Identifying the Most Accurate Available Space Analysis Method for Predicting Mandibular Third Molar Eruption or Impaction by Means of Panoramic Radiographs

Third molar impaction is a major problem facing the dental profession and its impacts on the dentition has long been a major concern. Third molar is the most frequently impacted tooth. The prevalence of mandibular third molar impaction has been reported from 18 to 32 percent which varies between populations and races.
This study was designed to determine the best retromolar space analysis from available methods with the highest correlation with mesio-distal width of mandibular third molar (MTM) in order to predict its eruption or impaction.
Patients and Measurements were carried out on digital panoramic radiographs of 98 Iranian patients. One hundred and seventy mandibular third molars were divided into 4 groups: impacted females, impacted males, erupted females and erupted males. Twenty eight points and 24 planes were marked on the radiographs: 11 points in relation to retromolar space analysis and the mesio-distal width of MTM; and 17 points in relation to some anatomic variables assumed to be related to MTM eruption or impaction. Using these landmarks, different methods were tested for analyzing the retromolar space and its relation to the width of the MTM. Student’s t-test was applied for comparison between erupted and impacted groups and ROC curve was drawn to determine the method with the highest specificity and sensitivity.
Among the performed retromolar space analysis, the method that measured the distance between distal surface of second molar and the anterior border of ramus parallel to functional occlusal plane had the highest correlation with the MTM width. Also, the impact of some anatomic factors including posterior ramus height, upper body length, etc. on MTM eruption or impaction was observed.
Retromolar space analysis on panoramic radiographs can be a relatively precise predictor for mandibular third molar eruption or impaction. This study also supports the multifactorial concept about third molar impaction.