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AP Indira et al

ORIGINAL ARTICLE

Correlation of Pericoronitis and the Status of Eruption of


Mandibular Third Molar: A Clinicoradiographic Study
AP Indira, Mahesh Kumar, Maria Priscilla David, Vaishali Mysore Rajshekar, Shashikala

ABSTRACT molar, at or above the occlusal plane and partially covered


Objective: The purpose of this study was to analyze the by soft or hard tissue.5
relationship between the status of eruption of mandibular third Treatment of pericoronitis runs from very conservative
molar and pericoronitis. to slightly radical therapy.1 If removal is postponed, there
Materials and methods: The sample consisted of 50 patients may be surgical risk and morbidity increases with patient’s
inclusive of both the genders with pericoronitis. After clinical age. Removal of tooth may prevent the fear of infection
examination, radiographic assessment was done by taking OPG
to assess the mandibular third molar position. Radiographic spread, which may result in severe complications. With the
assessment was done to analyze the angulations, height and above knowledge, the purpose of the study is to explore the
encapsulation of the mandibular third molar affected by relationship between the position of mandibular third molar
pericoronitis following Pell and Gregory and Winter’s classi- and pericoronitis which in turn can be applied in preventing
fication. Comparison of the data was done between type of
impaction and pericoronitis. complications in high-risk groups.
Results: In our study, among the sample of 50 patients with MATERIALS AND METHODS
pericoronitis, 43 (86%) cases of mandibular third molars were
partially erupted and seven (14%) cases were impacted. The study group consisted of 50 patients between age group
There was an increased prevalence of position IA (42%) of 18 and 34 years of both the genders with symptoms of
followed by IIB (34%) and IIA (20%) was observed. Vertical
pericoronitis who reported to the department of oral
and distoangular impaction was slightly more prevalent when
compared to other types. medicine and radiology, MR Ambedkar Dental College and
Conclusion: The status of impacted third molar may be
Hospital, Bengaluru.
correlated to the development of pericoronal infection process The patients were clinically examined after obtaining
and their potential complications. Partially erupted, position IA, an informed consent. Radiographic assessment was done
vertical and distoangular impactions can be advised for by taking orthopantomograph to assess the mandibular third
prophylactic removal, particularly to prevent surgical risks and
patients morbidity with age. molar status, following radiation protection protocol using
the Kodak-8000C digital cephalometric system. The selected
Keywords: Mandibular third molar, Impaction, Pericoronitis.
cases were examined clinically to assess the presence or absence
How to cite this article: Indira AP, Kumar M, David MP,
of teeth and encapsulation. According to their clinical status,
Rajshekar VM, Shashikala. Correlation of Pericoronitis and
the Status of Eruption of Mandibular Third Molar: A Clinico- the unerupted teeth were divided into two groups:
radiographic Study. J Indian Aca Oral Med Radiol 2013; 1. Completely unerupted mandibular third molars, i.e. teeth
25(2):112-115. that had not perforated the oral mucosa.
Source of support: Nil 2. Partially erupted mandibular third molars, i.e. teeth that
Conflict of interest: None had perforated the mucosa and were partially visible in
oral cavity.
INTRODUCTION The captured image was assessed and traced for the
status and angulation of mandibular third molar by using
In human dentition, the third molar has the highest impaction Windows Trophy Dicom and Master view 3 software (Figs 1
rate among all teeth.1 Although impacted third molars may and 2). The Pell and Gregory classification2 (see Fig. 1)
remain symptom free indefinitely, they usually produce was used to assess the ramus (horizontal) and occlusal
local, regional or systemic alterations of variable severity. (vertical) position of mandibular third molar in relation to
The most frequent problem being pericoronitis.2 Pericoronitis anterior border of ramus and distal aspect of second molar.
is an infection of the soft tissue around the crown of a Winter’s classification2 was used to assess angulation of
partially impacted tooth and is the most common pathological mandibular third molar in relation to long axis of mandibular
condition involving third molars that are most commonly second and third molar.
found among young individuals between 18 and 24 years.3,4
This is by far the most common acute problem in third molars. Inclusion Criteria
Previous studies have shown that the teeth at greatest • Patients with age 18 years and above.
risk in relation to acute pericoronitis are vertically erupted • Those patients presenting with clinical symptoms-
mandibular third molars in contact with adjacent second associated with impacted mandibular third molars.
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Correlation of Pericoronitis and the Status of Eruption of Mandibular Third Molar: A Clinicoradiographic Study

Fig. 1: Pell and Gregory’s classification (adapted from Checchi and Monaco)

molars, the increased prevalence of position IA (42%) was


observed followed by IIB (34%) and IIA (20%) (Table 2
and Graph 2). According to Winter’s classification, vertical
and distoangular impaction was more when compared to
other types (Table 2 and Graph 3). In relation to the side
pericoronitis was observed slightly more on right side in
27 (54%) cases (see Table 1).

DISCUSSION
Fig. 2: Assessment of status of eruption of mandibular third molar
Pericoronitis is the inflammation of the gingiva in relation to
Exclusion Criteria the crown of an incompletely erupted third molar. It is the
• Patients under 18 years of age. most common pathological condition involving third molars
• Patients with a congenital disorder, cysts and tumors that is most commonly found among young individuals
associated with mandibular third molar. between 18 and 24 years.3,4,6 The term impaction was
• Asymptomatic patients with impacted mandibular defined by Peterson as one that fails to erupt into the dental
third molar. arch within the expected time. The average age for the
eruption of mandibular third molars in male is approximately
RESULTS 3 to 6 months ahead of females. Pericoronitis can develop
In the present study, in the total sample of 50 patients with from the moment that the crown of an erupting third molar
pericoronitis, 43 (86%) were partially erupted and seven comes into contact with the oral cavity. Once the process
(14%) were impacted (Table 1 and Graph 1). According to has developed, it tends to become chronic and recur
the Pell and Gregory’s classification of impacted third intermittently until the tooth is fully erupted or
Journal of Indian Academy of Oral Medicine and Radiology, April-June 2013;25(2):112-115 113
AP Indira et al

Table 1: Eruption status of mandibular third molars


Status of mandibular third molar Number of cases with Status of mandibular third molar in
percentage relation to side in percentage
Right (54%) Left (46%)
Partially erupted 43 (86%) 23 (46%) 20 (40%)
Impacted 7 (14%) 4 (8%) 3 (6%)

Table 2: Position of the impacted third molar the erupting tooth as a result of genetic and environmental
Type of classification Status of third molar Percentage causes. When the third molar is partially erupted, there will
be break in the continuity of the mucosa which is more prone
Pell and Gregory Type IA 42
classification Type IB 2 for infection since it is difficult to access that area to maintain
Type IC 0 oral hygiene and trauma caused by the opposing maxillary
Type IIA 20
third molar.
Type IIB 34
Type IIC 2 The mean peak age range was 21.3 years. This finding
Type IIIA 0 was consistent with the study of Naosherwan Anwar et al.9
Type IIIB 0
The reason being the increased incidence of impacted
Type IIIC 0
Winter’s classification Vertical 28 mandibular third molar was found in this age group.
Mesioangular 20 In the present study, in relation to the side pericoronitis
Distoangular 28
was observed more prevalent on right side in 27 (54%) cases
Horizontal 24
in comparison to the left side with 23 (46%) cases.

treated.Although impacted third molars may remain


symptom-free indefinitely, they usually produce local,
regional, or systemic alterations of variable severity.2
Leone et al reported that 10% of extracted mandibular
third molars have previously suffered a pericoronal
infectious process.5
The clinical status of an unerupted tooth can be
accurately determined not only through use of radiographs
but also by means of oral examination, although panoramic
radiography is a standard technique that yields high-quality
information about the anatomic condition of the retromolar
region.7 Pell and Gregory and Winter’s classification was
used in this study as it is simple, practical and easy to apply.
The causes of impacted third molars include: Graph 1: Eruption status of mandibular third molars
• Reduced rate of growth in the length of the mandible, in
which there is insufficient increase in the length of the
mandible in proportion to the amount of tooth substance.
• Vertical direction of the condylar growth which is
associated with insufficient resorption at the anterior
ramus border.
• Backward-directed eruption of the dentition which
causes a decrease in space for third molars to erupt.
• Retarded maturation of dentition is a fourth factor
contributing to incomplete eruption.8
In the present study, in the total sample of 50 patients
with pericoronitis, 43(86%) cases were partially erupted and
seven (14%) cases were impacted. This finding was
consistent with the study conducted by Jirapun Punwutikorn
et al.7 the cause being inadequate space to accommodate Graph 2: Pell and Gregory classification

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Correlation of Pericoronitis and the Status of Eruption of Mandibular Third Molar: A Clinicoradiographic Study

REFERENCES
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4th ed. New York: WB Saunders; 1983:124.
In the present study, according to the Pell and Gregory’s 7. Punwutikorn J, Waikakul A, Ochareon P. Mandibular third
classification of impacted third molars, the increased molars: oral surgeons’ assessment of the indications for removal.
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8. Bjork A, Jensen E, Palling M. Mandibular growth and third
IIA (20%) was observed. This finding was consistent with molar impaction. Acta Odontol Scand 1956;14:231-272.
the study of Alcaraz et al (cited in Marqués NA).2 The reason 9. Anwar N, Khan AR, Narayan KA, Manan AHA. A six-year
could be because of the increased incidence of mandibular review of the third molar cases treated in the dental department
third molar being impacted in this position. of Penang Hospital in Malaysia. Dent Res J 2008;5(2):53-60.
10. Liedholm R, Knutsson K, Brehmer B, Lysell L. Pathosis associated
In this study, according to winter’s classification vertical with mandibular third molars subjected to removal. Oral Surg
(28%) and distoangular (28%) impaction was probably more Oral Med Oral Pathol Oral Radiol Endod 1996;82:10-17.
prevalent when compared to other types. This finding was 11. Venta I, Turtola L, Murtomaa HY, Lipaavalniemmi P. Third
consistent with Leone,5 Knutsson K et al10 who have showed molars as an acute problem in Finnish University Students. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 1993;76:135-140.
that third molars in the vertical position, or slightly
distoangular with partial mucosal and bony coverage, are
the presentations most likely to cause pericoronitis. This is ABOUT THE AUTHORS
because such positions have high frequency rate AP Indira (Corresponding Author)
of impaction.
Professor, Department of Oral Medicine and Radiology, MR Ambedkar
The risk of an acute problem was greatest for Dental College and Hospital, Bengaluru, Karnataka, India, Phone:
distoangular lower third molars. This may be explained by 25463097, e-mail: indira.ap.mradc@gmail.com
accumulation of food and the occlusal surface of a
distoangular third molar slope downward distally by occlusal Mahesh Kumar
movements. The amount of soft tissue surrounding a Senior Lecturer, Department of Oral Medicine and Radiology, Raja-
distoangular third molar may be greater than with rajeshwari Dental College, Bengaluru, Karnataka, India
mesioangular and horizontal impaction.11
Maria Priscilla David
CONCLUSION Professor and Head, Department of Oral Medicine and Radiology, MR
Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
The present study explores the correlation between the
pericoronitis and status of mandibular third molar. We Vaishali Mysore Rajshekar
conclude that the status of impacted third molar may be
Reader, Department of Oral Medicine and Radiology, MR Ambedkar
able to be correlated to the development of pericoronal Dental College and Hospital, Bengaluru, Karnataka, India
infectious process and their potential complications and can
be advised for prophylactic removal, particularly in position Shashikala
IA, vertical and distoangular impactions to prevent surgical Professor, Department of Oral and Maxillofacial Surgery, MR Ambedkar
risks and patients morbidity with age. Dental College and Hospital, Bengaluru, Karnataka, India

Journal of Indian Academy of Oral Medicine and Radiology, April-June 2013;25(2):112-115 115

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