The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population

Abstract

Classifications of impacted teeth allow defining the type and degree of retention, as well as assessing the degree of difficulty of the procedure. The aim of this study was to conduct retrospective analysis of the degree of retention and difficulty in the surgical removal of impacted mandibular third molars in the clinical material of the Department of Oral Surgery in 2013–2018. This study included 1585 dental panoramic radiographs of patients of the Department of Oral Surgery, who reported in 2013–2018, in order to perform surgical removal of the impacted mandibular third molar. Based on dental panoramic radiographs, the degree of retention was determined based on classifications according to Winter, according to Pell and Gregory, according to Tetsch and Wagner, and according to Asanami and Kasazaki. The difficulty of the procedure was also assessed based on the Pederson index. The most common types of lower wisdom tooth impaction are as follows: in Winter’s classification, mesial-angular impaction; in Tetsch and Wagner’s classification, oblique medial-angular impaction; in Pell and Gregory’s classification, impaction grade 2A; and in Asanami and Kasazaki’s classification, 3A and anterior inclination. In most cases of surgical removal of an impacted tooth, the anticipated difficulty of the procedure was rated as very difficult.

Effect of Platelet-Rich Fibrin Application on Non-Infectious Complications after Surgical Extraction of Impacted Mandibular Third Molars

“…Our study showed a more significant variation in the spatial position of teeth scheduled for extraction than in the above investigators. In addition, root anatomy, which is sometimes independent of the spatial position of the tooth, is an essential factor determining the difficulty of the procedure [51]. It should be noted that variations in the root structure of wisdom teeth often affect the anatomic scope of the surgical extraction procedure.…”

The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy

“…These symptoms can be observed particularly frequently as a consequence of surgical removal of mandibular third molars—a procedure considered to be the one of the most difficult and time-consuming among all oral surgery procedures. At the same time, it constitutes one of the most frequently performed procedures within this specialty [ 1 , 2 , 3 , 4 ]. The factors that determine the difficulty of the surgical procedure of avulsion of the third molar are depth and space available for removal of the impacted mandibular third molar, the angulation of the tooth, root spacing, size of the bone septum, presence or absence of a dilated tooth follicle, periodontal space, bone density, and the relation to the inferior alveolar nerve.…”

Assessment of Electrosensitivity of the Pulp of the Mandibular Second Molar after Surgical Removal of an Impacted Mandibular Third Molar

“…Table 1 summarizes the detailed results of the study sample. The spatial location of impacted third molars in the mandible was determined using Winter and Pell and Gregory's classifications [6]. The position of the impacted teeth is shown in Table 2.…”

“…Like any other surgery, it involves the risk of complications including tissue swelling, trismus, pain, infection, lip and tongue sensory deficits as well as damage to an adjacent tooth [3]. The age, gender of the patient, the degree of retention of the impacted tooth, and the operator's experience affect the appearance of complications associated with the surgical removal of an impacted mandibular third molar [4][5][6]. Complications prolong the postoperative recovery period and cause swelling, trismus, or inflammatory complications and may eventually lead to clinical changes in the mandibular second molar region [7].…”