Panoramic radiograph - a useful tool to assess the difficulty in extraction of third molars

Introduction: Third molars (TMs) are the most frequently impacted teeth due to the frequent lack of space in the dental arch resulting in their malposition or inability to erupt. Partially erupted TMs that cause recurrent inflammatory conditions must be removed. The aim of this study was to assess TM position on panoramic radiographs. Materials and methods: We evaluated 200 panoramic radiographs of patients 18-72 years of age. Teeth were assessed in terms of the presence of dental follicle, cervix/root ratio and root development stage. Maxillary TMs were assessed using the Archer and Pell and Gregory classifications, whereas the mandibular ones according to Pell and Gregory, Winter, IAN and Pederson classifications. Results: 622 TMs were assessed. In the maxilla, the most common type was A-positioned, vertically angulated TM with completely formed root/roots. In the mandible, the most common type was A1-positioned, mesioangular TM with completely formed root/roots and without enlarged follicle. According to Pederson's index, 59.44% TMs were moderately difficult to extract. Most roots were in contact with inferior alveolar nerve. Conclusions: The use of the classifications mentioned above is helpful in assessment of the surgery difficulty level. In the long term this allows to increase the predictability of the procedure and minimize the intra- and post-operative complications.