral Health 2016, 2, 1–4. [Google Scholar] [CrossRef]
  33. Rauf, S.; Ali, W.; Tariq, Q.; Chaudhry, R.; Kazmi, S.S.; Imtiaz, M. Pattern of mandibular third molar impaction: A radiographic study. Pak. Oral Dent. J. 2019, 39, 238–242. [Google Scholar]
  34. Al-Dajani, M.; Abouonq, A.O.; Almohammadi, T.A.; Alruwaili, M.K.; Alswilem, R.O.; Alzoubi, I.A. A Cohort Study of the Patterns of Third Molar Impaction in Panoramic Radiographs in Saudi Population. Open Dent. J. 2017, 11, 648. [Google Scholar] [CrossRef]
  35. Upadhyaya, C.; Chaurasia, N.K.; Neupane, I.; Srivastava, S. Incidence and Pattern of Impaction of Mandibular Third Molars: A Single Institutional Experience in Nepal. Kathmandu Univ. Med. J. (KUMJ) 2017, 15, 66–69. [Google Scholar]
  36. Haddad, Z.; Khorasani, M.; Bakhshi, M.; Tofangchiha, M.; Shalli, Z. Radiographic Position of Impacted Mandibular Third Molars and Their Association with Pathological Conditions. Int. J. Dent. 2021, 2021, e8841297. [Google Scholar] [CrossRef]
  37. Ogawa, A.; Fukuta, Y.; Nakasato, H.; Nakasato, S. Evaluation by dental cone-beam computed tomography of the incidence and sites of branches of the inferior dental canal that supply mandibular third molars. Br. J. Oral Maxillofac. Surg. 2016, 54, 1116–1120. [Google Scholar] [CrossRef]
  38. Yilmaz, S.; Adisen, M.Z.; Misirlioglu, M.; Yorubulut, S. Assessment of Third Molar Impaction Pattern and Associated Clinical Symptoms in a Central Anatolian Turkish Population. MPP 2016, 25, 169–175. [Google Scholar] [CrossRef]
  39. Kumar Pillai, A.; Thomas, S.; Paul, G.; Singh, S.K.; Moghe, S. Incidence of impacted third molars: A radiographic study in People’s Hospital, Bhopal, India. J. Oral Biol. Craniofac. Res. 2014, 4, 76–81. [Google Scholar] [CrossRef]
  40. Almendros-Marqués, N.; Berini-Aytés, L.; Gay-Escoda, C. Influence of lower third molar position on the incidence of preoperative complications. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol. 2006, 102, 725–732. [Google Scholar] [CrossRef]
  41. Enabulele, J.E. Gender Variation in Pattern of Mandibular Third Molar Impaction. JDODT 2017, 5, 1–4. [Google Scholar] [CrossRef]
  42. Tai, S.; Zhou, Y.; Pathak, J.L.; Piao, Z.; Zhou, L. The association of mandibular third molar impaction with the dental and periodontal lesions in the adjacent second molars. J. Periodontology. 2021, 92, 1392–1401. [Google Scholar] [CrossRef] [PubMed]
  43. Obiechina, A.E.; Arotiba, J.T.; Fasola, A.O. Third molar impaction: Evaluation of the symptoms and pattern of impaction of mandibular third molar teeth in Nigerians. Odonto-Stomatologie Tropicale = Trop. Dent. J. 2001, 24, 22–25. [Google Scholar]
  44. Prajapati, V.K.; Mitra, R.; Vinayak, K.M. Pattern of mandibular third molar impaction and its association to caries in mandibular second molar: A clinical variant. Dent. Res. J. 2017, 14, 137. [Google Scholar]