Unraveling the hidden connection: Impacted third molar classification and mandibular canal proximity on panoramic radiographs
Abstract
Objectives: This research is aimed to determine the relation between impacted mandibular third molar’s classification and mandibular canal proximity with panoramic radiograph at RSKGM-P FKG UPDM (B).Materials and Methods: This research used an analytical cross-sectional study. The number of samples in this study was 387 lower third molars from 206 digital panoramic radiographs. The samples were then analyzed based on their classification and their relation to the mandibular canal.
Results: The result showed in Pell & Gregory classification, the most related to the mandibular canal is class III (65.8%) with p = 0,000 and position B (58.1%) with p = 0,000. Based on the Winter classification, mesioangular angulation is the most related to the mandibular canal (52.9%) with p = 0,015. Based on the Rood & Shehab classification, it was found that the dominant relation A was 65% in class III with p = 0,000, in position B (58.3%) with p = 0,001, and in mesioangular angulation (61.1%) with p = 0,000.
Conclusion: This study shows that the less space available in the mandible, the deeper the position of the impacted tooth in the jaw and their angle affects the proximity of the impacted tooth to the mandibular canal and the radiographic sign of the proximity of the impacted mandibular third molar root to the mandibular canal. This illustrates the need to perform a panoramic radiographic examination prior to performing any intervention on the mandibular third molar.
References
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Septina F, Atika Apriliani W, Baga I. Prevalensi Impaksi Molar Ke Tiga Rahang Bawah Di Rumah Sakit Pendidikan Universitas Brawijaya Tahun 2018. E-Prodenta J Dent. 2021;5(2):450-60.
Passi D, Singh G, Dutta S, et al. Study of pattern and prevalence of mandibular impacted third molar among Delhi‑National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study. Natl J Maxillofac Surg. 2019;10(1):3-7.
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Saputra YG, Anindita PS, Pangemanan DHC. Ukuran dan bentuk lengkung gigi rahang bawah pada orang Papua. e-GIGI. 2016;4(2):253-8.
Fitri AM, Kasim A, Yuza AT. Impaksi gigi molar tiga rahang bawah dan sefalgia Amalia. J Kedokt Gigi Univ Padjadjaran. 2016;28(3):148-54.
Sahetapy DT, Anindita PS, Hutagalung BSP. Prevalensi Gigi Impaksi Molar Tiga Partial Erupted Pada Masyarakat Desa Totabuan. e-GIGI. 2015;3(2):2-7.
Faridha DS, Wardhana ES, Agustin ED. Gambaran Kasus Gigi Impaksi Dan Tingkat Pengetahuan Pasien Penderita Gigi Impaksi Di Rumah Sakit Islam Sultan Agung Semarang. Konf Ilm Mhs Unissula 2. 2019;7:40-6.
Fakhrurrazi F, Hakim R fanani, Rifani R. Hubungan Tingkat Kesulitan Dengan KomplikasiPost Odontektomi Gigi Impaksi Molar Ketiga Rahang BawahPada Pasien Di Instalasi Gigi Dan Mulut Rsudza Banda Ac. Cakradonya Dent J. 2015;7(1):745-806.
Rizqiawan A, Lesmaya YD, Rasyida AZ, Amir MS, Ono S, Kamadjaja DB. Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient’s Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study. Int J Dent. 2022;2022.
Lita YA, Hadikrishna I. Klasifikasi impaksi gigi molar ketiga melalui pemeriksaan radiografi sebagai penunjang odontektomi. J Radiol Dentomaksilofasial Indones. 2020;4(1):1-5.
Monaca G La, Vozza I, Giardino R, Annibali S, Pranno N, Cristalli MP. Prevention of neurological injuries during mandibular third molar surgery: technical notes. Ann Stomatol (Roma). 2017;8(2):45-52.
Tenrilili ANA, Yunus B, Rahman FUA. Third molar impaction prevalence and pattern: a panoramic radiography investigation. J Radiol Dentomaksilofasial Indones. 2023;7(1):9-14.
Kaffe I, Fishel D, Gorsky M. Panoramic radiography in dentistry. Clin Dent Rev. 2021;5(26):25-30, 19.-22
Boel T, Kumar SB. Gambaran Kanalis Mandibularis Kiri Secara Radiografi Panoramik Pada Warga Medan Selayang. Dentika Dent J. 2014;18(2):174-6.
Mortazavi H, Baharvand M, Safi Y, Dalaie K, Behnaz M, Safari F. Common conditions associated with mandibular canal widening: A literature review. Imaging Sci Dent. 2019;49(2):87-95.
Muñoz G, Dias FJ, Weber B, Betancourt P, Borie E. Anatomic Relationships of Mandibular Canal. A Cone Beam CT Study. Int J Morphol. 2017;35(4):1243-8.
Abdallah Edrees M, Moustafa Attia A, Abd Elsattar M, Fahmy Gobran H, Ismail Ahmed A. Course and Topographic Relationships of Mandibular Canal: A Cone Beam Computed Tomography Study. Int J Dent Oral Sci. 2017;4(March):444-9.
Pandithurai N, Gunasekar P, Saravanan T, Shakila K. Evaluation of Mandibular Canal Anatomy, Variations, and its Classification in Panoramic Radiographs: A Retrospective Study. J Sci Dent. 2023;13(1):7-10.
KalaiSelvan S, Ganesh SKN, Natesh P, Moorthy MS, Niazi TM, Babu SS. Prevalence and Pattern of Impacted Mandibular Third Molar: An Institution-based Retrospective Study Sundarrajan. Asian J Pharm Clin Res. 2017;7(10):1-5.
Yasin Ertem S, Anlar H. Evaluation of the Relation Between Impacted Mandibular Third Molar Classification and Inferior Alveolar Canal. J Dent Indones. 2020;27(1):17-22.
Kamadjaja DB, Asmara D, Khairana G. The correlation between Rood and Shehab’s radiographic features and the incidence of inferior alveolar nerve paraesthesia following odontectomy of lower third molars. Dent J (Majalah Kedokt Gigi). 2017;49(2):59-62.
Akbar MF, Hadikrishna I, Riawan L, Lita YA. Impacted Lower Third Molar Profile at Dental Hospital of Padjadjaran University. J Indones Dent Assoc. 2023;5(2):91-8.
Pradopo S, Nelwan SC, Dewi AM, et al. Duration of Growth Spurt based on Cervical Vertebrae Maturation In Indonesia Population. Indian J Forensic Med Toxicol. 2021;15(3):4088-94.
Adeyemo WL, James O, Oladega AA, et al. Correlation Between Height and Impacted Third Molars and Genetics Role in Third Molar Impaction. J Maxillofac Oral Surg. 2021;20(1):149-53.
Azhari A, Pramatika B, Epsilawati L. Differences between male and female mandibular length growth according to panoramic radiograph. Maj Kedokt Gigi Indones. 2019;1(1):43-9.
Muhamad AH, Nezar W. Prevalence of Impacted Mandibular Third Molars in Population of Arab Israeli: A Retrospective Study. IOSR J Dent Med Sci e-ISSN. 2016;15(1).
Haddad Z, Khorasani M, Bakhshi M, Tofangchiha M, Shalli Z. Radiographic position of impacted mandibular third molars and their association with pathological conditions. Int J Dent. 2021;2021(March).
Porgel M, K-E K, L A. Essentials of Oral and Maxillofacial Surgery. 1st ed. Wiley Blackwell; 2014.
Primo FT, Primo BT, Scheffer MAR, Hernández PAG, Rivaldo EG. Evaluation of 1211 Third Molars Positions According to the Classification of Winter, Pell & Gregory. Int J Odontostomatol. 2017;11(1):61-5.
Gümrükçü Z, Balaban E, Karabağ M. Is there a relationship between third-molar impaction types and the dimensional/angular measurement values of posterior mandible according to Pell & Gregory/Winter Classification? Oral Radiol. 2021;37(1):29-35.
Leversha J, McKeough G, Myrteza A, Skjellrup-Wakefiled H, Welsh J, Sholapurkar A. Age and gender correlation of gonial angle, ramus height and bigonial width in dentate subjects in a dental school in Far North Queensland. J Clin Exp Dent. 2016;8(1):e49-e54.
Sukma Suntana M, Lenggogeni Nasroen S, Fadhilah I. Classification of Winter Impaction of Mandible Third Molar on the Distance of the Mandibular Canals on Panoramic Radiographs At Rsgmp Unjani. J Heal Dent Sci. 2023;2(Volume 2 No 3):455-66.
Utama MD, Abdi MJ, Makmur ZZ. HUBUNGAN KLASIFIKASI IMPAKSI MOLAR KETIGA MANDIBULA DENGAN JARAK KANAL MANDIBULAR PADA RADIOGRAFI PANORAMIK DI KLINIK MEDICAL CENTER. Indones J Public Heal. 2024;2(2):286-94.
Savani CM, Panicker K, Kiran BSR, Uppada UK. Does Darkening of Roots or Loss of White Line on Panoramic Radiographs Pose a Risk for Inferior Alveolar Nerve Damage? A CBCT Evaluation. J Orofac Sci. 2018;10(2):101-7.
Halder M, Chhaparwal Y, Pentapati KC, Patil V, Smriti K, Chhaparwal S. Quantitative and Qualitative Correlation of Mandibular Lingual Bone with Risk Factors for Third Molar Using Cone Beam Computed Tomography. Clin Cosmet Investig Dent. 2023;15(September):267-77.
Khojastepour L, Khaghaninejad MS, Hasanshahi R, Forghani M, Ahrari F. Does the Winter or Pell and Gregory Classification System Indicate the Apical Position of Impacted Mandibular Third Molars? J Oral Maxillofac Surg. 2019;77(11):2222.e1-2222.e9.
Gu L, Zhu C, Chen K, Liu X, Tang Z. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat. 2018;40(6):609-14.
Afridi SU, Baseer N, Durrani Z, Afridi MI, Jehan S. Association Between Angulation of MAndibular Third Molar Impaction with facial skeletal types and cephalometric landmarks. Khyber Med Univ J. 2022;14(1):47-55.
Santosh P. Impacted mandibular third molars: Review of literature and a proposal of a combined clinical and radiological classification. Ann Med Health Sci Res. 2015;5(4):229.
Septina F, Atika Apriliani W, Baga I. Prevalensi Impaksi Molar Ke Tiga Rahang Bawah Di Rumah Sakit Pendidikan Universitas Brawijaya Tahun 2018. E-Prodenta J Dent. 2021;5(2):450-60.
Passi D, Singh G, Dutta S, et al. Study of pattern and prevalence of mandibular impacted third molar among Delhi‑National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study. Natl J Maxillofac Surg. 2019;10(1):3-7.
Dusak PK, Dewi KK. DIISRIBUSI FREKUENSI TEKNIK ODONTEKTOMI BERDASARKAN KLASIFIKASI IMPAKSI MOLAR KETIGA RAHANG BAWAH YANG DILAKUKAN MAHASISWA KEPANITERAAN KLINIK BEDAH MULUT RSGM FKG UPDM (B). MANUJU MALAHAYATI Nurs J. 2022;4(10):2520-6.
Lacerda-Santos JT, Granja G lica L, De Vasconcelos Cat o MHC, et al. Signs of the proximity of third molar roots to the mandibular canal: an observational study in panoramic radiographs. Gen Dent. 2020;68(2):30-5.
Saputra YG, Anindita PS, Pangemanan DHC. Ukuran dan bentuk lengkung gigi rahang bawah pada orang Papua. e-GIGI. 2016;4(2):253-8.
Fitri AM, Kasim A, Yuza AT. Impaksi gigi molar tiga rahang bawah dan sefalgia Amalia. J Kedokt Gigi Univ Padjadjaran. 2016;28(3):148-54.
Sahetapy DT, Anindita PS, Hutagalung BSP. Prevalensi Gigi Impaksi Molar Tiga Partial Erupted Pada Masyarakat Desa Totabuan. e-GIGI. 2015;3(2):2-7.
Faridha DS, Wardhana ES, Agustin ED. Gambaran Kasus Gigi Impaksi Dan Tingkat Pengetahuan Pasien Penderita Gigi Impaksi Di Rumah Sakit Islam Sultan Agung Semarang. Konf Ilm Mhs Unissula 2. 2019;7:40-6.
Fakhrurrazi F, Hakim R fanani, Rifani R. Hubungan Tingkat Kesulitan Dengan KomplikasiPost Odontektomi Gigi Impaksi Molar Ketiga Rahang BawahPada Pasien Di Instalasi Gigi Dan Mulut Rsudza Banda Ac. Cakradonya Dent J. 2015;7(1):745-806.
Rizqiawan A, Lesmaya YD, Rasyida AZ, Amir MS, Ono S, Kamadjaja DB. Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient’s Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study. Int J Dent. 2022;2022.
Lita YA, Hadikrishna I. Klasifikasi impaksi gigi molar ketiga melalui pemeriksaan radiografi sebagai penunjang odontektomi. J Radiol Dentomaksilofasial Indones. 2020;4(1):1-5.
Monaca G La, Vozza I, Giardino R, Annibali S, Pranno N, Cristalli MP. Prevention of neurological injuries during mandibular third molar surgery: technical notes. Ann Stomatol (Roma). 2017;8(2):45-52.
Tenrilili ANA, Yunus B, Rahman FUA. Third molar impaction prevalence and pattern: a panoramic radiography investigation. J Radiol Dentomaksilofasial Indones. 2023;7(1):9-14.
Kaffe I, Fishel D, Gorsky M. Panoramic radiography in dentistry. Clin Dent Rev. 2021;5(26):25-30, 19.-22
Boel T, Kumar SB. Gambaran Kanalis Mandibularis Kiri Secara Radiografi Panoramik Pada Warga Medan Selayang. Dentika Dent J. 2014;18(2):174-6.
Mortazavi H, Baharvand M, Safi Y, Dalaie K, Behnaz M, Safari F. Common conditions associated with mandibular canal widening: A literature review. Imaging Sci Dent. 2019;49(2):87-95.
Muñoz G, Dias FJ, Weber B, Betancourt P, Borie E. Anatomic Relationships of Mandibular Canal. A Cone Beam CT Study. Int J Morphol. 2017;35(4):1243-8.
Abdallah Edrees M, Moustafa Attia A, Abd Elsattar M, Fahmy Gobran H, Ismail Ahmed A. Course and Topographic Relationships of Mandibular Canal: A Cone Beam Computed Tomography Study. Int J Dent Oral Sci. 2017;4(March):444-9.
Pandithurai N, Gunasekar P, Saravanan T, Shakila K. Evaluation of Mandibular Canal Anatomy, Variations, and its Classification in Panoramic Radiographs: A Retrospective Study. J Sci Dent. 2023;13(1):7-10.
KalaiSelvan S, Ganesh SKN, Natesh P, Moorthy MS, Niazi TM, Babu SS. Prevalence and Pattern of Impacted Mandibular Third Molar: An Institution-based Retrospective Study Sundarrajan. Asian J Pharm Clin Res. 2017;7(10):1-5.
Yasin Ertem S, Anlar H. Evaluation of the Relation Between Impacted Mandibular Third Molar Classification and Inferior Alveolar Canal. J Dent Indones. 2020;27(1):17-22.
Kamadjaja DB, Asmara D, Khairana G. The correlation between Rood and Shehab’s radiographic features and the incidence of inferior alveolar nerve paraesthesia following odontectomy of lower third molars. Dent J (Majalah Kedokt Gigi). 2017;49(2):59-62.
Akbar MF, Hadikrishna I, Riawan L, Lita YA. Impacted Lower Third Molar Profile at Dental Hospital of Padjadjaran University. J Indones Dent Assoc. 2023;5(2):91-8.
Pradopo S, Nelwan SC, Dewi AM, et al. Duration of Growth Spurt based on Cervical Vertebrae Maturation In Indonesia Population. Indian J Forensic Med Toxicol. 2021;15(3):4088-94.
Adeyemo WL, James O, Oladega AA, et al. Correlation Between Height and Impacted Third Molars and Genetics Role in Third Molar Impaction. J Maxillofac Oral Surg. 2021;20(1):149-53.
Azhari A, Pramatika B, Epsilawati L. Differences between male and female mandibular length growth according to panoramic radiograph. Maj Kedokt Gigi Indones. 2019;1(1):43-9.
Muhamad AH, Nezar W. Prevalence of Impacted Mandibular Third Molars in Population of Arab Israeli: A Retrospective Study. IOSR J Dent Med Sci e-ISSN. 2016;15(1).
Haddad Z, Khorasani M, Bakhshi M, Tofangchiha M, Shalli Z. Radiographic position of impacted mandibular third molars and their association with pathological conditions. Int J Dent. 2021;2021(March).
Porgel M, K-E K, L A. Essentials of Oral and Maxillofacial Surgery. 1st ed. Wiley Blackwell; 2014.
Primo FT, Primo BT, Scheffer MAR, Hernández PAG, Rivaldo EG. Evaluation of 1211 Third Molars Positions According to the Classification of Winter, Pell & Gregory. Int J Odontostomatol. 2017;11(1):61-5.
Gümrükçü Z, Balaban E, Karabağ M. Is there a relationship between third-molar impaction types and the dimensional/angular measurement values of posterior mandible according to Pell & Gregory/Winter Classification? Oral Radiol. 2021;37(1):29-35.
Leversha J, McKeough G, Myrteza A, Skjellrup-Wakefiled H, Welsh J, Sholapurkar A. Age and gender correlation of gonial angle, ramus height and bigonial width in dentate subjects in a dental school in Far North Queensland. J Clin Exp Dent. 2016;8(1):e49-e54.
Sukma Suntana M, Lenggogeni Nasroen S, Fadhilah I. Classification of Winter Impaction of Mandible Third Molar on the Distance of the Mandibular Canals on Panoramic Radiographs At Rsgmp Unjani. J Heal Dent Sci. 2023;2(Volume 2 No 3):455-66.
Utama MD, Abdi MJ, Makmur ZZ. HUBUNGAN KLASIFIKASI IMPAKSI MOLAR KETIGA MANDIBULA DENGAN JARAK KANAL MANDIBULAR PADA RADIOGRAFI PANORAMIK DI KLINIK MEDICAL CENTER. Indones J Public Heal. 2024;2(2):286-94.
Savani CM, Panicker K, Kiran BSR, Uppada UK. Does Darkening of Roots or Loss of White Line on Panoramic Radiographs Pose a Risk for Inferior Alveolar Nerve Damage? A CBCT Evaluation. J Orofac Sci. 2018;10(2):101-7.
Halder M, Chhaparwal Y, Pentapati KC, Patil V, Smriti K, Chhaparwal S. Quantitative and Qualitative Correlation of Mandibular Lingual Bone with Risk Factors for Third Molar Using Cone Beam Computed Tomography. Clin Cosmet Investig Dent. 2023;15(September):267-77.
Khojastepour L, Khaghaninejad MS, Hasanshahi R, Forghani M, Ahrari F. Does the Winter or Pell and Gregory Classification System Indicate the Apical Position of Impacted Mandibular Third Molars? J Oral Maxillofac Surg. 2019;77(11):2222.e1-2222.e9.
Gu L, Zhu C, Chen K, Liu X, Tang Z. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat. 2018;40(6):609-14.
Afridi SU, Baseer N, Durrani Z, Afridi MI, Jehan S. Association Between Angulation of MAndibular Third Molar Impaction with facial skeletal types and cephalometric landmarks. Khyber Med Univ J. 2022;14(1):47-55.
Published
2024-12-31
How to Cite
KURNIATI, Novi; HANI, Sabrina Tiara.
Unraveling the hidden connection: Impacted third molar classification and mandibular canal proximity on panoramic radiographs.
Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI), [S.l.], v. 8, n. 3, p. 103-112, dec. 2024.
ISSN 2686-1321.
Available at: <http://jurnal.pdgi.or.id/index.php/jrdi/article/view/1281>. Date accessed: 08 jan. 2025.
doi: https://doi.org/10.32793/jrdi.v8i3.1281.
Section
Original Research Article
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
