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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 3-6

Radiographic assessment of agenesis, impaction, and pararadicular radiolucencies in relation with third molar in Nashik City of Maharashtra


Department of Oral Medicine and Radiology, MGV'S KBH Dental College, Nashik, Maharashtra, India

Date of Web Publication1-Jul-2016

Correspondence Address:
Bhushan Sukdeo Ahire
Ganesh Niwas, Near Public School, Vakhari Road, Gunjalnagar, Deola, Nashik - 423 102, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-4696.185185

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  Abstract 

Introduction: The third molar develops entirely after birth and also it is the last tooth to erupt in all ethnic groups despite racial variations in the eruption sequence. Tooth development with effects on tooth size, shape, position, and total absence is affected due to environmental factors, systemic diseases, genetic polymorphisms, and teratogens.
Aims and Objectives: The aim of this study was to assess the prevalence of agenesis, impaction, and pararadicular radiolucencies in relation with third molars.
Materials and Methods: One hundred digital orthopantomograph (OPG) scans of patients of age ranging from 18 to 25 years were selected randomly from the digital OPG database of the Department of Oral Medicine and Radiology, and then assessment and analysis were carried out. Results: Overall agenesis rate was about 14.5%. Bilateral agenesis of maxillary and mandibular third molars was about 14% and 13%, respectively. Overall impaction rate was about 21.92%. Mesioangular impaction rate was about 57.33% whereas distoangular impaction rate was about 26.66%. Prevalence of pararadicular radiolucencies was only about 0.8% with mandibular predilection.
Conclusion: As the agenesis of the third molars is increasing, they can be considered as vestigial. Prevalence of impaction of the third molars is increasing. Pararadicular radiolucencies are mostly seen with mandibular third molar.

Keywords: Agenesis, impaction, pararadicular radiolucency, third molars


How to cite this article:
Ahire BS, Bhoosreddy AR, Bhoosreddy S, Shinde MR, Pandharbale AA, Kunte VR. Radiographic assessment of agenesis, impaction, and pararadicular radiolucencies in relation with third molar in Nashik City of Maharashtra. J Dent Allied Sci 2016;5:3-6

How to cite this URL:
Ahire BS, Bhoosreddy AR, Bhoosreddy S, Shinde MR, Pandharbale AA, Kunte VR. Radiographic assessment of agenesis, impaction, and pararadicular radiolucencies in relation with third molar in Nashik City of Maharashtra. J Dent Allied Sci [serial online] 2016 [cited 2019 Nov 13];5:3-6. Available from: http://www.jdas.in/text.asp?2016/5/1/3/185185


  Introduction Top


Wisdom teeth are nothing but the third and final set of molars that most people get in their late teens or early twenties.[1]

The third molar (M3) develops entirely after birth and also it is the last tooth to erupt in all ethnic groups despite racial variations in the eruption sequence. Tooth development with effects on tooth size, shape, position, and total absence is affected due to environmental factors, systemic diseases, genetic polymorphisms, and teratogens.[2]

Not only for the dentists but also for the students of other scientific fields such as anthropology and genetics, third molars are of much importance because they play an important role to the understanding of the process of evolution.[3]

The human need for large and powerful jaws has been eliminated due to the advent of civilization and the use of soft and refined diet, so the incidence of the third molars getting impacted or genetically missing is the highest. Hence, the third molars may be considered “vestigial.”[3]

Tooth agenesis or hypodontia is defined as the developmental absence of one or more teeth either in primary or permanent dentition. Agenesis of one or more permanent teeth is a common anomaly in human.[4] The incidence of agenesis has been reported to vary from 2.6% to 11.3%, depending on the demographic and geographic profiles. Third molar agenesis, another type of hypodontia, has a prevalence of 9–30%.[5]

Impacted teeth are defined as those teeth whose normal eruption is either prevented by adjacent teeth or bone, malpositioning, and lack of space in the dental arch or some other impediments.[1]

Impaction of the third molar is a high incident problem occurring in up to 73% of the young adults in Europe. Delayed timing of eruption and being the last tooth in the dental arch are considered to be the common etiological factors, but if impactions can be predicted at an early stage, then they can be better managed.[6]

Apart from the aspect of agenesis and impaction of the third molars, the third molars are also found to be associated with pararadicular radiolucencies. It is most often situated just distal to the third molar roots. They are considered to be a variation of normal radiographic anatomy.[3]

The present study was undertaken to review the prevalence of agenesis, impaction, and pararadicular radiolucencies in relation with the third molars in a population of age group 18–25 years in Nashik city of Maharashtra.

Aims and objectives

The aim of this study was to assess the prevalence of agenesis, impaction, and pararadicular radiolucencies in relation with the third molars.


  Materials and Methods Top


The study was conducted in the Department of Oral Medicine and Radiology by collecting digital orthopantomograph (OPG). The sample size of the study was one hundred digital OPG scans.

The inclusion criteria of the study group were as follows:

  • OPGs of patients of age 18–25 years
  • OPGs of patients who had no history of extraction/exfoliation
  • OPGs of patients who are nonsyndromic and no systemic disorders
  • No history of trauma.


The radiographs were analyzed by observing on the monitor of a PC. The radiographs were interpreted for the following aspects:

  • Number of third molars present per person
  • Number of third molars revealing agenesis
  • Number of impacted third molars
  • Type of impaction of third molar
  • Association of pararadicular radiolucencies in association with third molars
  • Gender of the patient was also noted.


The pattern of impaction is determined by measuring the angle formed between the lines intersecting the long axis of the second and third molars. The long axis runs through the midpoints of the occlusal surface and bifurcation. The angle formed is used to interpret the mesial or distal inclination in relation to the second molar. When the angle exceeds 65°, impaction is considered horizontal.[7],[8] The third molars that had reached the occlusal plane in relation to the second molar are considered normally erupted teeth. Impacted third molars were also grouped according to their position as vertical, horizontal, mesioangular, and distoangular.

Any well-defined radiolucency in the pararadicular region of the third molars which may or may not have destructed the lamina dura was classified as pararadicular radiolucency. The results were analyzed.


  Results Top


One hundred digital OPG scans including 65 females and 35 males [Table 1] having age group ranging from 18 to 25 years were analyzed.
Table 1: Gender distribution

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Overall agenesis rate of the third molars was found to be in 14.5%. In the maxilla, bilateral agenesis of the third molars was found in 11% whereas mandibular bilateral agenesis was found in 10% [Table 2]a and [Table 2]b.
Table 2:

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Table 3:

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Overall impaction rate was found to be 21.92% in total OPG scans. The various types of impaction status of the third molars were being shown in [Table 3]a and [Table 3]b. The prevalence of pararadicular radiolucencies was rare, only about 0.8% and mostly occurred in the mandibular third molars distally [Table 4].
Table 4: Prevalence of pararadicular radiolucencies

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{Table 5}{Table 6}


  Discussion Top


Though much advances are made on stem cells in dentinogenesis, vaccine for dental caries, etc., still we lack behind in preventing the occurrence of impaction which is a complication of normal eruption that is created by the host due to etiologies such as jaw size, facial growth, tooth size, overlying cysts or tumors, trauma, reconstructive surgery, and the host with systemic disorders and syndromes.[9]

The third molar is a tooth characterized by the variability in the time of its formation, by widely varying crown and root morphology, and by its varying presence or absence in the mouth cavity.[10]

Although agenesis influences the chronology of tooth eruption and the number of teeth present in the dental arch, it also influences the dentofacial structure. Few studies have evaluated the relation between different kinds of agenesis and craniofacial structure and those that do show conflicting results.[10]

Radiolucencies such as paradental cyst, mandibular-infected buccal cyst, and lateral radicular cyst, which are present around the radicular portion of the tooth, are collectively termed as pararadicular radiolucencies. Paradental cyst is mostly seen with mandibular third molars having pericoronitis or inflammation. Many reports have suggested that the mandibular-infected buccal cyst which arise from crevicular epithelium, reduced enamel epithelium, cell rests of Malassez and the dental follicle, and paradental cyst is the same entity.[11]

To our knowledge, this is the first study in the city of Maharashtra, a state in the western part of India, to evaluate the status of the third molars in a population of age group ranging from 18 to 25 years. As such, this study has the potential to make a substantial contribution to ongoing debate on the outcome of third molars, i.e., whether they should be prophylactically removed or preserved.

In our study, overall agenesis of the third molars was found to be 14.5% as compared to previous studies done by Sandhu and Kapila, 1982 (7.78%); Hattab, 1995 (9.1%); and Garib, 2005 (20.7%).[7],[12],[13]

We have also documented the prevalence of bilateral agenesis of the third molar, which was 11% in maxilla and 10% in mandible. In addition, agenesis of all the third molars was found to be 6%. Komerik et al.[14] found that bilateral agenesis of the third molar was around 18.5% in maxilla and 13% in mandible.

In our study, agenesis of the right maxillary third molars was 14%, left maxillary third molars was 17%, left mandibular third molars was 13%, and right mandibular third molars was 14%. These results are approximately in accordance with a study conducted by Komerik et al.[14]

The prevalence of the third molar impaction after examining one hundred digital OPG scans of both sexes was found to be 21.92%. Previous studies have shown prevalence of impaction of the third molars as of 33%,[7] 37%.[15]

In our results, out of the 400 third molars, 58 third molars showed agenesis and out of the remaining 342 third molars, 75 were found to be impacted. And out of the 75 third molars, mesioangularly impacted were 57.33%, distoangularly impacted were 26.66%, horizontally impacted were 8%, vertically impacted were 6%, and buccally impacted were 1.3% whereas Kaur and Sheikh [16] found 29.2% of mesioangular, 16% of distoangular, 36.6% of vertical, and 18% of horizontal impaction with third molars in North Indian population.

In our study population, only 0.8% of the pararadicular third molar radiolucencies were present. Two positive cases are of females. Only one female revealed the presence of bilateral pararadicular third molar radiolucencies. Hence, the total number of detected pararadicular radiolucencies is 3. Bohay et al. documented only 7.8% of the frequency of mandibular pararadicular third molar radiolucencies. Females were found to be more affected than males.[17]


  Conclusion Top


From the above study, it can be concluded that agenesis of the maxillary left third molar was more common and overall agenesis rate is 6%. Bilateral agenesis of the maxillary third molar was 11% whereas bilateral agenesis of the mandibular third molar was 10%. Mesioangular was found to be the most common pattern of impaction. Moreover, the occurrence of pararadicular radiolucencies is rare but with predilection for mandibular third molars distally.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kaushik SK, Gupta SK. Impacted third molar surgery and the aviator. IJASM 2010;54:26-31.  Back to cited text no. 1
    
2.
John J, Nambiar P, Mani SA, Mohamed NH, Ahmad NF, Murad NA. Third molar agenesis among children and youths from three major races of Malaysians. J Dent Sci 2012;7:211-7.  Back to cited text no. 2
    
3.
Kaur B, Sheikh S, Pallagatti S. Radiographic assessment of agenesis of third molars and para-radicular third molar radiolucencies in population of age group 18-25 years old – A radiographic survey. Arch Oral Res 2012;8:13-8.  Back to cited text no. 3
    
4.
Sujon MK, Alam MK, Enezei HH, Rahman SA. Third molar impaction and agenesis: A review. Int J Pharm Bio Sci 2015;6:1215-21.  Back to cited text no. 4
    
5.
Altan AB, Bıcakci AA. Is third-molar agenesis related to the incidence of other missing teeth? Turk J Orthod 2015;27:143-7.  Back to cited text no. 5
    
6.
Lakhani MJ, Kadri W, Mehdi H, Sukhia H, Bano A, Yaqoob S. Anterior arch crowding – A possible predictor for mandibular third molar impaction. J Ayub Med Coll Abbottabad 2011;23:63-5.  Back to cited text no. 6
    
7.
Hattab FN, Rawashdeh MA, Fahmy MS. Impaction status of third molars in Jordanian students. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:24-9.  Back to cited text no. 7
    
8.
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. 8
    
9.
Nevile BW, Damm DD, Allen CM, Bouquot JE. Abnormalities of teeth. In: Oral and Maxillofacial Pathology. Reprinted 2005. 2nd ed. Elsevier: Saunders; 2005. p. 66-67.  Back to cited text no. 9
    
10.
Sánchez MJ, Vicente A, Bravo LA. Third molar agenesis and craniofacial morphology. Angle Orthod 2009;79:473-8.  Back to cited text no. 10
    
11.
Lim AA, Peck RH. Bilateral mandibular cyst: Lateral radicular cyst, paradental cyst, or mandibular infected buccal cyst? Report of a case. J Oral Maxillofac Surg 2002;60:825-7.  Back to cited text no. 11
    
12.
Sandhu SS, Kapila BK. Incidence of impacted third molars. J Indian Dent Assoc 1982;54:441-4.  Back to cited text no. 12
    
13.
Garib DG, Zanella NL, Peck S. Associated dental anomalies: Case report. J Appl Oral Sci 2005;13:431-6.  Back to cited text no. 13
    
14.
Komerik N, Topal O, Esenlik E, Bolat E. Skeletal facial morphology and third molar agenesis. J Res Pract Dent 2014;14:1-11.  Back to cited text no. 14
    
15.
Vohra FS, Gill AS, Sharma SP. A radiographic study of agenesis of third molars in individuals with clinically absent third molars. J Indian Dent Assoc 1993;64:221-4.  Back to cited text no. 15
    
16.
Kaur B, Sheikh S. Status of third molars in North Indian population – A radiographic survey. J Dent Peers 2013;1:10-9.  Back to cited text no. 16
    
17.
Bohay RN, Mara TW, Sawula KW, Lapointe HJ. A preliminary radiographic study of mandibular para-radicular third molar radiolucencies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:97-101.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 4], [Table 2], [Table 3]



 

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