External root resorption of second molars caused by impacted third molars: an observational study in panoramic radiographs

Abstract Objective This research investigate the presence of external root resorption (ERR) in second molars caused by impacted third molars in panoramic radiographs, relating to the position of third molars according to classification of Winter, Pell and Gregory. Material and method A cross-sectional, retrospective study using panoramic radiographs obtained from January 2014 to December 2015. The inclusion criterion was the presence of a second molar adjacent to an impacted third molar. Data were analyzed using descriptive and inferential statistics. Pearson's Chi-Square Test and Fisher's Exact Test (p≤0.05) were performed. Result The sample consisted of 584 panoramic radiographs, 356 (60.95%) of women, and 228 (39.05%) of men, the mean age was 25.31 years. The prevalence of ERR was 12.5%, and the group of 14-24 year olds was the most affected (p = 0.46). The presence of ERR was statistically higher in the mandible (42.1%) with p=0.01. The ERR located in the cervical (57.1%) and medium (58.8%) thirds was proportionally higher in the teeth with B2 (p=0.02) and mesio-angular positions (p=0.26). Conclusion The prevalence of ERR in second molars, caused by impacted third molars, was shown to be similar to results found in the literature, with no gender preference, this affects young patients, occurring frequently in mandible teeth, and presents greater severity in the cervical and middle thirds. The B2 and mesio-angular positions were more prone to ERR.

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Impacted Third Molars and Its Propensity to stimulate External Root Resorption in Second Molars: Comparison of Orthopantomogram and Cone Beam Computed Tomography

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1451 ◽

2017 ◽

Vol 8 (4) ◽

pp. 281-287

Author(s):

Almas Binnal ◽

Zeena V D'Costa ◽

Junaid Ahmed

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Root Resorption ◽

Third Molar ◽

Cone Beam ◽

Third Molars ◽

Panoramic Radiographs ◽

Second Molar ◽

Impacted Third Molar ◽

External Root Resorption

ABSTRACT Aim This study was designed to compare the efficiency of conebeam computed tomography (CBCT) with panoramic radiography to discern external root resorption (ERR) in second molars. Materials and methods This was a retrospective study with a sample size of 50 participants who had a total of 120 impacted third molars visible on panoramic radiographs and CBCT images. The presence of ERR on the neighboring second molar was assessed and the position of impacted third molar was determined using Pell and Gregory classification. The ERR was registered according to Al-Khateeb and Bataineh's criteria. The location and severity were assessed by Ericson et al criteria, and grading of ERR was done as per the criteria given by Nemcovsky. Results The CBCT was able to locate and identify extremely large number of cases with ERR on second molars in comparison with the panoramic radiographs. Based on Pell and Gregory classification, position B was most common. The ERR on second molars was most commonly seen at the cervical region. Most of the cases had mild severity. As per grading mentioned by Nemcovsky, maximum number of cases were given grade A followed by grade B. Conclusion According to our study and considering the threedimensional information obtained from CBCT, we found that ERR was better detected with CBCT. Clinical significance If on panoramic radiographs, a close contact is detected between the second molar and an impacted third molar, CBCT can be advised taking into account the “risk vs reward ratio.” How to cite this article D'Costa ZV, Ahmed J, Ongole R, Shenoy N, Denny C, Binnal A. Impacted Third Molars and Its Propensity to stimulate External Root Resorption in Second Molars: Comparison of Orthopantomogram and Cone Beam Computed Tomography. World J Dent 2017;8(4):281-287.

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Influence of Surgical Flap Design (Envelope and Szmyd) for Removal of Impacted Mandibular Third Molars on Clinical Periodontal Parameters: A Clinical Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094465 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4465

Author(s):

Muhtada Ahmad ◽

Zafar Ali Khan ◽

Tahir Ullah Khan ◽

Montaser N. Alqutub ◽

Sameer A. Mokeem ◽

...

Keyword(s):

Third Molar ◽

Periodontal Pocket ◽

Third Molars ◽

Chi Square ◽

Pocket Depth ◽

Clinical Attachment Loss ◽

Exact Test ◽

Second Molar ◽

Third Molar Extraction ◽

Flap Design

The aim of the study was to assess the influence of flap designs (Envelope flap (EF) and Szmyd flap (SF)) for impacted mandibular third molar extraction, on periodontal pocket depth (PPD), clinical attachment loss (CAL) and bone levels (BL) of second molar. Sixty patients indicated for third molar extractions with healthy second molars were allocated into two groups: EF and SF (n = 30). Third molars were assessed for angulation, root patterns, depth of impactions and relation with ramus (Pell and Gregory classification). Extraction of third molars was performed and PPD, CAL and BL around second molars at 0, 3 and 6 month (mon) follow-ups (FU) were assessed clinically and radiographically. ANOVA, Chi-square and Fisher’s exact test were employed to compare periodontal factors between EF and SF groups, considering p ≤ 0.05 as significant. Sixty participants with a mean age of 23.22 ± 3.17 were included in the study. Based on angulation, the most common impaction in the EF and SF groups was mesio-angular (EF, 50%; SF, 36.7%). Buccal and distal PPD showed a significant increase (p < 0.001) in both EF and SF patients from baseline to 6 mon. EF patients showed significantly higher distal and buccal CAL (6.67 ± 0.18 mm; 6.91 ± 0.17 mm) and BL (7.64 ± 0.16 mm; 7.90 ± 0.15 mm) as compared to SF patients (CAL, 6.76 ± 0.26 mm; 6.91 ± 0.17 mm-BL, 7.42 ± 0.38 mm; 7.34 ± 0.34 mm) at 6 mon FU. SF showed better soft tissue attachment (PPD and CAL) and bone stability (less bone loss) around second molars compared to EF after third molar extractions regardless of the patient, tooth and operator factors.

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Frequency and Severity of Second Molar External Root Resorption Due to the Adjacent Third Molar and Related Factors: A Cone-Beam Computed Tomography Study

Frontiers in Dentistry ◽

10.18502/fid.v18i36.7561 ◽

2021 ◽

Author(s):

Shirin Sakhdari ◽

Sara Farahani ◽

Ehsan Asnaashari ◽

Sahel Marjani

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Root Resorption ◽

Third Molar ◽

Cone Beam ◽

Radiology Department ◽

Third Molars ◽

Related Factors ◽

Second Molar ◽

External Root Resorption

Objective: This study sought to assess the frequency and severity of second molar external root resorption (ERR) due to the adjacent third molar and its correlation with the position of third molar and other related factors using cone-beam computed tomography (CBCT). Materials and Methods: This cross-sectional study evaluated 320 second molars and their adjacent impacted third molars on CBCT scans of patients over 16 years, retrieved from the archives of Azad University Radiology Department. Presence/absence of second molar ERR, its location and severity (if present), and position of adjacent third molar were determined on CBCT scans, and recorded in a checklist. Data were analyzed using a logistic regression model. Results: The frequency of second molar ERR was 33.4% in the mandible and 14% in the maxilla. The severity of ERR was significantly correlated with the involved jaw (P=0.001) but had no correlation with age, gender, or depth of impaction of adjacent third molar (P>0.05). The mesioangular and horizontal positions of impacted third molars had a significant correlation with the frequency of second molar ERR (P<0.006). Conclusion: According to the results of this study, ERR occurring in second molars adjacent to third molars is common, especially in the mandible. Mesially inclined third molars have a greater potential of being associated with ERR in second molars.

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Analysis of External Root Resorption of the Second Molar Associated with an Impaction of the Third Molar by the Application of CBCT

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2019-0053 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Stefan Velickovic ◽

Milos Zivic ◽

Zlata Rajkovic ◽

Dragana Stanisic ◽

Aleksandra Misic ◽

...

Keyword(s):

Surgical Intervention ◽

Root Resorption ◽

Third Molar ◽

Third Molars ◽

Second Molar ◽

Dental Tissues ◽

Impacted Third Molar ◽

External Root Resorption ◽

Lower Jaw ◽

Total Prevalence

Abstract External root resorption (ERR) of a tooth represents a process in which irreversible damage occurs to solid dental tissues, more precisely of the cement and dentin. External resorption occurs on the root surface or periodontal ligament, and it is manifested by the loss of cement and/or dentine. The prevalence of ERR of the second molar associated with an impacted third molar, based on retro-alveolar radiography and orthopantomography, ranges from 0.3% to 24.2%. The aim of this research was to analyze ERR of the upper and lower jaw associated with the impacted third molar by the application of the Come Beam Computed Tomography. This study included 96 third molars in the upper and lower jaw of a total of 46 analyzed patients’ images. Total prevalence of the second molar ERR associated with the impacted third molar was 8.82%. The second molar ERR was observed in 8 patients (7.84%). Frequency of the second molar ERR in the lower jaw is higher, and it is 8.2%, while in the upper jaw it is only 1% (r = 0.032). Impacted third molars associated with the second molar ERR were most frequently in horizontal (5.1%) and mesioangular (4.1%) position (p = 0.000). The second molar ERR could be avoided by the preventive extraction of mesioangular or horizontal third molars. An adequate decision on the extraction of impacted third molars must be made by the careful assessment of risks and benefits of this surgical intervention. Before the surgical intervention, an adequate care of the second molar, adequate restoration, endodontic treatment or root resection should be done if necessary.

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Impact of CBCT on treatment decision related to surgical removal of impacted maxillary third molars: does CBCT change the surgical approach?

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20190209 ◽

2019 ◽

Vol 48 (8) ◽

pp. 20190209 ◽

Cited By ~ 4

Author(s):

Louise Hermann ◽

Ann Wenzel ◽

Lars Schropp ◽

Louise Hauge Matzen

Keyword(s):

Initial Treatment ◽

Root Resorption ◽

Treatment Plan ◽

Third Molar ◽

Treatment Decision ◽

Panoramic Image ◽

Third Molars ◽

Second Molar ◽

The Third ◽

External Root Resorption

Objectives: To assess factors influencing treatment decision for maxillary third molars referred for cone beam CT (CBCT). Parameters influencing the decision to treat and to remove either the maxillary second molar or third molar were pursued. Methods: 111 impacted maxillary third molars, clinically examined including a panoramic image, in 86 patients (mean age 26 years, range 15–55) were referred for CBCT on suspicion of pathology/root resorption in the second molar, based on information in the panoramic image. The following parameters were assessed from the patient’s file, including the radiographic images: (1) third molar angulation; (2) initial treatment plan based on clinical examination and the panoramic image; (3) diagnoses based on information from CBCT; (4) treatment decision after additional CBCT information was available; (5) pre-/post-operative complications; (6) treatment of the maxillary second molar. Results: 70 cases (63.1%) underwent treatment, while 41 (36.9%) received no treatment. Change in treatment plan was registered in 65 cases (58.6%) after CBCT. In 12 cases (10.8%), treatment changed from removal of the third to removal of the second molar, while 25 (22.5%) were scheduled for removal in the initial treatment plan; but after CBCT, the decision was not to treat. If external root resorption involved the pulp of the second molar, there was an almost 17 times higher risk that this tooth was removed instead of the third molar (logistic regression analysis: odds ratio 16.8; p < 0.001). Conclusions: Findings in CBCT often changed the treatment plan. Severe external root resorption observed in CBCT was the main decisive factor for removing the second instead of the third molar.

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Panoramic Radiographic Analysis of Signs of Proximity to the Third Molar Roots of the Mandibular Canal in Yemen

Journal of Medical Clinical Case Reports ◽

10.47485/2767-5416.1017 ◽

2020 ◽

Keyword(s):

Third Molar ◽

Mandibular Canal ◽

Cross Sectional Study ◽

Third Molars ◽

Cross Sectional ◽

Panoramic Radiographs ◽

Second Molar ◽

Female Patients ◽

The Third ◽

Dental Clinics

Objectives: The objectives of this study were to assess the relationship between the third molar and the mandibular canal, to identify the radiographic markers most prevalent in predicting connectivity between these structures, and to associate these signs and proximity with the position of the third molar according to Bell, Gregory’s and Winter’s classifications. Subjects and methods: A retrospective cross-sectional study was conducted in the city of Sana’a on a sample of Yemeni patients in Ammar Dental Clinics who underwent panoramic radiography in the year 2019 until September 2020. The study consisted of panoramic radiographs of 597 patients with third molars with a total of 1017 third molars; the number of males was 216 (36.2%) and 381 females (63.8%). The panoramic radiographs were evaluated for proximity signs. Inclusion criteria were patients of both sexes who had at least a fully formed third molar of the mandible that was adjacent to the second molar. The radiographs were excluded if evidence of cystic, neoplastic, or extensive caries processes was detected. Seven radiological signs were used to determine if there was contact between the third molar and the mandibular canal. Results: A proximity to the mandibular canal was verified for 620 (61%) of 1017 third molars. The most frequent radiographic signs of proximity were darkened roots (315 teeth [31%]) and discontinuity of the mandibular canal (267 teeth [26.3%]). Third molar/mandibular canal proximity was found significantly more frequently in female patients and in patients aged 24 years and younger (P < 0.001). The tooth positions most frequently associated with proximity between the third molar and the mandibular canal were position C (highest point of the third molar located at or below the cervical margin of the second molar) and the mesioangular position (long axis of the third molar angled mesially toward the second molar). Conclusions: The frequency of third molar/ mandibular canal proximity was greater in female patients and patients aged 24 years or younger. The most frequently observed signs of proximity were darkening of the roots and discontinuity of the mandibular canal. The tooth positions most frequently associated with proximity of the third molar to the mandibular canal were position C and the mesioangular position.

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Assessment of role of mandibular third molar in lower anterior crowding among orthodontic patients of Kathmandu Nepal

Orthodontic Journal of Nepal ◽

10.3126/ojn.v10i3.35486 ◽

2020 ◽

Vol 10 (3) ◽

pp. 21-26

Author(s):

Bashu Dev Pant ◽

Anjana Rajbhandari ◽

Resina Pradhan ◽

Manju Bajracharya ◽

Surendra Maharjan ◽

...

Keyword(s):

Third Molar ◽

Cross Sectional Study ◽

Third Molars ◽

Chi Square ◽

Cross Sectional ◽

Anterior Crowding ◽

Mandibular Third Molar ◽

Significant Difference ◽

Orthodontic Patients

Introduction: Crowding in mandibular arch increases with increasing age and etiology of crowding is multifactorial in nature. Role of mandibular third molar in lower anterior crowding remains a topic of controvery over a period of century. The objective of this study was to assess whether there is any correlation between presence of mandibular third molar position and lower anterior crowding. Materials and Method: On the basis of third molar position one hundred and six sample of pretreatment orthodontic patients aged between 17 to 38 years were divided into erupted, erupting and agenesis group. The study was conducted in Peoples Dental College and Hospital from January 2020 to March 2020 after obtaining ethical approval from the institutional review committee. This cross-sectional study was done on dental casts and orthopantomogram; brass wire was used for measuring arch length and digital vernier caliper for measuring tooth material with modified segmental arch analysis method. Result: Among 106 samples collected 55 (51.88%) were female and 51(48.11%) were male and the mean age was 21.53 ± 3.91 years, Chi square and ANOVA test was used for Statistical analysis. This study showed no statistically significant differences between third molar position and lower anterior crowding on right (P= 0.68) and left side (P = 0.45). The study also showed that association between the third molar position and lower anterior crowding is more on left side compared to right side. Conclusion: Mandibular third molars have not statistically significant difference in lower anterior crowding so, extraction of third molars for relieving the anterior crowding is not justifiable

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External root resorption of the second molar associated with mesially and horizontally impacted mandibular third molar: evidence from cone beam computed tomography

Clinical Oral Investigations ◽

10.1007/s00784-016-1888-y ◽

2016 ◽

Vol 21 (4) ◽

pp. 1335-1342 ◽

Cited By ~ 22

Author(s):

Dongmiao Wang ◽

Xiaotong He ◽

Yanling Wang ◽

Zhongwu Li ◽

Yumin Zhu ◽

...

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Root Resorption ◽

Third Molar ◽

Cone Beam ◽

Second Molar ◽

External Root Resorption ◽

Impacted Mandibular Third Molar ◽

Mandibular Third Molar

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Cone beam tomography and panoramic radiography in localization of impacted maxillary canine and detection of root resorption

STOMATOLOGY EDU JOURNAL ◽

10.25241/stomaeduj.2020.8(2).art.3 ◽

2021 ◽

Vol 8 (2) ◽

pp. 106-112

Author(s):

Seden Akan ◽

◽

Husamettin Oktay ◽

Keyword(s):

Root Resorption ◽

Cone Beam ◽

Test Results ◽

Chi Square ◽

Exact Test ◽

Panoramic Radiographs ◽

Panoramic Images ◽

Chi Square Test ◽

Index 2 ◽

Cone Beam Tomography

ntroduction The aim of this study was to evaluate cases of impacted maxillary canines (IMC) using cone beam tomography (CBCT) and panoramic images in an attempt to assess if panoramic radiographs can provide information compatible with CBCT results regarding canine position and root resorption. Methodology Fifty-six impacted maxillary canines from 48 patients were radiographically evaluated. The positions of the canine teeth were classified by Sector localization on panoramic radiographs and the same teeth were also analyzed by KPG on CBCT. Root resorptions in maxillary lateral incisors were also evaluated on CBCT. The relationships between panoramic and CBCT findings were compared by Chi-square test and Fischer’s exact test. Results Statistically significant correlations were found between panoramic Sectors and KPG indexes (p<0.001). KPG index values of 1, 3 and 4 corresponded to the panoramic Sectors 1, 4 and 5, respectively; but KPG index 2 matched the panoramic Sectors 3 and more often 2. Mid-alveolar impaction generally coincided with score 1 for both KPG index and panoramic Sector. In palatally IMC, this score value was generally 2 or 3 for the KPG index and 4 for the panoramic Sector (p≤0.001). Root resorptions in maxillary lateral incisors showed significant differences according to Sector localization and KPG index (p<0.05), namely they coincided with 2 and 3 in Sector evaluation and 2, 3 and 4 in KPG index. Conclusions Sector location on OPG is found to be related to KPG index on CBCT, and it can help evaluate mainly certain positions of impacted canines; thus, unnecessary CBCT scans are not requested.

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