The term “erumpere”, which means “to erupt”, refers to the movement of a developing tooth from its non-functional position to its corresponding functional and anatomical position in the dental arch.
However, for several reasons, some teeth fail to undergo this physiological process, leading to partial or complete tooth impaction. An unerupted tooth is defined as one that remains embedded within the jawbone, is covered by gingival tissue, and may be partially or entirely covered by bone.
Nevertheless, such a tooth is expected to erupt and come into occlusion based on clinical and radiographic findings. A partially erupted tooth is defined as one that does not fully erupt into its normal position but can still be seen in the oral cavity.
The term “tooth impaction” signifies that a tooth is obstructed from fully erupting into the oral cavity due to the blockage of the eruption path or a lack of space.
The third molars, followed by the maxillary canines, are the most frequently impacted teeth that are routinely encountered in dental practice. The frequency of mandibular third molar impaction is influenced by factors such as facial skeleton, gender, age, and ethnic group.
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Breik and Grupor reported a higher incidence of mandibular third molar impaction in individuals with a dolichofacial pattern (vertical growth; facial axis angle, <87) and in females (43%) compared to males (45%).
On the contrary, Padhye et al. observed a higher prevalence of third molar impaction in males (51.77%) than in females (48.33%). The study by KalaiSelvan et al. reported a prevalence of 45.8% in the Tamil population, while Prajapati et al. reported a higher prevalence of impacted mandibular third molars (IMTMs) among females aged 21–30.
A study by Selene Barone et al. reported a statistically significant correlation between the
Gonial angle and the position of the mandibular third molar. They observed that with a progressive decrease in the Gonial angle, a higher incidence of IMTMs was observed.
The worldwide prevalence of impacted third molars is 24%. Systemic local reasons and craniofacial development contribute to tooth impaction.
Systemic conditions, such as nutritional deficiencies, vitamin D insufficiency, anemia, rickets, Down’s syndrome, genetic factors, endocrine disturbances, and various syndromes and infectious diseases, play a significant role in tooth impaction.
Local factors and craniofacial development that can hinder eruption and lead to impaction include a premature loss of deciduous teeth, traumatic conditions, ankylosed teeth, inflammatory and pathological conditions, Gonial angle and an insufficient space in the dental arch.
Different imaging modalities, including conventional radiography and advanced three-dimensional imaging, are used in dental practice. The initial screening of oral-cavityrelated abnormalities is performed using periapical and panoramic radiography.
Intraoral periapical radiography is used whenever it is possible to position a radiographic sensor inside the oral cavity. This technique provides a sharp and detailed image of the impacted tooth and its relation to the inferior alveolar canal.
The tube-shift technique can be used to determine the relationship between a tooth and the inferior mandibular nerve.
However, due to the difficulties associated with positioning the device, panoramic radiography is more convenient to use.
An orthopantomogram (OPG) provides the advantage of being able to view the structures of the mandible, maxilla, and facial bone in a single broad image. It is beneficial for identifying different pathological conditions, assessing
carious and fractured teeth, detecting dental anomalies, and determining the presence of impacted teeth and pathologies.
However, there are several drawbacks linked to the
panoramic radiographic technique, including overlapping, magnification, blurred images, metal artifacts, and errors related to patient positioning and image acquisition.
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Therefore, the need for more accurate three-dimensional diagnosis has led to the introduction of cone-beam computed tomography (CBCT). CBCT is considered superior to conventional panoramic radiography because it provides a three-dimensional view of structures.
However, the routine use of CBCT in dental practice is controversial and limited to patients’ needs since it produces higher radiation doses than conventional dental radiography. The radiation doses resulting from a full field-of-view dental CBCT scan are reported to be 4–42 times higher than the doses from an OPG.
Thus, it is necessary to implement the ALADA (as low as diagnostically acceptable) concept, which has replaced the previous ALARA (as low as reasonably acceptable) concept, to control the use of CBCT.
In this study, IMTM was the primary predictor variable and bone loss in the adjacent MSM was the outcome variable. The null hypothesis was that there is no difference in bone in the adjacent MSM, regardless of the extraction of the IMTM.
Hence, this study aimed to compare changes in the bone level between patients who underwent the extraction of an IMTM and those who did not. The findings were also analyzed in relation to the gender and age of the patients. Additionally, the pattern of impaction in the study sample was examined.
