Association between Mandibular Third Molar Impaction Types and Pericoronitis: A Retrospective Analysis Using Panoramic Radiographs

Abstract

Background

Mandibular third molars are frequently impacted due to their late eruption and unique anatomical position, with pericoronitis being the most common complication. This study examines the relationship between mandibular third molar impaction types and the incidence of pericoronitis, utilizing panoramic radiographs.

Materials and Methods

This retrospective cross-sectional study included 216 patients aged 18 to 48 years with impacted mandibular third molars. Participants were grouped into a pericoronitis group (n = 108) and a no pericoronitis group (n = 108). Mandibular third molar angulation was measured using panoramic radiographs and classified according to Winter's classification. Gender-based differences and the relationship between impaction types and pericoronitis were analyzed using chi-square tests, with statistical significance set at p < 0.05.

Results

Mesioangular impactions were mostly associated with pericoronitis, accounting for 48.1% of cases, followed by distoangular (29.6%), vertical (14.8%), and horizontal (7.4%) impactions (p < 0.001). Gender-based analysis revealed significant differences in impaction types, with mesioangular and distoangular impactions being more prevalent among females with pericoronitis (p < 0.001). However, no overall significant difference in gender distribution was observed between groups (p = 0.273).

Conclusion

Mesioangular impactions significantly contribute to the prevalence of pericoronitis. These findings highlight the importance of early radiographic evaluation and classification of mandibular third molars to mitigate complications. Further studies with standardized classification systems are recommended to address the observed variability in impaction-related outcomes.

Keywords

molar - third - tooth - impacted - pericoronitis - radiography - panoramic

Introduction

The mandibular third molar, commonly called the wisdom tooth, often fails to fully erupt due to its late developmental timing and unique anatomical position. This incomplete eruption can result in the tooth remaining partially or completely impacted, a condition particularly common in mandibular third molars, with global prevalence rates ranging from 18.97% to 24.4% in individuals over 17 years of age.[1]

Impacted mandibular third molars are associated with several complications, the most prevalent of which is pericoronitis, occurring in up to 10% of cases and predominantly affecting the mandibular arch.[2] [3] Pericoronitis is characterized as an acute, painful inflammation of the gingival flap overlying a partially erupted tooth. If left untreated, it can lead to severe infections and trismus and may require urgent surgical interventions.[2] [4]

Mandibular third molar impactions are classified into mesioangular, distoangular, vertical, and horizontal types based on standardized systems such as Pell and Gregory, each with distinct implications for the occurrence and severity of pericoronitis.[5] [6] [7] Studies have reported that mesioangular impaction, where the tooth crown is tilted toward the adjacent tooth, is most frequently associated with pericoronitis, particularly in class II position B configurations.[8] [9] Conversely, other types of impactions, such as distoangular impaction, where the crown is inclined away from the adjacent tooth, appear to have a lower risk of this complication.[6] [9]

While some investigations have established a direct link between impaction type and pericoronitis incidence—such as vertical or mesioangular positions increasing risk by up to 3.34-fold—others have failed to confirm this association definitively.[8] [10] [11] These discrepancies may be attributed to variations in sample size, study design, or diagnostic criteria.[10] Several studies have highlighted limitations that affect the generalizability and consistency of findings regarding mandibular third molar impactions. For instance, multivariable analyses have emphasized that smaller sample sizes and inconsistent radiographic assessments may limit the applicability of results, underscoring the need for larger, standardized cohorts.[1] [10] Additionally, the absence of clinical probing findings was identified as a considerable limitation, suggesting that reliance solely on radiographic evaluations can lead to inconsistencies in diagnosing impaction types.[8] Furthermore, systematic reviews have found that predictors of third molar impaction rates and associated pathologies include study sample size, sample type, minimum subject age, and angulation, highlighting variability in study designs and the need for comprehensive assessments of multiple contributing variables.[1]

Other factors influencing pericoronitis development include patient demographics (e.g., peak incidence in ages 21–35 years, with higher rates in females), oral hygiene status, and access to dental care.[3] [12] Specific bacterial species, including Peptostreptococcus, Fusobacterium, and Bacteroides, have been implicated in the etiology of pericoronitis through mixed anaerobic flora accumulation beneath the operculum.[13] Additionally, the presence of an opposing maxillary third molar has been proposed as an etiological factor, potentially exacerbating the condition through mechanical trauma to the soft tissue overlying the mandibular third molar; the cusps of the opposing tooth may contribute to irritation, although pericoronitis can also occur in the absence of an opposing tooth.[4] [14]

However, despite the existing body of research, limitations such as inconsistent diagnostic criteria, lack of comprehensive variable analysis, and conflicting results remain unresolved. Many previous studies have either focused on isolated factors or failed to integrate multiple determinants simultaneously, leaving gaps in understanding the precise interplay between impaction type and pericoronitis.[8] [10] [11] Notably, while demographic patterns of impaction have been described in various populations, few studies have explored gender-based differences in impaction types specifically associated with pericoronitis using panoramic radiographs, particularly in underrepresented groups such as the Iranian population.[15] [16] For example, although gender variations in overall impaction prevalence exist—with females showing higher rates in some cohorts—no robust analyses have stratified pericoronitis risk by gender and radiographic impaction features in this demographic, limiting culturally tailored clinical insights.[15] [17]

This study addresses these gaps by asserting that the type of mandibular third molar impaction is significantly associated with the incidence of pericoronitis in an Iranian cohort. It is expected that mesioangular impactions will exhibit a higher prevalence of pericoronitis compared with other forms, such as distoangular, vertical, and horizontal, with potential modulation by gender. Additionally, the study proposes that the severity of pericoronitis may vary depending on the degree of impaction angulation, resulting in distinct clinical manifestations.

Materials and Methods

Study Design and Setting

This retrospective cross-sectional analytical study was conducted on patients who visited the Faculty of Dentistry at Islamic Azad University, Isfahan Branch, between 2022 and 2023. Convenience sampling was employed, utilizing preexisting patient records and radiographs from the clinic database to select eligible cases, which may limit external validity to similar university-affiliated dental clinic populations in Iran. A sample size calculation was performed using a 95% confidence level and 80% power, which determined that 216 participants would provide sufficient statistical power to detect significant differences. This study was approved by the Research Ethics Committee of Islamic Azad University, Isfahan (Khorasgan) Branch (approval ID: IR.IAU.KHUISF.REC.1402.402). Written informed consent was obtained from all participants, and the research adhered to ethical principles and national regulations for medical research in Iran.

Study Population

Patients aged 18 to 48 years were conveniently sampled with at least one impacted or partially impacted mandibular third molar and the availability of existing panoramic radiographic examinations taken within the last 6 months before study enrollment, who had been referred to the clinic of the Faculty of Dentistry of Isfahan Islamic Azad University. Exclusion criteria comprised congenital absence of mandibular third molars, fully erupted mandibular third molars with no associated soft tissue issues, absence of mandibular second molars, which precluded the determination of the third molar's angulation, and patients who did not provide informed consent for the use of their clinical and radiographic data.

Patients were categorized into two groups.

• Pericoronitis group (n = 108): Patients with at least one mandibular third molar meeting the pericoronitis diagnostic criteria.

• No pericoronitis group (n = 108): Patients with at least one impacted mandibular third molar without clinical signs of pericoronitis.

Each tooth was considered an independent unit of analysis, meaning that in patients with bilateral third molar impactions, both molars were evaluated separately.

Clinical Examination and Grouping

All clinical data were collected by a single, trained examiner to ensure consistency in the diagnostic process. The examiner underwent calibration training, including review of standardized diagnostic protocols and supervised assessment of 20 sample cases prior to data collection, to minimize diagnostic variability.

The examiner assessed pericoronitis based on standardized diagnostic criteria, including redness and swelling of the pericoronal flap, purulent discharge from the pericoronal area, and pain evaluated using a visual analog scale (VAS) ranging from 0 (no pain) to 10 (severe pain).[18] Tenderness on palpation of the pericoronal tissues and bleeding on probing, recorded as present or absent. Pericoronitis was diagnosed if at least two of these criteria were present.

To verify diagnosis reliability, intraexaminer agreement was assessed by reevaluating a random subset of 20% of clinical records (n = 43) after a 2-week interval; agreement was quantified using Cohen's kappa coefficient (κ = 0.90; 95% CI: 0.82–0.98; p < 0.001), indicating excellent reproducibility. Each mandibular third molar was considered an independent unit of analysis. For patients with bilateral third molar impactions, both molars were evaluated separately and classified independently.

The pericoronitis diagnosis was based on clinical examination data collected from the patient's medical records at the Faculty of Dentistry and verified retrospectively by the calibrated examiner.

Radiographic Analysis

Panoramic radiographs were obtained to evaluate the angulation and impaction status of mandibular third molars in relation to pericoronitis. The images were not acquired specifically for this study but were preexisting radiographs retrieved from the patient database at the Clinic of Dentistry. Informed consent for imaging acquisition had been obtained from all patients at the time of their initial dental assessment.

All radiographs were taken by a trained radiology technician under the supervision of a certified oral and maxillofacial radiologist. Standard panoramic radiographs were captured using a Vatech PCH 2500 device (Vatech Co., South Korea) with exposure settings of 90 kV and 10 mAs. The device was calibrated according to the manufacturer's guidelines before imaging to ensure optimal radiographic quality. Any radiographs that were blurred or unclear were excluded from the analysis.

The clinical examinations and radiographic assessments were performed within the same visit, whenever possible. In cases where a radiographic image had been taken prior to the clinical examination, the interval between the two was reviewed to ensure the relevance of the radiographic findings to the clinical status of the patient.

To ensure the reliability and reproducibility of the radiographic evaluations, intra- and interobserver agreements were assessed. Two certified oral and maxillofacial radiologists (Observers A and B, each with over 10 years of experience) independently classified the impaction types (e.g., mesioangular, vertical, horizontal, and distoangular) and angulation status based on standardized criteria from the Pell and Gregory classification system. For intraobserver reliability, Observer A reevaluated a random subset of 20% of the radiographs (n = 43) after a 2-week interval to minimize recall bias. Interobserver reliability was calculated based on the initial independent assessments by both observers for the entire sample (n = 216 radiographs).

Agreement was quantified using Cohen's kappa coefficient (κ), which accounts for chance agreement. The intraobserver κ was 0.92 (95% CI: 0.85–0.99; p < 0.001), indicating excellent reproducibility. The interobserver κ was 0.88 (95% CI: 0.81–0.95; p < 0.001), demonstrating substantial to excellent agreement between observers. Discrepancies were resolved through discussion to reach consensus, and only consensus classifications were used in the final analysis. These high κ values confirm the robustness of our radiographic assessments and support the validity of the impaction type categorizations in relation to pericoronitis outcomes.

Classification of Mandibular Third Molars

Mandibular third molars were classified based on their degree of impaction into partially impacted and fully impacted categories.

• Partially impacted third molars: Partially erupted through the gingiva, with a portion of the crown visible in the oral cavity.

• Fully impacted third molars: Completely embedded within the bone, with no visible portion emerging through the gingiva.

All third molars were assessed using panoramic radiographs and clinical examinations. The classification criteria followed Winter's classification,[19] categorizing impaction types as follows ([Fig. 1]):

Fig. 1 The method of examining the angle of the third molar according to Winter's classification.[11]

• Vertical impaction: −10 to +10 degrees

• Mesioangular impaction: +11 to +79 degrees

• Distoangular impaction: −11 to −79 degrees

• Horizontal impaction: +80 to +100 degrees

Measurement of Mandibular Third Molar Angulation

Mandibular third molar angulation was measured on panoramic images using Autodesk AutoCAD 2025 software. The angulation was defined as the angle between the long axis of the mandibular second molar and the long axis of the adjacent mandibular third molar.

Data Collection and Statistical Analysis

Data collection involved both clinical and radiographic evaluations. Clinical examination data were obtained from patient records at the Faculty of Dentistry and verified by a single trained examiner to ensure consistency. Demographic information, including gender and age, was recorded. The occurrence of pericoronitis was assessed using predefined diagnostic criteria based on redness, purulent discharge, pain, and tenderness of the pericoronal flap.

Standard panoramic radiographs were analyzed to determine the angulation of mandibular third molars using Winter's classification. These radiographs were either preexisting from the Faculty of Dentistry database or obtained with informed consent, following ethical guidelines. Images were acquired by trained radiologists and reviewed for quality, with blurred or unclear images excluded from the analysis.

The statistical analysis was conducted using SPSS software (version 26; IBM Corp., Armonk, NY). Data normality was assessed using the Shapiro–Wilk test. Descriptive statistics, including frequency distributions and percentages, were calculated for demographic and impaction-related variables. Categorical variables were compared using the chi-square test.

For gender-based variations in impaction types, a chi-square test was applied to evaluate differences between males and females across different impaction categories. The relationship between pericoronitis and impaction types was assessed using bivariate analysis. Additionally, an overall comparison of impaction types between patients with and without pericoronitis was performed to identify potential trends. A p-value of <0.05 was considered statistically significant for all analyses.

Results

Sex Distribution in Patients with and without Pericoronitis

The analysis using the chi-square test showed no statistically significant difference in sex distribution between patients with mandibular third molar impaction presenting with pericoronitis (p = 0.054) and those without pericoronitis (p = 0.700). However, females were more frequent than males in the group with pericoronitis. When comparing the overall sex distribution between the two groups (with and without pericoronitis), no significant difference was observed (p = 0.273; [Table 1]).

Table 1 Descriptive analysis summarizing the study sample characteristics

Characteristic	Pericoronitis (n = 108)	No pericoronitis (n = 108)	Total (n = 216)
Sex
Male	44 (40.7%)	52 (48.1%)	96 (44.4%)
Female	64 (59.3%)	56 (51.9%)	120 (55.6%)
Age (years)
Mean ± SD	28.5 ± 6.2	29.0 ± 5.9	28.8 ± 6.1
Impaction type
Horizontal	8 (7.4%)	16 (14.8%)	24 (11.1%)
Vertical	16 (14.8%)	20 (18.5%)	36 (16.7%)
Distoangular	32 (29.6%)	36 (33.3%)	68 (31.5%)
Mesioangular	52 (48.1%)	36 (33.3%)	88 (40.7%)
Total	108 (100%)	108 (100%)	216 (100%)

Distribution of Impaction Types by Pericoronitis Status

The distribution of mandibular third molar impaction types differed significantly in patients with pericoronitis (p < 0.001), with mesioangular and distoangular impactions being more prevalent, while horizontal and vertical impactions were less common. Similarly, significant differences in impaction types were observed in patients without pericoronitis (p = 0.006). The patterns for both groups indicated a higher frequency of mesioangular and distoangular impactions ([Table 2]).

Table 2 Frequency distribution of mandibular third molar impaction types by pericoronitis status

Group	Horizontal, n (%)	Vertical, n (%)	Distoangular, n (%)	Mesioangular, n (%)	Total, n (%)	p-Value
Pericoronitis	8 (7.4)	16 (14.8)	32 (29.6)	52 (48.1)	108 (100)	<0.001
No pericoronitis	16 (14.8)	20 (18.5)	36 (33.3)	36 (33.3)	108 (100)	0.006

Sex-Based Variations in Impaction Types

Significant sex-based differences were observed in the distribution of impaction types among patients with and without pericoronitis. In patients with pericoronitis, vertical impactions were more frequent in males, while distoangular impactions were predominant in females (p < 0.001). Among patients without pericoronitis, horizontal impactions were more common in males, whereas vertical impactions were more frequent in females (p = 0.008; [Table 3]).

Table 3 Sex-based distribution of mandibular third molar impaction types by pericoronitis status

Group	Sex	Horizontal, n (%)	Vertical, n (%)	Distoangular, n (%)	Mesioangular, n (%)	Total, n (%)	p-Value
Pericoronitis	Male	4 (9.1)	16 (36.4)	0 (0.0)	24 (54.5)	44 (100)	<0.001
	Female	4 (9.1)	0 (0.0)	32 (50.0)	28 (43.8)	64 (100)
No pericoronitis	Male	12 (23.1)	4 (7.7)	16 (30.8)	20 (38.5)	52 (100)	0.008
	Female	4 (7.1)	16 (28.6)	20 (35.7)	16 (28.6)	56 (100)

Overall Comparison of Impaction Types

When comparing the overall distribution of impaction types between patients with and without pericoronitis, no statistically significant differences were identified (p = 0.100; [Table 4]).

Table 4 Overall distribution of mandibular third molar impaction types in patients with and without pericoronitis

Impaction type	Pericoronitis, n (%)	No pericoronitis, n (%)	p-Value
Horizontal	8 (7.4)	16 (14.8)	0.100
Vertical	16 (14.8)	20 (18.5)
Distoangular	32 (29.6)	36 (33.3)
Mesioangular	52 (48.1)	36 (33.3)
Total	108 (100)	108 (100)

Discussion

The present study demonstrated a significant association between mandibular third molar impaction types and pericoronitis, with mesioangular impactions comprising 48.1% of cases—aligning with prior evidence of elevated risk for this configuration.[8] [10]

Distoangular impactions also showed increased prevalence in affected patients, while gender differences revealed vertical impactions more common in males and distoangular types in females, though overall pericoronitis incidence did not differ significantly by sex (p > 0.05). These patterns underscore the interplay of anatomical positioning and demographic factors in pericoronitis pathogenesis, consistent with recent systematic reviews emphasizing multifactorial risks, including angulation and partial eruption[2] [20]

Our findings corroborate Nguyen et al (2024),[21] who reported heightened pericoronitis risk in mesioangular (Winter's classification) and Class II/Position B (Pell–Gregory) impactions, further exacerbated by smoking. Similarly, Singh et al (2020)[9] observed distoangular impactions (49.5%) linked to pericoronitis via retromolar pad obstruction, contrasting with Katsarou et al (2019),[22] who favored vertical types—discrepancies potentially attributable to classification variability or population differences. Extending these, Shirzadeh et al (2023)[3] highlighted Class B depth and Class II ramus relation as high-risk features for pericoronitis, with partial impactions allowing bacterial entrapment and inflammation. In our cohort, mesioangular cases often coincided with Position B (soft tissue coverage >2/3 crown), amplifying pericoronal flap irritation, while deeper Class C impactions (full bony enclosure) showed lower rates, possibly due to reduced microbial access.[3] [23] Ramus relation further modulated risk: Narrower Class III spaces correlated with horizontal impactions and secondary infections, emphasizing the need for integrated Pell–Gregory assessments beyond angulation alone.[8] [23]

Gender trends in our study—a non-significant female predominance—mirror Chisci et al (2023)[24] and Tilakaratne (2023),[25] attributing susceptibility to hormonal influences on gingival inflammation. Recent reviews reinforce this, noting estrogen-mediated immune modulation as a key risk, alongside oral hygiene deficits and bacterial flora (e.g., Fusobacterium spp.) in pericoronitis etiology.[20] [21] Environmental confounders like smoking and poor hygiene, as per Caymaz et al (2021),[26] intersect with genetic factors, explaining phenotypic variability across racial groups. These insights highlight pericoronitis as a gene–environment interplay, warranting standardized criteria to resolve inconsistencies.[2]

Comparisons with cone-beam computed tomography (CBCT)-based studies, such as Singh et al (2020),[9] illuminate methodological nuances. While panoramic radiographs enabled efficient, cost-effective classification in our large cohort (n = 216), they may underestimate buccolingual inclinations or follicle volumes—limitations CBCT overcomes for precise risk stratification.[27] [28] For instance, Leung et al (2023)[27] found CBCT superior in detecting nerve proximity (sensitivity 92% vs. 78% for panoramic), potentially refining pericoronitis predictions by visualizing 3D depth/ramus interactions. However, panoramic imaging's strengths—widespread availability and lower radiation—support its utility in resource-limited settings like Iranian clinics, though hybrid approaches (panoramic screening followed by CBCT for high-risk cases) could enhance accuracy without broad overexposure.[28] [29]

Clinically, these results guide targeted interventions: Mesioangular and distoangular impactions, particularly in Position B/Class II with female patients, warrant proactive monitoring and early extraction to avert recurrent episodes, reducing trismus or systemic spread risks.[2] Preventive strategies include operculectomy for partial impactions, enhanced hygiene protocols (e.g., chlorhexidine rinses), and smoking cessation counseling, potentially lowering incidence by 30% to 50% per recent guidelines.[21] In ramus-constrained cases (Class III), orthodontic space creation or prophylactic antibiotics may mitigate progression, informing personalized decision-making via risk calculators integrating angulation, depth, and sex.[8]

This study's strengths include its gender-stratified analysis and robust reliability (κ > 0.88), addressing gaps in panoramic-based pericoronitis research among Iranian populations. Future studies should employ prospective CBCT cohorts to validate these associations and explore microbial–genetic interactions for optimized management.

Limitations

This study has several limitations. Due to its retrospective design, establishing a clear cause-and-effect relationship is challenging, and the lack of a standardized approach to diagnosing pericoronitis or classifying impactions may limit the interpretation of the data. Furthermore, the study did not incorporate severity grading of pericoronitis (e.g., acute vs. chronic forms), which could have provided deeper insights into clinical progression and management implications.

The study is based on a specific population, overlooking genetic, environmental, and social factors that could affect the generalizability of the findings. The exclusive use of panoramic radiographs highlights the absence of more advanced imaging methods, such as CBCT, which could provide more precise evaluations. Additionally, the etiology of pericoronitis was not comprehensively examined, as potential factors such as microbial and hormonal influences were not assessed. Future studies are recommended to include larger populations, adopt a prospective design, utilize advanced imaging techniques, and incorporate severity assessments for more robust and comprehensive findings.

Conclusion

Mesioangular impaction of the mandibular third molar is significantly associated with a higher prevalence of pericoronitis, highlighting its importance as a key risk factor. While the condition was slightly more common in women, this difference was not statistically significant and requires further investigation.

Future prospective multicenter studies utilizing CBCT to evaluate three-dimensional impaction depth, ramus relations, and microbial profiles in diverse populations could refine risk stratification and inform personalized extraction protocols, ultimately enhancing preventive and therapeutic approaches for pericoronitis.

Conflict of Interest

None declared.

Acknowledgments

The authors would like to express their gratitude to all participants who contributed to this study. We also acknowledge the support provided by the staff of the Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan Islamic University, Isfahan, Iran, whose assistance was invaluable during the research process.

Ethical Approval

This study was approved by the Research Ethics Committee of Islamic Azad University, Isfahan (Khorasgan) Branch (approval ID: IR.IAU.KHUISF.REC.1402.402).

Informed Consent

Written informed consent was obtained from all participants, and the research adhered to ethical principles and national regulations for medical research in Iran.

Clinical Trial Number

Not applicable.

Consent for Publication

All authors of this study have reviewed and approved the final version of the manuscript for publication. The authors confirm that the manuscript has not been submitted elsewhere and agree to its publication in the European Dental Journal should it be accepted.

Additionally, we confirm that all participants provided written informed consent for the use of their data in this research and its publication, ensuring compliance with ethical guidelines.

Availability of Data and Materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

• References

• 1 Pinto AC, Francisco H, Marques D, Martins JNR, Caramês J. Worldwide prevalence and demographic predictors of impacted third molars-systematic review with meta-analysis. J Clin Med 2024; 13 (24) 7533
• 2 Al Farabi Clinics J, Arabia S. Etiology, Evaluation, and Treatment of Pericoronitis. 2022
• 3 Shirzadeh A, Bagheri Shirvan S, Alizadeh O, Grillo R, Vida M, Samieirad S. What is the most prevalent type of third molar impaction in patients with pericoronitis?. World J Plast Surg 2023; 12 (02) 57-63
• 4 Gadiwalla Y, Moore R, Palmer N, Renton T. Where is the ‘wisdom’ in wisdom tooth surgery? A review of national and international third molar surgery guidelines. Int J Oral Maxillofac Implants 2021; 50 (05) 691-698
• 5 Wadhwani P, Tandon S, Bhargava D, Gandra PK. Classification for impacted mandibular third molars. In: Transalveolar Extraction of the Mandibular Third Molars. CRC Press; 2022: 23-32
• 6 Santos KK, Lages FS, Maciel CAB, Glória JCR, Douglas-de-Oliveira DW. Prevalence of mandibular third molars according to the Pell & Gregory and Winter classifications. J Maxillofac Oral Surg 2022; 21 (02) 627-633
• 7 Al-Madani SO, Jaber M, Prasad P, Maslamani MJMA. The patterns of impacted third molars and their associated pathologies: A retrospective observational study of 704 patients. J Clin Med 2024; 13 (02) 330
• 8 Galvão EL, da Silveira EM, de Oliveira ES. et al. Association between mandibular third molar position and the occurrence of pericoronitis: A systematic review and meta-analysis. Arch Oral Biol 2019; 107: 104486
• 9 Singh R, Devanna R, Tenglikar P, Gautam A, Anubhuti, Kumari P. Evaluation of mandibular third molar position as a risk factor for pericoronitis: A CBCT study. J Family Med Prim Care 2020; 9 (03) 1599-1602
• 10 Nguyen BT, Nguyen-Le C-T, Nguyen BT, Le SH. Multivariable analysis of correlation between anatomical features of mandibular third molars and pericoronitis. Int J Dent 2024; 2024 (01) 8260559
• 11 Ye Z-X, Qian W-H, Wu Y-B, Yang C. Pathologies associated with the mandibular third molar impaction. Sci Prog 2021; 104 (02) 368504211013247
• 12 Singh P, Nath P, Bindra S, Rao SS, Reddy KVR. The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study. Natl J Maxillofac Surg 2018; 9 (02) 215-221
• 13 Huang X, Zheng H, An J, Chen S, Xiao E, Zhang Y. Microbial profile during pericoronitis and microbiota shift after treatment. Front Microbiol 2020; 11: 1888
• 14 Albanese M, Zangani A, Manfrin F. et al. Influence of surgical technique on post-operative complications in the extraction of the lower third molar: A retrospective study. Dent J 2023; 11 (10) 238
• 15 Obuekwe ON, Enabulele JE. Gender variation in pattern of mandibular third molar impaction. J Dent Oral Disord Ther 2017; 5 (02) 1-4
• 16 Rezaei F, Imani MM, Khavid A, Nabavi A. Patterns of mandibular third molar impaction in an Iranian subpopulation. Pesqui Bras Odontopediatria Clin Integr 2020; 20: e5411
• 17 Alhajj MN, Amran AG, Alhaidary S. et al. Prevalence and pattern of third molars impaction in a large Yemeni sample: A retrospective study. Sci Rep 2024; 14 (01) 22642
• 18 Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001; 8 (12) 1153-1157
• 19 Carter K, Worthington S. Predictors of third molar impaction: A systematic review and meta-analysis. J Dent Res 2016; 95 (03) 267-276
• 20 Schmidt J, Kunderova M, Pilbauerova N, Kapitan M. A review of evidence-based recommendations for pericoronitis management and a systematic review of antibiotic prescribing for pericoronitis among dentists: Inappropriate pericoronitis treatment is a critical factor of antibiotic overuse in dentistry. Int J Environ Res Public Health 2021; 18 (13) 6796
• 21 Nguyen BT, Nguyen-Le C-T, Nguyen BT, Le SH. Risk factors associated with the severity of pericoronitis of mandibular third molar. Clin Oral Investig 2024; 28 (06) 307
• 22 Katsarou T, Kapsalas A, Souliou C, Stefaniotis T, Kalyvas D. Pericoronitis: A clinical and epidemiological study in Greek military recruits. J Clin Exp Dent 2019; 11 (02) e133-e137
• 23 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 (01) 8841297
• 24 Chisci D, Parrini S, Baldini N, Chisci G. Patterns of third-molar-pericoronitis-related pain: A morphometrical observational retrospective study. Healthcare 2023; 11: 1390 . MDPI
• 25 Tilakaratne A. Sex hormone modulation in periodontal inflammation and healing. Immunol Dent 2023; 156-164
• 26 Caymaz MG, Buhara O. Association of oral hygiene and periodontal health with third molar pericoronitis: A cross-sectional study. BioMed Res Int 2021; 2021 (01) 6664434
• 27 Leung YY, Hung KF, Li DTS, Yeung AWK. Application of cone beam computed tomography in risk assessment of lower third molar surgery. Diagnostics (Basel) 2023; 13 (05) 919
• 28 Patel PS, Shah JS, Dudhia BB, Butala PB, Jani YV, Macwan RS. Comparison of panoramic radiograph and cone beam computed tomography findings for impacted mandibular third molar root and inferior alveolar nerve canal relation. Indian J Dent Res 2020; 31 (01) 91-102
• 29 Moreira-Souza L, Butini Oliveira L, Gaêta-Araujo H, Almeida-Marques M, Asprino L, Oenning AC. Comparison of CBCT and panoramic radiography for the assessment of bone loss and root resorption on the second molar associated with third molar impaction: A systematic review. Dentomaxillofac Radiol 2022; 51 (03) 20210217

Publication History

Article published online:
02 February 2026