Investigation of the Relationship Between Mandibular Gonial Angle and Impacted Mandibular Third Molar

Year 2024, Volume: 6 Issue: 2, 192 - 199, 30.08.2024

Yiğit Ali Özkubat , Nesrin Saruhan , Yasin Koşar , Görkem Tekin , Ömür Dereci

https://doi.org/10.51122/neudentj.2024.102

Abstract

Aim: The aim of this study is to investigate changes in the gonial angles of impacted lower third molars and associated parameters in individuals with impacted lower third molars aged twenty years and below.
Material and Methods: A retrospective study included 963 patients with impacted third molars. Impaction classification was done according to Pell-Gregory criteria. The teeth were divided into eight main groups based on their relationship with the ramus and second molar (1, 2, 3) and the depth within the bone (A, B, C). Teeth classified as erupted in 1A were excluded from the study. Gonial angle, mesiodistal distance (MDM), retromolar eruption distance (RED), retromolar eruption ratio (RER), A° (angle between the Gonion-symphysis plane and the long axis of the third molar), and B° (angle between the Gonion-symphysis plane and the long axis of the second molar) were evaluated. Panoramic radiographs were analyzed using specialized software to measure angles and distances. The angles and measurements were compared among impacted groups and genders. Statistical analyses including Pearson correlation and ANOVA tests were used to assess relationships between measurements and impact parameters. A significance level of p<0.05 was considered statistically significant.
Results: In females, the A was found to be significantly larger than in males (p<0.05). In males, however, RSM and RSO were found to be significantly larger than in females (p<0.05). There was no significant variation in gonial angle among the impaction groups. A angle was the narrowest in group 3/B and the largest in group 2/A.
Conclusion: While gonial angle are not a definitive indicator of impacted third molars, the study emphasizes the importance of A° and RED in predicting impaction.

Keywords

third molar, Classification, Panoramic radiography

Mandibular Gonial Açı ile Alt Yirmi Yaş Diş Gömülülüğü Arasındaki İlişkinin Araştırılması

Abstract

Amaç: Bu çalışmanın amacı, alt yirmi yaş dişlerine sahip bireylerde gömülülük gösteren dişlerin gonial açıları ve bu durumla ilişkili parametrelerdeki değişiklikleri araştırmaktır.
Gereç ve Yöntemler: Retrospektif olarak yapılan araştırmada gömülü üçüncü molar dişleri olan 963 hasta çalışmaya dahil edildi. Gömülülük sınıflaması Pell-Gregory kriterlerine göre yapıldı. Dişin ramus ve 2. molar ile olan ilişkisine göre (1,2,3) ve dişin kemik içerisindeki derinliğine (A, B, C) göre sekiz ana gruba ayrılmıştır.1A sınıflamasındaki dişler sürmüş kabul edilerek çalışma dışı bırakılmıştır. Gonial açı, meziodistal mesafe (MDM), retromolar sürme mesafesi (RSM), retromolar sürme oranı (RSO), A(Gonion-simfiz noktaları arasına çizilen düzlem ile 3. molar diş uzun ekseni arasındaki açı) ve B(Gonion-simfiz arasına çizilen düzlem ile 2. molar dişin uzun ekseni arasındaki açı) değişkenleri değerlendirilmiştir. Panoramik radyografiler özel bir yazılım kullanılarak açılar ve mesafeler ölçülerek analiz edildi. Açı ve ölçümler gömülü grupları ve cinsiyetler arasında karşılaştırıldı. Ölçümler ve etki parametreleri arasındaki ilişkileri değerlendirmek için Pearson korelasyonu ve ANOVA testlerini içeren istatistiksel analizler kullanıldı. İstatistiksel anlamlılık değeri p<0,05 olarak kabul edilmiştir.
Bulgular: Kadınlarda A açısı, erkeklere göre anlamlı olarak daha büyük bulunmuştur (p<0.05). Erkeklerde ise RSM ve RSO, kadınlara göre anlamlı olarak daha büyük bulunmuştur (p<0.05). Gömülülük grupları arasında gonial açı bakımından anlamlı değişim bulunamamıştır. A açısı 3/B grubunda en dar açı iken 2/A grubunda en büyük açıya sahiptir.
Sonuç: Gonial açı üçüncü molar dişlerin gömülü kalmasının kesin bir göstergesi olmasa da, çalışma A˚ ve RSM’nin gömülü kalmayı öngörmedeki öneminin altını çizmektedir.

Keywords

Panoramik radyografi, sınıflama, üçüncü molar

References

• Amanat N, Mirza D, Rizvi KF. Pattern of third molar impaction: frequency and types among patients attending urban teaching hospital of Karachi. Pak Oral and Dental J. 2014;1:34-7
• Saputri RI, De Tobel J, Vranckx M, Ockerman A, Vlierberghe MV, Fieuws S et al. Is third molar development affected by third molar impaction or impaction-related parameters? Clin Oral Investig. 2021;12:6681-93.
• Carter K, Worthington S. Predictors of Third Molar Impaction: A Systematic Review and Meta-analysis. J Dent Res. 2016;95:267-76.
• Capelli J. Mandibular growth and third molar impaction in extraction cases. Angle Orthod. 1991;61:223-9.
• Uthman AT. Retromolar space analysis in relation to selected linear and angular measurements for an Iraqi sample. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:76-82.
• Ventä I, Murtomaa H, Ylipaavalniemi P. A device to predict lower third molar eruption. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84:598-603.
• Lauesen SR, Andreasen JO, Gerds TA, Christensen SS, Borum M, Hillerup S. Association between third mandibular molar impaction and degree of root development in adolescents. Angle Orthod. 2013;83:3-9.
• Castella P, Albright RH, Straja S, Tuncay OC. Prediction of mandibular third molar impaction in the orthodontic patient from a panoramic radiograph. Clin Orthod Res. 1998;1:37-43.
• Demirel O, Akbulut A. Evaluation of the relationship between gonial angle and impacted mandibular third molar teeth. Anat Sci Int. 2020;95:134-42.
• Radhakrishnan PD, Sapna Varma NK, Ajith VV. Dilemma of gonial angle measurement: Panoramic radiograph or lateral cephalogram. Imaging Sci Dent. 2017;2:93-7.
• Pell GJ. Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest. 1933;39:330-8.
• Alhadi Y, Al-Shamahy H, Aldilami A, Al-Hamzy M, Al-Haddad K. Prevalence and pattern of third molar impaction in sample of Yemeni adults. On J Dent Oral Health. 2019;5:1-4.
• Ventä I, Murtomaa H, Turtola L, Meurman J, Ylipaavalniemi P. Clinical follow-up study of third molar eruption from ages 20 to 26 years. Oral Surg Oral Med Oral Pathol. 1991;72:150-3.
• Barone S, Antonelli A, Averta F, Diodati F, Muraca D, Bennardo F, et al. Does Mandibular Gonial Angle Influence the Eruption Pattern of the Lower Third Molar? A Three-Dimensional Study. J Clin Med. 2021;10:4057.
• Moshfeghi M, Ahsaie MG, Heidari N, Ghashami M. The Relationship Between the Gonial Angle, Ramus Height, And the Type of Third-Molar Impaction: A Panoramic Radiographic Study. Journal of Dental School, Shahid Beheshti University of Medical Sciences. 2023;41:109-14.
• Verma A, Sharma P, Bhatnagar S. Evaluation and prediction of impacted mandibular third molars by panoramic radiography: A retrospective study. International Journal of Orthodontic Rehabilitation. 2017;8:101.
• Hattab FN, Alhaija ES. Radiographic evaluation of mandibular third molar eruption space. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:285-91.
• Begtrup A, Grønastøð H, Christensen IJ, Kjær I. Predicting lower third molar eruption on panoramic radiographs after cephalometric comparison of profile and panoramic radiographs. Eur J Orthod. 2013;35:460-6.
• Kaur R, Kumar AC, Garg R, Sharma S, Rastogi T, Gupta VV. Early prediction of mandibular third molar eruption/impaction using linear and angular measurements on digital panoramic radiography: A radiographic study. Indian J Dent. 2016;7:66-9.
• Altonen M, Haavikko K, Mattila K. Developmental position of lower third molar in relation to gonial angle and lower second molar. Angle Orthod. 1977;47:249-55.
• Richardson ME. The etiology and prediction of mandibular third molar impaction. Angle Orthod. 1977;47:165-72.
• Kaye E, Heaton B, Aljoghaiman EA, Singhal A, Sohn W, Garcia RI. Third-Molar Status and Risk of Loss of Adjacent Second Molars. J Dent Res. 2021;100:700-5.
• Ricketts RM. A principle of arcial growth of the mandible. Angle Orthod.1972;42:368-86.
• Balla SB, Nambi NK, Nambi S, Chinnala B, Bojji M, Mula AP, et al. Legal age determined by a new threshold value of third molar maturity index in subjects with impacted mandibular third molars: An orthopantomographic study in south Indian adolescents. Int J Legal Med. 2022;136:251-9.
• Mollaoglu N, Cetiner S, Güngör K. Patterns of third molar impaction in a group of volunteers in Türkiye. Clin Oral Investig. 2002;6:109-13.
• Quiros J, Palma A. The mandibular third molar: a method for predicting its eruption. Ortho J. 1999;2:8-15.
• Richardson ME. The etiology and prediction of mandibular third molar impaction. Angle Orthod. 1977;47:165-72.
• Sewerin I. Preoperative radiographic examination of the mandibular 3rd molars using 4 projections. 1. Technics. Tandlaegebladet. 1984;88:1-4.
• Niedzielska IA, Drugacz J, Kus N, Kreska J. Panoramic radiographic predictors of mandibular third molar eruption. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:154-8.
• Ganss C, Hochban W, Kielbassa AM, Umstadt HE. Prognosis of third molar eruption. Oral Surg Oral Med Oral Pathol.1993;76:688-93.
• Eröz UB, Ceylan I, Aydemir S. An investigation of mandibular morphology in subjects with different vertical facial growth patterns. Aust Orthod J. 2000;16:16-22.
• Brown LH, Berkman S, Cohen D, Kaplan AL, Rosenberg M. A radiological study of the frequency and distribution of impacted teeth. J Dent Assoc S Afr. 1982;37:627-30.
• Hugoson A, Kugelberg CF. The prevalence of third molars in a Swedish population. An epidemiological study. Community Dent Health. 1988;5:121-38.
• Murtomaa H, Turtola L, Ylipaavalniemi P, Rytömaa I. Status of the third molars in the 20- to 21-year-old Finnish university population. J Am Coll Health. 1985;34:127-9.
• Hassan AH. Pattern of third molar impaction in a Saudi population. Clin Cosmet Investig Dent. 2010;2:109-13.
• Quek SL, Tay CK, Tay KH, Toh SL, Lim KC. Pattern of third molar impaction in a Singapore Chinese population: a retrospective radiographic survey. Int J Oral Maxillofac Surg. 2003;32:548-52.