A Comparative Pan-Oral Radiographic Survey of Third Molars in Black and In Indian South Africans
Colin J Perumal*
Division of Maxillofacial and Oral Surgery, Grey’s Hospital, South Africa
*Corresponding author: Colin J Perumal, Division of Maxillofacial and Oral Surgery, Grey’s Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa. Email: colmax@tiscali.co.za
Received Date: 19 July, 2017; Accepted Date: 02 September, 2017; Published Date: 08 September, 2017
1.
Abstract
Aims and Objectives: To determine and compare the frequency, angulations, depth and distance of impacted M3s in black and Indian South Africans.
Materials and Methods: One thousand and six hundred panoral radiographs of black and Indian South Africans were collected from a private Maxillo-facial practice in Durban. The frequency, angulations, depth and distance of impactions was determined. The impacted M3s (third molars) were classified according to these parameters.
Results: The study consisted of a balanced sample of 564 Indians and 564 black patients. There was no difference in racial and gender frequency between the two racial groups. There were a total of 2483 impacted teeth giving a frequency of 67.8%. In the black patients, the frequency of impactions was 37.8%. In Indian patients the frequency of impacted M3s was 31.4%. This difference was highly significant. There was a significant difference in the numbers of impacted, non-impacted and missing M3s between the two groups. No significance in angle of impactions was noted. However, there was an extremely significant difference in the depth and distance of impactions between the two groups (Table 5 and 6).
Conclusion: The frequency of M3 impaction has been determined and using a standardized system the impacted M3s have been classified according to the angle of impaction, the vertical depths and to their antero-posterior distance between the mesial surface of the M3 and the anterior border of the ramus of the mandible. These parameters were statistically compared in the Indians and black groups. It is now possible to adequately define the severity of the impactions and should together with the variables such as the patient’s age and association of the tooth roots with the inferior dental canal, allow the maxillofacial and oral surgeon to determine the degree of difficulty of removal of the M3s, and to advise patients accordingly
1.
Introduction
The most commonly impacted teeth are the mandibular third molars, followed by the maxillary third molars. This is not surprising since the third molar is the last tooth to erupt and adequate space is therefore critical. Whatever the reasons for impaction, the surgical removal of wisdom teeth remains a multimillion-dollar industry all over the world with South Africa being no exception [4]. The costs involved have to be paid usually by third party health care funders and of course this ultimately results in higher subscription rates for all their members. Often patients themselves or the State will have to pay. In addition, most patients take time off work for the procedures and recovery resulting in loss of productivity and income.
Surgical removal of third molars is one of the most commonly performed operations in England and Wales [5]. It has been estimated to have cost the National Health Service (NHS) in the region of 30 million pounds in 1994, and accounted for up to 90% of patients on maxillo-facial waiting lists. There is unfortunately no comparable data from South Africa but one can reasonably assume that for white South Africans at least, the situation would not be very different from that which prevailed in the United Kingdom [5,6].
What is even more disconcerting is that in surveys from the UK (United Kingdom), it was reported that 35% of 25,000 wisdom teeth removed were disease free [7]. Other studies have reported frequencies as low as 4% and as high as 43% [8,9]. Besides the question of health economics and beneficence there is also a need to study the reasons for tooth impaction. The racially mixed South African society provides an ideal opportunity to conduct such studies.
Words such as wisdom teeth and M3 will be used interchangeably in the text to denote third molars as will M2, which will denote second molars.
The National Institute for Clinical Excellence (NICE) is a part of the National Health Services (NHS) and was established in 1999 as a special health authority to provide patients, health authorities, and the public with reliable and authoritative guidance on current best practice [8-10]. The NICE guidelines on the removal of wisdom teeth states that:
As there is no reliable evidence to support a health benefit to patients from the prophylactic removal of pathology free third molars:
a) The routine practice of prophylactic removal of pathology free impacted wisdom teeth should be discontinued in the NHS [9,10].
b)
The standard of care for wisdom
teeth by health care workers should be no different to that given to other
teeth.
c) Surgical removal of impacted third molars should be limited to patients with evidence of pathology which includes un-restorable caries, non-treatable pulpal or peri-apical pathology, pericoronitis (more than one bout), cellulitis, abscess or osteomyelitis, internal or external resorption of the tooth or adjacent teeth, fracture of the tooth, disease of the tooth follicle including cyst or tumor, tooth impeding surgery, or tooth that is involved in or within the field of tumor resection or reconstructive jaw surgery.
In England and Wales it was estimated that implementation of the guidelines should release a capacity of up to 5 million pounds, in the specialty of Maxillofacial and Oral Surgery (MFOS) in the NHS [6].
In Finland, indications for preventative removals as presented in the evidence-based Current Care Guidelines for the management of M3s state that preventative removals at a young age are justified for 3 groups of teeth in the mandible:
Partially impacted teeth in the horizontal position, partially erupted teeth in the vertical position and incomplete roots growing close to the mandibular canal. It has been estimated that only 25% of M3s need to be removed preventatively at a young age [13].
As a result of the NICE guidelines the volume of M3 removal decreased in all sectors during the 2000s. The proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore an increase occurred in the mean age for surgical admissions. The change in age correlated with a change in the indications for M3 surgery with a reduction in impaction but an increase in caries and pericoronitis as aetiologic factors [4].
2.2. Reasons for removing wisdom teeth
The reasons for the removal of wisdom teeth can generally be classified as follows:
a) Caries of the third molar or of the distal aspect of the second molar where the impacted tooth abuts against the crown or the root.
b)
Pericoronitis or periodontal bone
loss on the mesial or distal aspect of the third molar including paradental
cyst formation, widening of the pericoronal follicular space and ulceration of
the cheek or retromolar tissues caused by an abnormal angulation or position of
the third molar.
c)
Desorption of the distal aspect of
the crown or roots of the second molar where the third molar abuts on this
tooth.
d)
Presence of a dentigerous cyst or tumor
such as an ameloblastoma, which has developed from the dental follicle of the
third molar.
e)
Electively because the third molars
are perceived to be:
·
Causing headaches or facial pain
·
Causing late lower arch crowding
·
A potential risk for development of
a cyst or tumor
·
Non-functional
·
A risk for fracture of the angle of
the mandible
f)
Bilateral removal even if disease free
as a prophylactic measure [14] For professionals
the estimation of a high probability of complications was a pivotal factor in
deciding whether to prophylactically remove impacted third molars [15]. The most common form of pathological lesions
detected in a radiographic survey of 6780 panoramic radiographs of patients
referred for removal of third molars was impacted teeth (22.5%) [16].
Retention of M3s in the presence of periodontal inflammation was associated with significant increases in the serum interleukin- 6, soluble intracellular adhesion molecule - 1, and C–reactive protein levels [17].
For patients who elect to retain their third molars, active surveillance as opposed to follow up only when required, has been recommended [18].
Any radiographic examination should result in a positive benefit to the patient in terms of change of management or prognosis [19]. The limitations of panoramic radiographs have been demonstrated in many studies. These include distortion and loss of detail. A survey has shown panoramic radiography to have the lowest correlation with the consensus radiographic standard when a group of military trainees with generalized dental pathoses were evaluated [20]. The number of panoramic radiographs taken in general dental practice has risen steadily over the last 20 years, at a rate greater than that seen for intraoral radiographs [19,21].
A study from England and Wales has shown that the main reason for taking panoramic radiographs was as a general screen or as a view for unerupted or impacted teeth, which were then presumably scheduled for unnecessary removal [21].
High yield selection criteria for panoramic radiography has been proposed as a means of reducing unnecessary examinations, limiting radiation dosages and reducing financial costs to patients and to health service providers [21].
2.5. Frequency of pathological lesions associated with impacted third molars
Mourshed (1964) [25] has calculated the risk of dentigerous cyst formation as being 1 in every 144 impacted teeth, whereas in a study from Johannesburg, the risk of cyst formation has been shown to vary with the sites of impaction with impacted first premolars exhibiting the highest risk [26].
Other studies showed cystic changes in 50% of follicles of radiographically normal impacted lower M3s. The patients were usually older than 20 years of age and the impacted lower M3s were usually in a vertical position [27]. In a similar histological study, dentigerous cyst formation was detected in the follicles of 37% of impacted lower M3s and 25% of impacted upper M3s [28] and in 23% of radiographically non-impacted M3s [29].
A study of the dental follicles of 185 impacted third molars from 170 patients with no signs of abnormal radiolucency (follicular space < 3mm) showed that 53% of the specimens had developed pathoses. The frequency of pathoses was higher in the 20-30 year old age group in men. In the mandible, dentigerous cysts constituted the majority of the detected pathological alterations (38%), followed by ameloblastomas (5.8%), sulfur granules (4%), foreign body granulomas and hyperplastic nonkeratinised squamous epithelium (3%) [30].
In a systematic review Marciani (2012) [31] found that periodontal disease was the most frequently associated pathology with asymptomatic third molars. At baseline 25% of asymptomatic patients had at least 1 probing depth of 5 mm in the M3 region either distal to the second molars or around the M3s. Probing depths deeper than 5 mm were associated with an attachment loss of > 2mm in nearly all patients. This attachment loss, coupled with colonization of periodontal pathogens increased the odds significantly for generalized periodontal disease.
One of the most often cited reasons for recommending removal of disease free wisdom teeth is poor position and lack of space and thus impaction is expected, or that the presence of the third molars contributes to incisor crowding. These decisions are often made at a very early age. The fact of the matter is that despite good intentions we are unable to explain or predict or prevent dental crowding. While it is likely that third molars play a role in the aetiology of crowding they are only one factor to consider in making decisions about third molar management. The cause of dental crowding is multifactorial and while third molars may play a significant role, in some patients, the current state of knowledge does not allow us to identify with accuracy who is at risk [32].
A study designed to measure the position and eruption status of third molars in Indian patients over a period of time showed that a significant number of impacted mandibular third molars had changed their position and had become fully erupted by the time the individual was 24 years of age. The authors concluded that unpredictable changes in the position and angulations of teeth continued to occur even after the age of 19 years [33]. Another systematic review concluded that impacted teeth that remain static with no changes in position or angulations over time are rare [34]. Such movement may occur even after the age of 25 years [32].
Another often cited reason is the possible effect of erupting or impacted third molars on the stability of the rest of the dentition especially following orthodontic correction. A study by Richardson and co-workers reported the results of a longitudinal study carried out in Belfast to study the dentitions of 160 children from the age of 10 to 11 years until their third molars were erupted or diagnosed as impacted. They concluded that late lower arch crowding has mulifactorial aetiology but there was evidence to implicate the developing third molar as a contributing factor during the teenage years [33].
This evidence suggested that it was only those third molars, which erupt, or attempt to erupt in a reduced space, that caused the problem. Impacted third molars that tip mesially to become horizontally impacted were unlikely to exert much mesial force, as were the milder mesio-angular vertical and distoangular impactions especially once the formation of the root was complete. Furthermore removal of impacted third molars did not reduce proximal contact tightness [33].
2.7. Classifications of third molar impactions
The anatomic position of the third molar is an important variable in predicting difficulty of extraction, risk and post-operative complications. Three systems are in common use to classify impacted third molars, which are:
a) Winter’s method (winter, 1926) [34]
2.
Distoangular impactions: The third
molar lies obliquely in the bone, the crown of the tooth pointing distally
towards the ramus, the roots approximating the distal root of the second molar.
3.
Vertical impactions: The third molar
is in its normal vertical position, but is prevented from erupting by
impingement on the distal surface of the second molar or the anterior border of
the ramus of the mandible. (In most cases of this type, there is simply a lack
of space for eruption).
4.
Horizontal impactions: The third
molar is in a horizontal position with respect to the body of the mandible, and
the crown may or may not be in contact with the distal surface of the second
molar crown or roots. (In this type of impaction, the third molar may lie at
any level within the bone from the crest of the ridge to the inferior border of
the mandible).
o
10 to 10 degrees - Vertical impaction
o
11 to 79 degrees - Mesioangular impaction
o
80 to 100 degrees - Horizontal impaction
o
-11 to -79 degrees - Distoangular impaction
o
-80 to -111 degrees-Others - mesio
inverted, disto inverted or disto horizontal Buccolingual impaction
2)
Distance of impaction- That is the
distance from the mesial aspect of the impacted M3 to the anterior border of
the ramus of the mandible, designated into 3 types: I, II and III.
b)
The level of tooth impactions
c)
The angle of the tooth impactions in
Black and in Indian South Africans
4. Materials and Methods
Each radiograph that was to be assessed was placed on a viewing box and the template of the generic second molar superimposed over each of the second molars of the radiographs in turn (Figures 2 and 3).
A line was drawn through the longitudinal axis of the third molar (Line C) (Figure 4). A ruler was then placed along this line and the angle of impaction read at point D along the circumference of the protractor. The point D represents the angle of impaction formed by the intersection of lines B and C.
Using the
system as described, the teeth were classified into the following types of
impaction:
If the
angle of the third molar was between -10˚
to +10˚ and it’s CEJ was at the level
of the CEJ of the adjacent second molar, then the tooth in question (M3) was
regarded as not impacted. This would be true only if there were no distal bony
coverage as shown in Figure 5 and Figure 6 (Type
I).
b) Depth of impaction
The Pell
and Gregory criteria are summarized in Table 1,
Part A (designated level A, B and C) refers to the vertical depth of impactions
relative to the occlusal plane and the cemento-enamel junction of the M2 i.e.
the vertical degree of impaction and part B (designated as Type I, II and III)
which refers to the distance from the mesial aspect of the M3 to the anterior
border of the ramus of the mandible i.e. the antero-posterior degree of impaction.
In
summary, each third molar included in the study was classified as being
impacted or non- impacted, and if impacted, could be described by its angle of
impaction [37] as well as its vertical depth of
impaction relative to the adjacent teeth (Level A, B and C in Table 1 Part A)
and to the distance of the impacted M3 to the ramus of the mandible (Type I,
II, III in Table 1 Part B). For the maxilla in this study, only the angles were
measured as was done for the mandible, which was described by Quek et al (2003)
[37].
5. Results
5.3. Missing, impacted and non-impacted
M3s
5.3.1. Site distribution of impacted M3s
5.3.3. Vertical depth of impaction of third molars (Table 1 Part A)
5.3.4.
Distance
of mesial surface of M3 to the anterior border of the ramus of the mandible (Table 1 Part B)
vs- versus
6.5. Comparison with previous studies
from South Africa (Table 8 and 9)
6.7. Limitations of this study
The aims and objectives of this study have largely been met.
·
Current data are insufficient to
refute or to support prophylactic removal versus active surveillance of
asymptomatic disease free M3s [18]. Areas of
future research have been identified. These include:
2.
The efficacy of active surveillance
as a management strategy
3.
Assessing risks and benefits of M3
retention compared with extraction By measuring the long-term progression of
local and systemic inflammatory disease [18]:
·
Such information should be made
available to the patient when deciding on whether to prophylactically remove
impacted M3s.
·
The determination of pathology in
impacted M3s did not form a part of this study as very few impacted M3s had any
associated pathology.
9.
Acknowledgement
Figure 1:
Template of the generic second molar with protractor super-imposed.
Figure 2: Sketch representing panoramic radiograph.
Figure 3:
Template of the second molar with protractor super-imposed.
Figure 4:
Reading of angles formed by lines B and C and taken at point D.
Figure 5: Diagrammatic representation of a
vertically non-impacted tooth (a), and a vertically impacted tooth (b and c).
Figure 6a: Diagrammatic representation of the
depth of impaction assessed by its relationship to the cervical line of the
adjacent second molar (Table 1 Part A)
Figure 6b: Diagrammatic representation of the
relationship of the crown of the third molar distance to the ascending ramus of
the mandible (Arrows indicate the distance between the two vertical lines).
Annexure A
PART A |
|
- DEPTH |
|
|
|
|
|
The occlusal plane of the impacted tooth is at the same level as the occlusal plane of the |
Level A = |
|
|
|
|
Second molar. |
|
|
|
|
|
The occlusal plane of the impacted tooth is between the occlusal plane and the cervical line |
Level B = |
|
|
|
|
of the second molar. |
|
|
|
Level C = |
|
The impacted tooth is below the cervical line of the second molar. |
|
|
|
PART B |
- DISTANCE |
|
|
|
|
|
|
There is sufficient space between the ramus and the distal part of the second molar for the |
Class І = |
|
|
|
|
Accommodation of the mesiodistal diameter of the third molar. |
|
|
|
|
|
The space between the second molar and the ramus of the mandible is less than the |
Class П = |
|
|
|
|
mesiodistal diameter of the third molar. |
|
|
|
Class Ш = |
|
All or most of the third molar is in the ramus of the mandible. |
|
|
|
Table 1: Description of Pell and Gregory Classification (extracted from García, Sampedro, Rey et al, 2000) [38].
Race |
Males |
Females |
Total |
Indians |
277 (49.11) |
287 (50.89) |
564 (50.00) |
Blacks |
272 (48.23) |
292 (51.77) |
564 (50.00) |
Total sample |
549 (48.67) |
579 (51.33) |
1128 (100.00) |
Table 2: Gender and race distribution.
Race |
Gender |
Impacted |
Non Impacted |
Missing |
Potential number of 3rd Molars |
Indians |
Males |
611 (13.5) |
313 (6.9) |
184 (3.7) |
1108 |
Females |
526 (11.7) |
355 (7.9) |
200 (4.4) |
1148 |
|
Total |
1137 (25.2) |
668 (14.8) |
369 (8.2) |
2256 |
|
Blacks |
Males |
645 (14.3) |
220 (4.9) |
239 (5.3) |
1088 |
Females |
701 (15.5) |
239 (5.3) |
297 (6.5) |
1168 |
|
Total |
1346 (29.8) |
459 (10.2) |
533 (11.8) |
2256 |
|
Combined Total |
2483 (55.0) |
1127 (25.0) |
902 (20.0) |
4512 |
Table 3: Numbers of impacted, non-impacted, and missing M3s in blacks and in Indian males and females (Total number of potential M3s considered: n=4512).
Type of Impactions |
Race |
Maxilla |
Mandible |
Totals |
Mesioangular |
Indian |
74 (3.0) |
297 (12.0) |
371 (14.9) |
Blacks |
66 (2.7) |
181 (7.3) |
247 (9.9) |
|
Distoangular |
Indian |
538 (21.7) |
215 (8.7) |
753 (30.3) |
Blacks |
523 (21.1) |
210 (8.5) |
733 (29.5) |
|
Horizontal |
Indian |
3 (0.1) |
108 (4.3) |
111 (4.5) |
Blacks |
8 (0.3) |
77 (3.1) |
85 (3.4) |
|
Vertical |
Indian |
33 (1.3) |
58 (2.3) |
91 (3.7) |
Blacks |
35 (1.4) |
57 (2.3) |
92 (3.7) |
|
Inverted |
Indian |
0 (0) |
0 (0) |
0 (0) |
Blacks |
0 (0) |
0 (0) |
0 (0) |
|
Totals |
Indian |
648 (26.1) |
678 (27.3) |
|
Blacks |
632 (25.5) |
525 (21.1) |
||
Combined Totals |
1280 (51.6) |
1203 (48.4) |
2483 (100) |
Table 4: Frequency of angles of impaction and of site in the two race groups (Total number of impacted M3s. n=2483, Refer to Table 3).
Race |
Gender |
A |
B |
C |
Indians |
Males |
304 (12.0) |
210 (8.5) |
123 (5.0) |
Females |
272 (11.0) |
247 (10.0) |
170 (6.8) |
|
Total |
576 (23.2) |
457 (18.4) |
293 (11.8) |
|
Blacks |
Males |
173 (7.0) |
166 (6.7) |
268 (11.0) |
|
Females |
175 (7.0) |
113 (4.6) |
262 (10.6) |
|
Total |
348 (14.0) |
279 (11.2) |
530 (21.3) |
Combined Total |
|
924 (37.2) |
736 (29.7) |
823 (33.1) |
Table 5: Depth of impactions in Indian and black males and females (Total number of impacted M3s. n=2483) (Levels A, B and C).
TYPE |
IM |
BM |
IF |
BF |
Type I |
372 (15.0) |
165 (6.6) |
423 (17.0) |
176 (7.1) |
Type II |
179 (7.2) |
135 (5.4) |
45 (1.8) |
104 (4.2) |
Type III |
101 (4.1) |
359 (14.5) |
92 (3.7) |
332 (13.4) |
Totals |
652 (26.3) |
659 (26.5) |
560 (22.6) |
612 (24.6) |
Key: IM – Indian Male, BM – Black Male, IF – Indian Female, BF – Black Female
|
Parameters |
Tests |
Significant |
Level |
|
yes |
no |
|||
Intra - observer |
student t test |
|
✓
|
p > 0,05 |
Inter - Observer |
student t test |
|
✓
|
p > 0,05 |
Race (blacks vs Indians) |
Yates Chi Square |
|
✓
|
p > 1,00 |
Gender (Blacks vs Indians) |
Yates Chi Square |
|
✓
|
p > 0,05 |
Missing, impacted and Non- impacted |
|
|
|
|
Blacks vs Indians |
Chi square |
✓
|
|
p = 0,0001 |
Indian males vs Indian females |
Chi square |
✓
|
|
p = 0,0001 |
Black males vs Indian males |
Chi square |
✓
|
|
p = 0,0001 |
Black females vs Indian females |
Chi square |
✓
|
|
p = 0,0001 |
Black males vs Black females |
Chi square |
✓
|
|
p = 0,3985 |
Impacted and Non-impacted |
|
|
|
|
Indians vs Blacks |
Yates Chi Square |
✓
|
|
p = 0,001 |
Indian males vs Indian females |
Yates Chi Square |
✓
|
|
p = 0,054 |
Indian males vs Black males |
Yates Chi Square |
✓
|
|
p = 0,0001 |
Indian females vs Black females |
Yates Chi Square |
✓
|
|
p = 0,0001 |
Black males vs Black females |
Yates Chi Square |
|
✓
|
p = 1,000 |
Site Maxilla vs Mandible |
|
|
|
|
Indians vs Blacks |
Chi Square |
|
✓
|
p > .000 |
Indian males vs Indian females |
Chi Square |
|
✓
|
p > .000 |
Black males vs Black females |
Chi Square |
|
✓
|
p > .000 |
Indian males vs Black males |
Chi Square |
|
✓
|
p > .000 |
Indian females vs Black females |
Chi Square |
|
✓
|
p > .000 |
Table 7: Summary of statistical significance.
Parameters |
Tests |
Significant |
Level |
|
yes |
no |
|||
Angles of Impactions |
|
|
|
|
Blacks vs Indians |
Chi Square |
|
✓
|
P > 1,000 |
Depth of Impactions |
|
|
|
|
Blacks vs Indians |
Yates Chi Square |
✓
|
|
p = 0,0001 |
Black males vs Indian males |
Yates Chi Square |
✓
|
|
p = 0,0001 |
Black females vs Indian |
|
|
|
|
females |
Yates Chi Square |
✓ |
|
p = 0,0001 |
Black males vs Black females |
Yates Chi Square |
✓ |
|
p = 0,0252 |
Indian males vs Indian females |
Yates Chi Square |
✓ |
|
p = 0,0058 |
Distance of Impactions |
|
|
|
|
Blacks vs Indians |
Yates Chi Square |
✓ |
|
p = 0,0001 |
Black males vs Indian males |
Yates Chi Square |
✓ |
|
p = 0,0001 |
Black females vs Indian |
|
|
|
|
females |
Yates Chi Square |
✓ |
|
p = 0,0001 |
Black males vs Black females |
Yates Chi Square |
✓ |
|
p = 0,1572 |
Indian males vs Indian females |
Yates Chi Square |
✓ |
|
p = 0,0001 |
Study |
Number of impactions |
||||||||||
Female |
Site |
Total Frequency of impacted M3s |
|||||||||
B |
W |
I |
O |
B |
W |
I |
O |
Max |
Mand |
||
Perumal, 2013, This study. (South Africa) |
645 (14.3%) |
- |
611 (13.5%) |
- |
701 (15.5%) |
- |
526 (11.7%) |
- |
1280 (51.6%) |
1203 (48.4%) |
68.8% n=3610 |
Brown et al, 1982 (South Africa) [26] |
79 (28.0%) |
221 (34.9%) |
- |
- |
41 (15.8%) |
231 (34.6%) |
- |
- |
372 (29.5%) |
606 (48.1%) |
52.3% n=1869 |
Van der Linden et al, 1995 (South Africa) [24] |
- |
409 (41%) |
- |
- |
- |
592 (59%) |
- |
- |
1135 (62.9%) |
1737 (94.0%) |
78.8% n=3652 |
Sandhu et al, 2008 (India) [33] |
- |
- |
- |
- |
- |
- |
- |
- |
74 (50.7%) |
72 (49.3%) |
100% n=146 |
Krausz et al, 2005 (Israel) [43] |
- |
- |
- |
14 (46%) |
- |
- |
- |
11 (44%) |
- |
- |
100 % n=25 |
Akarsalan and Kocabay, 2009 (Turkey) [44] |
- |
- |
- |
348 (50.9%) |
- |
- |
- |
336 (49.1%) |
- |
- |
100% n=648 |
Quek et al, 2003 (Chinese in Singapore) [37] |
- |
- |
- |
574 (41.4%) |
- |
- |
- |
811 (58.6%) |
306 (22.1%) |
1079 (77.9%) |
60.7% n=2281 |
Jaffar and Tin-Oo, 2009 (Malaysia) [45] |
- |
- |
- |
97 (50%) |
- |
- |
- |
97 (50%) |
- |
- |
100% n=194 |
Obiechina et al, 2001 (Nigeria) [39] |
- |
- |
- |
157 (46.45%) |
- |
- |
- |
181 (53.55%) |
- |
- |
100% n=473 |
Table 8: Various comparative studies on third molar impaction.
Study |
Total number of impactions = n |
Vertical |
Mesioangular |
Distoangular |
Horizontal |
Other |
Total Frequency of impactions |
Perumal, 2013, This study. (South Africa) |
3610 |
183 (7.3%) |
618 (24.9%) |
1486 (59.9%) |
196 (7.9%) |
- |
68.80% |
Brown et al. 1982 (South Africa) [26] |
1896 |
- |
- |
- |
- |
- |
- |
Van der Linden et al. 1995 (South Africa) [24] |
3652 |
774 (27.0%) |
998 (34.7%) |
489 (17.0%) |
320 (11.1%) |
291 (10.2%) |
78.60% |
Sandhu et al. 2005 (India) [33] |
146 |
96 (65.8%) |
22 (15%) |
28 (19.2%) |
- |
- |
100.00% |
Krausz et al. 2005 (Israel) [43] |
25 |
16 (64%) |
8 (32%) |
1 (4.0%) |
- |
- |
100.00% |
Akarsalan and Kocabay, 2009 (Turkey) [44] |
684 |
267 (39%) |
207(30.2%) |
52(7.6%) |
156(23%) |
2(0.3%) |
100.00% |
Quek et al. 2003 (Chinese in Singapore) [37] |
2281 |
103 (9.5%) |
642 (59.5%) |
106 (9.8%) |
190 (17.6%) |
344 (24.9%) |
60.70% |
Jaffar and Tin-Oo, 2009 (Malaysia) [45] |
197 |
24 (12.2%) |
103 (52.3%) |
18 (9.1%) |
52 (26.4%) |
- |
100.00% |
Obiechina et al, 2001 (Nigeria) [39] |
473 |
143 (30.2%) |
228 (48.2%) |
26 (5.5%) |
2 (0.42%) |
- |
84.40% |
Table 9: Various comparative studies on third molar angles of impaction.
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