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Prevalence and factors affecting the formation of second molar distal caries in a Turkish population
Int. J. Oral Maxillofac. Surg. 2009; 38: 1279–1282 doi:10.1016/j.ijom.2009.07.007, available online at http://www.sciencedirect.com
Clinical Paper Oral Surgery
Prevalence and factors affecting the formation of second molar distal caries in a Turkish population
¨ zec¸a, S¸. Hergu¨ner Sisob, ˙I. O U. Tas¸demira, S¸. Ezirganlia, G. Go¨ktolgab a Department of Oral and Maxillofacial Surgery, Cumhuriyet University, Dental School, Sivas, Turkey; bDepartment of Restorative Dentistry, Cumhuriyet University, Dental School, Sivas, Turkey
¨ zec¸, S¸. Hergu¨ner Siso, U. Tas¸demir, S¸. Ezirganli, G. Go¨ktolga: Prevalence and ˙I. O factors affecting the formation of second molar distal caries in a Turkish population. Int. J. Oral Maxillofac. Surg. 2009; 38: 1279–1282. # 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Abstract. The aim of this study was to evaluate the prevalence of second molar distal caries in a Turkish population and to determine the factors that affect it. Clinical records and panoramic radiographs of partially erupted mandibular third molars were reviewed in this retrospective study. The analysis outcome measures were the patients’ age, second molar distal caries, third molar angulation and second and third molar contact point localization. Prevalence of second molar distal caries in the population was 20%. This prevalence was 47% when the third molar had an angulation of 31–708 (majority of mesioangular third molars) and 43% at 70–908 (all horizontal third molars). The contact point on the second molar amelocemental junction and increasing age had significant effects on caries formation. The results revealed that second molar distal caries justifies prophylactic third molar removal and partially erupted third molars that have an angulation of 30–908 with a contact point on the amelocemental junction should be removed to prevent second molar distal caries.
The prophylactic removal of impacted third molars is defined as the surgical removal of asymptomatic third molars, when patients do not have, and have not had, any symptoms and/or pathologies associated with impacted third molars. The decision to remove third molars associated with pathology is often straightforward, but the necessity and validity of prophylactic third molar removal is questioned by many investigators.1,14 0901-5027/1201279 + 04 $36.00/0
Second molar distal caries justifies the prophylactic removal of third molars. Mc Ardle and Renton13 assumed that distal caries in the second molar is specific and would not develop in the absence of the impacted third molar. Second molar distal caries have been seen in association with partially erupted lower third molars.13,16,21 The development of distal caries in the second molar requires a restorative and possible endodontic procedure to conserve the second molar in addition to the removal
Keywords: third molar; prophylactic removal; second molar distal caries. Accepted for publication 13 July 2009 Available online 7 August 2009
of the third molar; sometimes extraction of the second molar is also indicated. Disease patterns and the prevalence of impacted third molars have been investigated in many countries. Similar studies also have been carried out in Turkey, but none included second molar distal caries.8,15,18 The aim of this study was to determine the prevalence of second molar distal caries in a Turkish population and to determine its association with age, the angular position of the partially erupted
# 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
1280
¨ zec¸ et al. O
mandibular third molar and the second and third molar contact point. Materials and methods
This retrospective study was carried out by reviewing the clinical records of patients. Partially erupted third molars (in which the tooth has penetrated the mucosa but is partially covered by bone or soft tissue, or both), whether reaching the occlusal plane or not, were included in this study. The records of 485 patients with 585 partially erupted mandibular third molars were examined using panoramic radiographs to determine the prevalence of second molar distal caries. The angulation of the third molar, the second and third molar contact point and the patients’ age were also recorded. The angulation of the third molar tooth was determined by measuring the acute angle between lines drawn parallel to the mandibular occlusal plane and the third molar occlusal plane. The tangential lines were drawn through the tips of the cusps. Tracing paper attached to the panoramic radiography was used for these drawings. The second and third molar contact point was categorized according to the second molar amelocemental junction. The categories were: on the amelocemental junction; above the amelocemental junction; and below the amelocemental junction. All the authors reviewed the panoramic radiographs. Prior to the investigation, calibration of the examiners was undertaken until intra-examiner reliability and reproducibility was achieved. The panoramic radiographs were viewed on a radiographic view box and were assessed under standardized conditions. In doubtful cases, a consensus was reached by discussion. SPSS 10.0 for Windows (SPSS Inc., Chicago, USA) was used to analyse the data. Differences were tested for statistical significance using the X2 test. Statistical significance was defined as p < 0.05. Results
The prevalence of second molar distal caries was 20% (n = 117). The median age of the group was 25.2 years (range 18–49 years) and a statistically significant relationship between age and second molar distal caries was observed (Fig. 1) (X2 = 46.78; df = 3; p < 0.05). Third molar angulations were categorized into three groups: 0–308, 31–708 and 71–908. Fig. 2 shows the relationship between the angulation categories and the prevalence of second molar caries. The prevalence of second molar distal caries was determined
Fig. 1. Patient age and prevalence of second molar distal caries.
Fig. 2. Partially erupted third molar angulation and prevalence of second molar distal caries.
Fig. 3. Contact point localization and prevalence of second molar distal caries.
as very low (0–308). The relationship between third molar angulation and second molar distal caries was statistically df = 5; significant (X2 = 139.28; p < 0.05). Fig. 3 shows the relationship between contact point localization and the prevalence of second molar distal caries. The risk of second molar distal caries formation was statistically significantly linked to the amelocemental junction category (X2 = 92.59; df = 2; p < 0.05). Discussion
Many authors consider there is little evidence to support the prophylactic removal
of impacted third molars, although they pose a risk of a pathological condition, the risk is small compared with the risks of operative and postoperative complications and the costs of unnecessary removal.1,14,20 Studies of third molars show that partially erupted third molars present a higher frequency of symptoms than molars covered by tissue or erupted.7,11,12,16 Hill and Walker10 evaluated fully or partially impacted mandibular third molars that were untreated for 5 years and determined that partially erupted teeth were more likely to require extraction. These results show that discussing the prophylactic removal of par-
Prevalence and factors affecting the formation of second molar distal caries in a Turkish population tially erupted third molars is more important than fully impacted third molars. The incidence of second molar distal caries is 0.5–8%.3–5,11,12,21,24 The highest incidence of second molar distal caries was reported by Van der Linden et al22 as 32% in South Africa. In the present study, the incidence of second molar distal caries was 20%, which is higher than all other values, except one, in the English literature. The authors compared the effect of the degree of angulation of the third molar on caries formation and found that values of 30–698 and 70–908 led to a significant risk of second molar distal caries. Venta et al.23 classified third molars according to angulation as: vertical tooth between 108; mesioangular tooth 11–708; and horizontal tooth 71–908. If the present results are categorized according to this classification, mesioangular third molars that have an angulation more than 308 and horizontal third molars justify prophylactic third molar removal. A relatively small number of caries were determined at 0–308 (all vertical and some mesioangular) and in the authors’ opinion this incidence does not justify the prophylactic removal of third molars related to second molar distal caries. Other studies suggested that second molar distal caries were seen especially at partially erupted mesioangular lower third molars.13,17,21 Unlike these studies, the authors determined that not all mesioangular third molars posed the same risk, and partially erupted horizontal third molars were also in the high risk group. The authors also evaluated the effect of second and third molar contact point on the formation of second molar distal caries. They determined that contact point on the second molar amelocemental junction had a statistically significant effect on caries formation. Contact point localization above the amelocemental junction posed less risk than the other positions. It has been suggested that the development of distal caries in the second molar is a protracted process that develops over time and increases with continued exposure to the oral cavity. Consequently, these patients are older than the usual patients who have third molars removed.13 The results of this study confirmed this and showed that the incidence of second molar distal caries increased with the patient’s age. Panoramic radiographic evaluation was the weak point of this study. Extraoral radiographic techniques to detect proximal caries have been shown to be inferior
1281
Fig. 4. An example of high risk third molar position and second molar distal caries.
to intraoral techniques.2,6,9 Demineralization is an important factor for carious detection with radiography. Early carious lesions that have insufficient demineralization may not be detected with panoramic radiography but an advanced caries penetrating to the dentin can be detected. Scarfe et al.19 determined that for overall diagnostic accuracy bitewings were superior to panoramic radiographs but for dentine-pulp caries there were no significant differences in accuracy between the two modalities. Rushton et al.17 determined that panoramic radiography is appropriate for clinically evident caries lesions. These results support advanced caries detection with panoramic radiography. The authors assume that the amount of second molar distal caries found was less than the actual value. Hansen9 determined the sensitivity for the detection of proximal caries was 33% for panoramic radiography and 80% for bitewings. This suggests that detecting proximal caries with panoramic radiography yields high false-negative results. Clark et al.6 compared the clinical findings of bitewing, panoramic radiography, and panoramic radiography plus bitewing and found that panoramic radiography plus bitewing identified significantly more proximal carious surfaces than clinical examination. In this study, if the authors could have evaluated the second molar distal caries with panoramic plus bitewing, they would have been able to detect initial caries lesions and would have found a higher number of second molar distal caries. In this study, the authors detected only advanced caries, so false-positive results must be low. In the clinical situation, false-positive results do not harm the patient. In every situation, the authors
suggest the prophylactic removal of the third molars. After removal, the distal side of the second molar can be evaluated clinically. Even though the diagnosis of caries is not accurate, the removal will prevent the formation of future caries. In conclusion, Turkey is an economically developing country and routine prophylactic removal of impacted third molars will be too costly. Identifying those teeth presenting a higher risk of complications related to third molar preservation is the key for development of indications for prophylactic third molar surgery. The results of this study indicated that, partially erupted third molars that have an angulation of 30–908 and a contact point on the amelocemental junction should be removed to prevent second molar distal caries (Fig. 4). Funding
None Competing interests
None declared Ethical approval
Not required References 1. Adeyemo WL. Do pathologies associated with impacted lower third molars justify prophylactic removal? A critical review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006: 102: 448–452. 2. Akarslan ZZ, Akdeveliog˘lu M, Gu¨ngo¨r K, Erten H. A comparison
1282
3.
4.
5.
6.
7.
8.
9.
10.
¨ zec¸ et al. O
of the diagnostic accuracy of bitewing, periapical, unfiltered and filtered digital panoramic images for approximal caries detection in posterior teeth. Dentomaxillofac Radiol 2008: 37: 458–463. Al-Khateeb TH, Bataineh AB. Pathology associated with impacted mandibular third molars in a group of Jordanians. J Oral Maxillofac Surg 2006: 64: 1598– 1602. Bataineh AB, Albashaireh ZS, Hazza’a AM. The surgical removal of mandibular third molars: a study in decision making. Quintessence Int 2002: 33: 613– 617. Chu FC, LI˙ TK, Lui VK, Newsome PR, Chow RL, Cheung LK. Prevalence of impacted teeth and associated pathologies-a radiographic study of the Hong Kong Chinese population. Hong Kong Med J 2003: 9: 158–163. Clark HC, Curzon ME. A prospective comparison between findings from a clinical examination and results of bitewing and panoramic radiographs for dental caries diagnosis in children. Eur J Paediatr Dent 2004: 5: 203–209. Eliasson S, Heimdahl A, Nordenram A. Pathological changes related to longterm impaction of third molars. A radiographic study. Int J Oral Maxillofac Surg 1989: 18: 210–212. Gu¨ven O, Keskin A, Akal UK. The incidence of cysts and tumors around impacted third molars. Int J Oral Maxillofac Surg 2000: 29: 131–135. Hansen BF. Clinical and roentgenologic caries detection. A comparison DentoMaxillo-Facial Radiology 1980: 9: 34– 36. Hill CM, Walker RV. Conservative, non-surgical management of patients presenting with impacted lower third molars:
11.
12.
13.
14.
15.
16.
17.
18.
a 5-year study. Br J Oral Maxillofac Surg 2006: 44: 347–350. Knutsson K, Brehmer B, Lysell L, Rohlin M. Pathoses associated with mandibular third molars subjected to removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996: 82: 10–17. Lysell L, Rohlin M. A study of indications used for removal of the mandibular third molar. Int J Oral Maxillofac Surg 1988: 17: 161–164. McArdle LW, Renton TF. Distal cervical caries in the mandibular second molar: an indication for the prophylactic removal of the third molar? Br J Oral Maxillofac Surg 2006: 44: 42–45. Mercier P, Precious D. Risks and benefits of removal of impacted third molars. A critical review of the literature. Int J Oral Maxillofac Surg 1992: 21: 17–27. Mollaoglu N, Cetiner S, Gu¨ngo¨r K. Patterns of third molar impaction in a group of volunteers in Turkey. Clin Oral Investig 2002: 6: 109–113. Punwutikorn J, Waikakul A, Ochareon P. Symptoms of unerupted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999: 87: 305–310. Rushton VE, Horner K, Worthington HV. Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002: 93: 488–495. Sag˘lam AA, Tu¨zu¨m MS. Clinical and radiologic investigation of the incidence, complications, and suitable removal times for fully impacted teeth in the Turkish population. Quintessence Int 2003: 34: 53–59.
19. Scarfe WC, Langlais RP, Nummikoski P, Dove SB, McDavid WD, Deahl ST, Yuan CH. Clinical comparison of two panoramic modalities and posterior bitewing radiography in the detection of proximal dental caries. Oral Surgery Oral Medicine Oral Pathology 1994: 77: 195– 207. 20. Song F, Landes DP, Glenny AM, Sheldan TA. Prophylactic removal of impacted third molars: an assessment of published reviews. Br Dent J 1997: 182: 339–346. 21. Stephens RG, Kogon SL, Reid JA. The unerupted or impacted third molar-a critical appraisal of its pathologic potential. J Can Dent Assoc 1989: 55: 201–207. 22. Van der Linden W, Cleaton-Jones Lownie M. Diseases and lesions associated with third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995: 75: 142–145. 23. Venta¨ I, Murtomaa H, Turtola L, Meurman J, Ylipaavalniemi P. Assessing the eruption of lower third molars on the basis of radiographic features. Br J Oral Maxillofac Surg 1991: 29: 259–262. 24. Yamaoka M, Furusawa K, Yamamoto M. Influence of adjacent teeth on impacted third molars in the upper and lower jaws. Aust Dent J 1995: 40: 233–235. Address: ¨ zec¸ I˙lker O ¨ niversitesi Cumhuriyet U Dis¸hekimlig˘i Faku¨ltesi ADC¸H ve Cerrahisi AD 58140 Sivas/Turkey Tel.: +90 346 219 1010/2710 Fax: +90 346 219 1237 E-mail: [email protected]
Clinical Paper Oral Surgery
Prevalence and factors affecting the formation of second molar distal caries in a Turkish population
¨ zec¸a, S¸. Hergu¨ner Sisob, ˙I. O U. Tas¸demira, S¸. Ezirganlia, G. Go¨ktolgab a Department of Oral and Maxillofacial Surgery, Cumhuriyet University, Dental School, Sivas, Turkey; bDepartment of Restorative Dentistry, Cumhuriyet University, Dental School, Sivas, Turkey
¨ zec¸, S¸. Hergu¨ner Siso, U. Tas¸demir, S¸. Ezirganli, G. Go¨ktolga: Prevalence and ˙I. O factors affecting the formation of second molar distal caries in a Turkish population. Int. J. Oral Maxillofac. Surg. 2009; 38: 1279–1282. # 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Abstract. The aim of this study was to evaluate the prevalence of second molar distal caries in a Turkish population and to determine the factors that affect it. Clinical records and panoramic radiographs of partially erupted mandibular third molars were reviewed in this retrospective study. The analysis outcome measures were the patients’ age, second molar distal caries, third molar angulation and second and third molar contact point localization. Prevalence of second molar distal caries in the population was 20%. This prevalence was 47% when the third molar had an angulation of 31–708 (majority of mesioangular third molars) and 43% at 70–908 (all horizontal third molars). The contact point on the second molar amelocemental junction and increasing age had significant effects on caries formation. The results revealed that second molar distal caries justifies prophylactic third molar removal and partially erupted third molars that have an angulation of 30–908 with a contact point on the amelocemental junction should be removed to prevent second molar distal caries.
The prophylactic removal of impacted third molars is defined as the surgical removal of asymptomatic third molars, when patients do not have, and have not had, any symptoms and/or pathologies associated with impacted third molars. The decision to remove third molars associated with pathology is often straightforward, but the necessity and validity of prophylactic third molar removal is questioned by many investigators.1,14 0901-5027/1201279 + 04 $36.00/0
Second molar distal caries justifies the prophylactic removal of third molars. Mc Ardle and Renton13 assumed that distal caries in the second molar is specific and would not develop in the absence of the impacted third molar. Second molar distal caries have been seen in association with partially erupted lower third molars.13,16,21 The development of distal caries in the second molar requires a restorative and possible endodontic procedure to conserve the second molar in addition to the removal
Keywords: third molar; prophylactic removal; second molar distal caries. Accepted for publication 13 July 2009 Available online 7 August 2009
of the third molar; sometimes extraction of the second molar is also indicated. Disease patterns and the prevalence of impacted third molars have been investigated in many countries. Similar studies also have been carried out in Turkey, but none included second molar distal caries.8,15,18 The aim of this study was to determine the prevalence of second molar distal caries in a Turkish population and to determine its association with age, the angular position of the partially erupted
# 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
1280
¨ zec¸ et al. O
mandibular third molar and the second and third molar contact point. Materials and methods
This retrospective study was carried out by reviewing the clinical records of patients. Partially erupted third molars (in which the tooth has penetrated the mucosa but is partially covered by bone or soft tissue, or both), whether reaching the occlusal plane or not, were included in this study. The records of 485 patients with 585 partially erupted mandibular third molars were examined using panoramic radiographs to determine the prevalence of second molar distal caries. The angulation of the third molar, the second and third molar contact point and the patients’ age were also recorded. The angulation of the third molar tooth was determined by measuring the acute angle between lines drawn parallel to the mandibular occlusal plane and the third molar occlusal plane. The tangential lines were drawn through the tips of the cusps. Tracing paper attached to the panoramic radiography was used for these drawings. The second and third molar contact point was categorized according to the second molar amelocemental junction. The categories were: on the amelocemental junction; above the amelocemental junction; and below the amelocemental junction. All the authors reviewed the panoramic radiographs. Prior to the investigation, calibration of the examiners was undertaken until intra-examiner reliability and reproducibility was achieved. The panoramic radiographs were viewed on a radiographic view box and were assessed under standardized conditions. In doubtful cases, a consensus was reached by discussion. SPSS 10.0 for Windows (SPSS Inc., Chicago, USA) was used to analyse the data. Differences were tested for statistical significance using the X2 test. Statistical significance was defined as p < 0.05. Results
The prevalence of second molar distal caries was 20% (n = 117). The median age of the group was 25.2 years (range 18–49 years) and a statistically significant relationship between age and second molar distal caries was observed (Fig. 1) (X2 = 46.78; df = 3; p < 0.05). Third molar angulations were categorized into three groups: 0–308, 31–708 and 71–908. Fig. 2 shows the relationship between the angulation categories and the prevalence of second molar caries. The prevalence of second molar distal caries was determined
Fig. 1. Patient age and prevalence of second molar distal caries.
Fig. 2. Partially erupted third molar angulation and prevalence of second molar distal caries.
Fig. 3. Contact point localization and prevalence of second molar distal caries.
as very low (0–308). The relationship between third molar angulation and second molar distal caries was statistically df = 5; significant (X2 = 139.28; p < 0.05). Fig. 3 shows the relationship between contact point localization and the prevalence of second molar distal caries. The risk of second molar distal caries formation was statistically significantly linked to the amelocemental junction category (X2 = 92.59; df = 2; p < 0.05). Discussion
Many authors consider there is little evidence to support the prophylactic removal
of impacted third molars, although they pose a risk of a pathological condition, the risk is small compared with the risks of operative and postoperative complications and the costs of unnecessary removal.1,14,20 Studies of third molars show that partially erupted third molars present a higher frequency of symptoms than molars covered by tissue or erupted.7,11,12,16 Hill and Walker10 evaluated fully or partially impacted mandibular third molars that were untreated for 5 years and determined that partially erupted teeth were more likely to require extraction. These results show that discussing the prophylactic removal of par-
Prevalence and factors affecting the formation of second molar distal caries in a Turkish population tially erupted third molars is more important than fully impacted third molars. The incidence of second molar distal caries is 0.5–8%.3–5,11,12,21,24 The highest incidence of second molar distal caries was reported by Van der Linden et al22 as 32% in South Africa. In the present study, the incidence of second molar distal caries was 20%, which is higher than all other values, except one, in the English literature. The authors compared the effect of the degree of angulation of the third molar on caries formation and found that values of 30–698 and 70–908 led to a significant risk of second molar distal caries. Venta et al.23 classified third molars according to angulation as: vertical tooth between 108; mesioangular tooth 11–708; and horizontal tooth 71–908. If the present results are categorized according to this classification, mesioangular third molars that have an angulation more than 308 and horizontal third molars justify prophylactic third molar removal. A relatively small number of caries were determined at 0–308 (all vertical and some mesioangular) and in the authors’ opinion this incidence does not justify the prophylactic removal of third molars related to second molar distal caries. Other studies suggested that second molar distal caries were seen especially at partially erupted mesioangular lower third molars.13,17,21 Unlike these studies, the authors determined that not all mesioangular third molars posed the same risk, and partially erupted horizontal third molars were also in the high risk group. The authors also evaluated the effect of second and third molar contact point on the formation of second molar distal caries. They determined that contact point on the second molar amelocemental junction had a statistically significant effect on caries formation. Contact point localization above the amelocemental junction posed less risk than the other positions. It has been suggested that the development of distal caries in the second molar is a protracted process that develops over time and increases with continued exposure to the oral cavity. Consequently, these patients are older than the usual patients who have third molars removed.13 The results of this study confirmed this and showed that the incidence of second molar distal caries increased with the patient’s age. Panoramic radiographic evaluation was the weak point of this study. Extraoral radiographic techniques to detect proximal caries have been shown to be inferior
1281
Fig. 4. An example of high risk third molar position and second molar distal caries.
to intraoral techniques.2,6,9 Demineralization is an important factor for carious detection with radiography. Early carious lesions that have insufficient demineralization may not be detected with panoramic radiography but an advanced caries penetrating to the dentin can be detected. Scarfe et al.19 determined that for overall diagnostic accuracy bitewings were superior to panoramic radiographs but for dentine-pulp caries there were no significant differences in accuracy between the two modalities. Rushton et al.17 determined that panoramic radiography is appropriate for clinically evident caries lesions. These results support advanced caries detection with panoramic radiography. The authors assume that the amount of second molar distal caries found was less than the actual value. Hansen9 determined the sensitivity for the detection of proximal caries was 33% for panoramic radiography and 80% for bitewings. This suggests that detecting proximal caries with panoramic radiography yields high false-negative results. Clark et al.6 compared the clinical findings of bitewing, panoramic radiography, and panoramic radiography plus bitewing and found that panoramic radiography plus bitewing identified significantly more proximal carious surfaces than clinical examination. In this study, if the authors could have evaluated the second molar distal caries with panoramic plus bitewing, they would have been able to detect initial caries lesions and would have found a higher number of second molar distal caries. In this study, the authors detected only advanced caries, so false-positive results must be low. In the clinical situation, false-positive results do not harm the patient. In every situation, the authors
suggest the prophylactic removal of the third molars. After removal, the distal side of the second molar can be evaluated clinically. Even though the diagnosis of caries is not accurate, the removal will prevent the formation of future caries. In conclusion, Turkey is an economically developing country and routine prophylactic removal of impacted third molars will be too costly. Identifying those teeth presenting a higher risk of complications related to third molar preservation is the key for development of indications for prophylactic third molar surgery. The results of this study indicated that, partially erupted third molars that have an angulation of 30–908 and a contact point on the amelocemental junction should be removed to prevent second molar distal caries (Fig. 4). Funding
None Competing interests
None declared Ethical approval
Not required References 1. Adeyemo WL. Do pathologies associated with impacted lower third molars justify prophylactic removal? A critical review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006: 102: 448–452. 2. Akarslan ZZ, Akdeveliog˘lu M, Gu¨ngo¨r K, Erten H. A comparison
1282
3.
4.
5.
6.
7.
8.
9.
10.
¨ zec¸ et al. O
of the diagnostic accuracy of bitewing, periapical, unfiltered and filtered digital panoramic images for approximal caries detection in posterior teeth. Dentomaxillofac Radiol 2008: 37: 458–463. Al-Khateeb TH, Bataineh AB. Pathology associated with impacted mandibular third molars in a group of Jordanians. J Oral Maxillofac Surg 2006: 64: 1598– 1602. Bataineh AB, Albashaireh ZS, Hazza’a AM. The surgical removal of mandibular third molars: a study in decision making. Quintessence Int 2002: 33: 613– 617. Chu FC, LI˙ TK, Lui VK, Newsome PR, Chow RL, Cheung LK. Prevalence of impacted teeth and associated pathologies-a radiographic study of the Hong Kong Chinese population. Hong Kong Med J 2003: 9: 158–163. Clark HC, Curzon ME. A prospective comparison between findings from a clinical examination and results of bitewing and panoramic radiographs for dental caries diagnosis in children. Eur J Paediatr Dent 2004: 5: 203–209. Eliasson S, Heimdahl A, Nordenram A. Pathological changes related to longterm impaction of third molars. A radiographic study. Int J Oral Maxillofac Surg 1989: 18: 210–212. Gu¨ven O, Keskin A, Akal UK. The incidence of cysts and tumors around impacted third molars. Int J Oral Maxillofac Surg 2000: 29: 131–135. Hansen BF. Clinical and roentgenologic caries detection. A comparison DentoMaxillo-Facial Radiology 1980: 9: 34– 36. Hill CM, Walker RV. Conservative, non-surgical management of patients presenting with impacted lower third molars:
11.
12.
13.
14.
15.
16.
17.
18.
a 5-year study. Br J Oral Maxillofac Surg 2006: 44: 347–350. Knutsson K, Brehmer B, Lysell L, Rohlin M. Pathoses associated with mandibular third molars subjected to removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996: 82: 10–17. Lysell L, Rohlin M. A study of indications used for removal of the mandibular third molar. Int J Oral Maxillofac Surg 1988: 17: 161–164. McArdle LW, Renton TF. Distal cervical caries in the mandibular second molar: an indication for the prophylactic removal of the third molar? Br J Oral Maxillofac Surg 2006: 44: 42–45. Mercier P, Precious D. Risks and benefits of removal of impacted third molars. A critical review of the literature. Int J Oral Maxillofac Surg 1992: 21: 17–27. Mollaoglu N, Cetiner S, Gu¨ngo¨r K. Patterns of third molar impaction in a group of volunteers in Turkey. Clin Oral Investig 2002: 6: 109–113. Punwutikorn J, Waikakul A, Ochareon P. Symptoms of unerupted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999: 87: 305–310. Rushton VE, Horner K, Worthington HV. Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002: 93: 488–495. Sag˘lam AA, Tu¨zu¨m MS. Clinical and radiologic investigation of the incidence, complications, and suitable removal times for fully impacted teeth in the Turkish population. Quintessence Int 2003: 34: 53–59.
19. Scarfe WC, Langlais RP, Nummikoski P, Dove SB, McDavid WD, Deahl ST, Yuan CH. Clinical comparison of two panoramic modalities and posterior bitewing radiography in the detection of proximal dental caries. Oral Surgery Oral Medicine Oral Pathology 1994: 77: 195– 207. 20. Song F, Landes DP, Glenny AM, Sheldan TA. Prophylactic removal of impacted third molars: an assessment of published reviews. Br Dent J 1997: 182: 339–346. 21. Stephens RG, Kogon SL, Reid JA. The unerupted or impacted third molar-a critical appraisal of its pathologic potential. J Can Dent Assoc 1989: 55: 201–207. 22. Van der Linden W, Cleaton-Jones Lownie M. Diseases and lesions associated with third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995: 75: 142–145. 23. Venta¨ I, Murtomaa H, Turtola L, Meurman J, Ylipaavalniemi P. Assessing the eruption of lower third molars on the basis of radiographic features. Br J Oral Maxillofac Surg 1991: 29: 259–262. 24. Yamaoka M, Furusawa K, Yamamoto M. Influence of adjacent teeth on impacted third molars in the upper and lower jaws. Aust Dent J 1995: 40: 233–235. Address: ¨ zec¸ I˙lker O ¨ niversitesi Cumhuriyet U Dis¸hekimlig˘i Faku¨ltesi ADC¸H ve Cerrahisi AD 58140 Sivas/Turkey Tel.: +90 346 219 1010/2710 Fax: +90 346 219 1237 E-mail: [email protected]