Home Print this page Email this page
Users Online: 353
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 3  |  Issue : 1  |  Page : 24-27

Frequency of impacted and missing third molars among orthodontic patients in the population of Punjab


1 Department of Orthodontics & Dentofacial Orthopedics, Dasmesh Institute of Research & Dental Sciences, Faridkot, Punjab, India
2 Private practitioner, Jagraon, India
3 Department of Oral and Maxillofacial Surgery, Gian Sagar Dental College & Hospital, Rajpura, India
4 Department of Orthodontics and Dentofacial Orthopedics, Rama Dental College, Kanpur, India

Date of Web Publication27-Sep-2012

Correspondence Address:
Sumit Bansal
Department of Orthodontics & Dentofacial Orthopedics, Dasmesh Institute of Research & Dental Sciences, Faridkot, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions
  Abstract 

Background : The pattern of third molar impactions and agenesis varies in different population groups. The frequency of mandibular third molar impaction and agenesis is quite frequent in the population of Punjab.
Materials and Methods : Pretreatment records of 400 patients, who underwent orthodontic treatment in the Punjab population (aged 13 to 25 years; mean age = 17.5 years) were entered into the study for checking the frequency of missing third molars and out of those, 200 patients with presence of third molars and more than 2/3 rd root formation (aged 18 to 25 yrs; mean age = 22.5 yrs) were evaluated for frequency of impacted third molars. The prevalence of third molar impactions and agenesis was calculated in terms of gender and jaw involvement.
Results : Among the 400 subjects studied, 167 third molars were missing in 104 patients (26%). Among the 200 subjects with more than 2/3 rd root formation who were studied for impacted third molars, 64 subjects (32 %) were diagnosed with 112 third molar impactions. It was found that the frequency of impacted third molars was more in mandible than in the maxilla.
Conclusion : These results suggest that impaction and agenesis of the third molar is a relatively common finding these days. Frequency of impacted third molar teeth is more than the missing third molars.

Keywords: Impaction, mineralization, third-molar agenesis


How to cite this article:
Bansal S, Gupta K, Garg S, Srivastava SC. Frequency of impacted and missing third molars among orthodontic patients in the population of Punjab. Indian J Oral Sci 2012;3:24-7

How to cite this URL:
Bansal S, Gupta K, Garg S, Srivastava SC. Frequency of impacted and missing third molars among orthodontic patients in the population of Punjab. Indian J Oral Sci [serial online] 2012 [cited 2017 Sep 25];3:24-7. Available from: http://www.indjos.com/text.asp?2012/3/1/24/101672


  Introduction Top


Third molars are most likely to be impacted than any other teeth in the oral cavity. [1],[2] The third molars can vary considerably in size, contour and relative position to the other teeth. All mandibular and maxillary third molars show more variation in development than any of the other teeth in the mouth. Most of the mandibular third molars are undersized. Mandibular third molars are the most likely to be impacted, wholly or partially in the jaw. The lack of space accommodation has been proposed as the chief cause. [3] During the correction of the malocclusion, it is the duty of the orthodontist to correct all the possible tooth malalignments and as most of the orthodontic patients are in the growing age group, early knowledge of the third molar eruption status will help in better treatment of the patient. Castella et al, found that the impaction of third molars in the mandible was a predictable event both in extraction and non-extraction patients. [4] Agenesis of the third molar is also a common occurrence, but its frequency varies in different studies. [5],[6],[7] The frequency of the third molar agenesis in decreasing order of occurrence is two, followed by one, three and all four third molars [8] and in another study, it is referred to as one missing third molar followed by two, three and all the four third molars. [9]


  Materials and Methods Top


This study was undertaken with the pretreatment records of 400 orthodontic patients in the population of Punjab. The patients between 13 to 25 yrs of age and those who had not received previous orthodontic treatment were included in the study. These subjects were evaluated for the frequency of missing third molars. A third molar was classified as developmentally missing when there was no evidence that it had been extracted and when there was no sign of mineralization of the third molar tooth crown on the panoramic radiographs. Radiographs taken at the initial examination were used to determine the presence of third molar germs. The third molar agenesis was calculated with respect to gender predilection and jaw involvement. In a total sample size of 400 patients, 200 patients (aged 18 to 25 yrs; mean age, 22.5 yrs) with presence of 3 rd molars, whose root formation was more than 2/3 rd complete were checked for frequency of impacted third molars. A 3 rd molar tooth was classified as impacted when it has not erupted into oral cavity even after 2/3 rd root completion. The prevalence of third molar impactions and agenesis was again calculated in terms of gender and jaw involvement. Subjects with congenital deformities, such as a cleft palate and patients with any kind of oral pathologies were excluded from the study. In addition, the subjects with a missing tooth other than a third molar were not included in the study. None of the subjects had undergone surgical removal or extraction of third molar in the past.


  Results Top


In a sample of 400 subjects, present study showed that 167 third molars were missing in 104 patients (26%). The study revealed that the frequency of missing maxillary third molars (60%) is almost 1.5 times more than the mandibular ones (40%). 46 females had 76 and 16 males had 24 missing maxillary third molars respectively. 30 females had 49 and 12 males had 18 missing mandibular third molars respectively [Table 1] and [Figure 1].
Figure 1: Missing third molars

Click here to view


Among the 200 subjects with presence of 3 rd molars and more than 2/3 rd root completion, 64 subjects (30%) in total were diagnosed with 112 third molar impactions. Out of these 34 were males and 30 were females. Two males and two female patients had two maxillary impacted third molars each. Frequency of impacted third molars was more in mandible than in the maxilla. More than 90% of the impacted teeth in this study were mandibular third molars. 32 male patients and 28 female patients having impacted teeth despite 2/3 rd root completion had a total of 57 and 51 impacted mandibular third molars respectively. [Table 2] and [Figure 2].
Figure 2: Impacted third molars

Click here to view
Table 1: Missing third molars


Click here to view
Table 2: Impacted third molars


Click here to view



  Discussion Top


Third molars are most likely to be impacted than any other teeth in the oral cavity. [1],[2] In this study, mandibular third molars were more often impacted as compared to the maxillary third molars. These results are in conjunction with studies conducted in past which showed impaction rate of mandibular third molars is more than that of maxillary third molars. [10],[11] Lack of adequate retromolar space may be considered as the main factor in the third molar impactions. [3],[12],[13] Other factors can be the vertical height of the anterior border of the ramus, length of the posterior basal corpus, mesio-distal diameters of the first, second and the third molars, number of third molar roots, inclination of the first molar, vertical height of the posterior border of the ramus, vertical height of alveolar crest, and height and the width of the retro-molar space, which all tend to decrease in direct proportion to the possibility of impaction of the third molar. [14] Third molar impactions were found to be more common in the female patients as compared to the male patients in previous study as well as present study. [15]

Among the various factors which demand attention with retained impacted third molars is the fact that the patients are more susceptible to angle fracture of the mandible. [16],[17] Besides, patients with impacted mandibular third molars may present with pain, caries, gingivitis and oral infections. [18] These are the reasons, why prophylactic extraction of fully impacted third molar teeth is considered as an ideal approach by many dental surgeons these days. [19],[20]

Present study revealed that 167 third molars were missing (26 %) which is more than that reported by Lynham (22.7%), [5] Sandhu et al. (11.5%) [6] and Hattab et al (9.1%) [7] It has been suggested that the frequency of missing third molars was more in females than males [21],[22] which is again in confirmation with our study. Current study also showed that the third molar agenesis was more common in the maxilla as compared to mandible. It has been found in the previous studies that when a third molar is absent, agenesis of the remaining teeth is 13 times more likely. [23]

Almost half of the patients had either missing or impacted third molar teeth, thus showing the increased tendency of variability in development of the third molar.


  Conclusion Top


Third molar impaction and agenesis are relatively common these days owing to the diet pattern and genetic predisposition. [11],[24],[25] We have found in our study that impactions were more common in the mandible than in the maxilla that can be attributed to lack of adequate retromolar space. [3],[12],[13] Third molar impactions were more common in the male patients as compared to the female patients.

Present study also supported previous studies suggesting that third molar agenesis was more common in the maxillary third molars [21],[22] and that it is more common in the female patients. [22]

 
  References Top

1.Bishara SE, Andreasen G. Third molars: a review. Am J Orthod 1983;83:131-7.  Back to cited text no. 1
[PUBMED]    
2.Dachi SF, Howell FV. A survey of 3874 routine full-mouth radiographs. II. A study of impacted teeth. Oral Surg Oral Med Oral Pathol 1961;14:1165-9.  Back to cited text no. 2
    
3.Ash MM. Wheeler's dental anatomy, physiology and occlusion, 7 th ed. Philadelphia: W.B. Saunders; 1993. p. 266-99.  Back to cited text no. 3
    
4.Castella P, Albright RH Jr, Straja S, Tuncay OC. Prediction of mandibular third molar impaction in the orthodontic patient from a panoramic radiograph. Clin Orthod Res 1998;1:37-43.  Back to cited text no. 4
[PUBMED]    
5.Lynham A. Panoramic radiographic survey of hypodontia in Australian Defence Force recruits. Aust Dent J 1990;35:19-22.  Back to cited text no. 5
[PUBMED]    
6.Sandhu S, Kaur T. Radiographic evaluation of the status of third molars in the Asian-Indian students. J Oral Maxillofac Surg 2005;63:640-5.  Back to cited text no. 6
[PUBMED]    
7.Hattab FN, Fahmy MS, Rawashedeh MA. Impaction status of third molars in Jordanian students. Oral Surg Oral Med Oral Pathol 1995;79:24-9.  Back to cited text no. 7
    
8.Banks HV. Incidence of third molar development. Angle Orthod 1934;4:223-33.  Back to cited text no. 8
    
9.Nanda RS. Agenesis of the third molar in man. Am J Orthod Dentofacial Orthop 1954;40:698-706.  Back to cited text no. 9
    
10.Breik O, Grubor D. The incidence of mandibular third molar impactions in different skeletal face types. Aust Dent J 2008;53:320-4.  Back to cited text no. 10
[PUBMED]    
11.Olasoji HO, Odusanya SA. Comparative study of third molar impaction in Rural and urban areas of south-western Nigeria. Odontostomatol Trop 2000;2:25-8.   Back to cited text no. 11
    
12.Bjo¨rk A, Jensen E, Palling M. Mandibular growth and third molar impaction. Acta Odont Scand 1956;14:231-71.  Back to cited text no. 12
    
13.Bjo¨rk A. Variations in the growth pattern of the human mandible: Longitudinal radiographic study by the implant method. J Dent Res 1963;42(Suppl 1):400-11.  Back to cited text no. 13
    
14.Kaya GS, Aslan M, Ömezli MM, Dayi E. Some morphological Features related to mandibular third molar impaction. J Clin Exp Dent 2010;2:e12-7.  Back to cited text no. 14
    
15.Quek SL, Tay CK, Tay KH, Toh SL, Lim KC. Pattern of third molar impaction in a Singapore Chinese population: A retrospective radiographic survey. Int J Oral Maxillofac Surg 2003;32:548-52.  Back to cited text no. 15
    
16.Fuselier JC, Ellis EE 3 rd , Dodson TB. Do mandibular third molars alter the risk of angle fracture? J Oral Maxillofac Surg 2002;60:514-8.  Back to cited text no. 16
    
17.Meisami T, Sojat A, Sàndor GK, Lawrence HP, Clokie CM. Impacted third molars and risk of angle fracture. Int J Oral Maxillofac Surg 2002;31:140-4.  Back to cited text no. 17
    
18.McGrath C, Comfort MB, Lo EC, Luo Y. Can third molar surgery improve quality of life? A 6- month cohort study. J Oral Maxillofac Surg 2003;61:759-63.  Back to cited text no. 18
    
19.Saðlam AA, Tüzüm MS. Clinical and radiologic investigation of the incidence, complications, and suitable removal times for fully impacted teeth in the Turkish population. Quintessence Int 2003;34:53-9.  Back to cited text no. 19
    
20.Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: Postoperative complications and their risk factors. J Can Dent Assoc 2007;73:325-31.  Back to cited text no. 20
    
21.Daito M, Tanaka T, Hieda T. Clinical observations on the development of third molars. J Osaka Dent Univ 1992;26:91-104.   Back to cited text no. 21
    
22.Celikoglu M, Kamak H. Patterns of third-molar agenesis in An orthodontic patient population with different skeletal malocclusions. Angle Orthod 2012;82:165-9.  Back to cited text no. 22
    
23.Bailit HL. Dental variation among populations: an anthropologic view. Dent Clin North Am 1975;19:125-39.  Back to cited text no. 23
    
24.Odunsanya SA. Third molar impaction among Nigeria youths. Odontostomatol Trop 1984;2:76-83.  Back to cited text no. 24
    
25.De Coster PJ, Marks LA, Martens LC, Huysseune A. Dental agenesis: Genetic and clinical perspectives. J Oral Pathol Med 2009;38:1-17.  Back to cited text no. 25
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed3334    
    Printed134    
    Emailed0    
    PDF Downloaded328    
    Comments [Add]    

Recommend this journal