|Year : 2016 | Volume
| Issue : 5 | Page : 540-543
|Prevalence of impacted permanent mandibular second molars in South Indian population: A cross-sectional study
Manali Ramakrishanan Srinivasan1, Saravanan Poorni1, Alagarsamy Venkatesh2, Babu Vasanthi1
1 Department of Conservative Dentistry and Endodontics, Sri Venkateswara Dental College and Hospital, Dr. MGR Medical University, Chennai, Tamil Nadu, India
2 Department of Conservative Dentistry and Endodontics, Sree Balaji Dental College and Hospital, Bharath University, Chennai, Tamil Nadu, India
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|Date of Submission||14-Mar-2014|
|Date of Decision||02-Apr-2014|
|Date of Acceptance||20-Aug-2016|
|Date of Web Publication||13-Dec-2016|
| Abstract|| |
Aims: The aim of this study is to retrospectively determine the prevalence of impacted second molars and associated dental and radiographic findings in South Indian population.
Settings and Design: Cross-sectional design.
Materials and Methods: Dental records of 4976 patients depending on the selection criteria from various dental clinics in South India were retrospectively analyzed in this study. All selected radiographs and records were examined by the two authors. The angle of impacted second molars was also recorded on panoramic radiographs. Data were tabulated and analyzed.
Results: The prevalence of impacted second mandibular molars was found to be 0.16%. In seven cases, the impaction was unilateral with three on the left and four on the right, and in one case, it was bilateral. The prevalence was found to be more in females than males. The angle of impaction was found to range from 19° to 80°.
Conclusions: Although the prevalence of impacted second molars is low, it is crucial to diagnose early for optimal treatment.
Keywords: Impacted second molars, prevalence, second mandibular molar
|How to cite this article:|
Srinivasan MR, Poorni S, Venkatesh A, Vasanthi B. Prevalence of impacted permanent mandibular second molars in South Indian population: A cross-sectional study. Indian J Dent Res 2016;27:540-3
Impaction is defined as failure of tooth eruption caused by a physical obstacle in the eruption path or the abnormal position of the tooth.  The commonly impacted permanent teeth are usually the third molars, maxillary canines or central incisors, and mandibular second premolars.  Nevertheless, the occurrence of impacted second molars is on the rise in today's clinical practice.
|How to cite this URL:|
Srinivasan MR, Poorni S, Venkatesh A, Vasanthi B. Prevalence of impacted permanent mandibular second molars in South Indian population: A cross-sectional study. Indian J Dent Res [serial online] 2016 [cited 2019 Nov 15];27:540-3. Available from: http://www.ijdr.in/text.asp?2016/27/5/540/195645
The prevalence rate of impaction of permanent molars is 0.08% for second maxillary molar and <0.01% for the first mandibular molar.  Literature search revealed that there are not many studies that have reported the prevalence of impacted second mandibular molars. In a radiographic study of 5000 American army recruits, it was 0.06%.  The prevalence seemed to be higher when patients of younger age were included. Varpio and Wellfelt  found 88 such cases among 10-19-year-olds in the public dental service in Sweden between 1960 and 1974, and estimated the prevalence to be 0.15%. A higher prevalence of 0.3% was found by Johnsen,  who examined radiographs of 1032 young people, aged 8-18, in the United States. In a radiographic study of 1041 12-year-old Hong Kong Chinese children in 1988, the prevalence of impacted permanent mandibular second molars was 0.58%.  Literature search also revealed the prevalence of impacted mandibular second molars in other similar population. ,,, Since there was a paucity of this data in the Indian population, the current study was undertaken. Thus, the aim of the present study is to investigate the prevalence of impacted permanent mandibular second molars and associated dental and radiographic findings in South Indian population.
| Materials and methods|| |
Dental records within 10 years obtained from 4976 patients of various dental clinics in South India were retrospectively analyzed in this study. The selection criteria were as follows:
For all patients in the sample, the annual records and panoramic radiographs, in some instances supplemented by periapical and occlusal radiographs, were examined. The selected dental records and radiographs were examined by the first author. Demographic data and dental findings for these patients were recorded. All selected radiographs and records were re-examined by the second author, and the results of the two examinations were compared for discrepancies. Data were tabulated and analyzed for distribution by sex and side of jaw, as well as for associated malocclusion.
- Records belonging to the period from 2004 to 2014
- Indians and older than 14 years
- No history of orthodontic treatment
- No hereditary diseases or systemic syndrome
- Unilateral or bilaterally impacted permanent mandibular second molars observed in the good-quality panoramic radiographs of the patients taken earlier for other reasons.
The angle of inclination of the impacted second molars was calculated by tracing the radiographs on overlying matte acetate paper. A line, which was perpendicular to the tangent to the tips of the cusps, was drawn through the middle of the crown and root of the impacted second molar, and another was drawn on the adjacent permanent first molar. The angle between these lines was measured twice, and the mean of the two measurements was taken as the angle of impaction.
| Results|| |
The dental records of the 4976 patients with an age range of 15-67 years from various clinics in South India were reviewed. Impaction of one or both permanent mandibular second molars was found in eight patients [Figure 1] [Figure 2] [Figure 3] [Figure 4], of which six were females and two were a male. The resulting prevalence of impacted second mandibular molars was found to be 0.16%. The male:female ratio was found to 1:3. In seven cases, the impaction was unilateral, and in one case, it was bilateral. Of the seven unilateral impactions, three were on the left and four on the right [Table 1]. The frequency of impacted second molars was found more on the right than on the left. All the cases presented with mesioangular impactions except one case that had a distoangular impaction.
|Figure 1: Orthopantomogram image of case with bilaterally impacted second mandibular molar|
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|Figure 2: Orthopantomogram image of case with impacted right second mandibular molar|
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|Figure 3: Orthopantomogram image of case with impacted left second mandibular molar|
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|Figure 4: Orthopantomogram image of case with impacted first and second mandibular molars|
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|Table 1: Overall prevalence of number of patients with impacted mandibular second molars in 4976 patients |
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All eight cases had either developing or impacted third molars. All cases have a significant malocclusion that required orthodontic intervention. Only one patient had both the first and second molars impacted. None of the cases reported missing first molars. The associated dental and radiographic findings are summarized in [Table 2]. The angle of impaction was found to range from 19° to 80°.
| Discussion|| |
The results of the present study showed that the prevalence of impacted second mandibular molars in South Indian population is 0.16%. This may be an underestimation as panoramic radiographs are not routinely taken for all the patients in clinical practice, and some deep impactions may have gone unnoticed. In spite of this, the prevalence was found to be a little higher than few other populations. , This can also be due to the larger tooth size in Indian population although the association has not been proved.
The molar impactions are difficult to prevent and detect early due to their multifactorial etiologies. The etiology of impaction may be related to an insufficient arch length, excessive tooth size, or excessive axial inclination. ,, According to Andreasen et al.,  three main causes have been identified for eruption disturbances: Ectopic position, obstacles in the eruption path, and failures in the eruption mechanism. Failure of tooth eruption is associated with various systemic and local factors.  Heredity is also mentioned as an etiologic factor. Recently, mutations in parathyroid hormone receptor 1 have been identified in several familial cases of primary failure of eruption. , The iatrogenic factors contributing to the second molar impaction are incorrectly fitted bands cemented onto the first molars, prevention of mesial drift of the first molar caused by a lip bumper or lingual arch therapy, and excessive tip back of the first molar during previous orthodontic treatment. ,
In the normal growth and development process, the second permanent molar tooth buds are distal to the first permanent molar and have a mesial inclination. This inclination is usually self-correcting as the resorption of the anterior border of the mandibular ramus occurs and the first permanent molar migrates into the leeway space for angular adjustment and eruption. However, this correction does not always happen, and the second molar can become impacted. Extraction of impacted second molars has been suggested to make room for unerupted third molars. Unfortunately, the eruption of the third molar in an upright position cannot be guaranteed. ,
Problems associated with impacted second molars include caries, periodontitis, resorption of adjacent teeth, cyst formation, malocclusion, and pain. , Treatment options for an impacted molar include extraction, orthodontic uprighting, surgical uprighting, transplantation, surgical-orthodontic approach, and dental implant replacement. ,,, Many orthodontic appliances and techniques have been suggested for uprighting impacted molars. A bonded attachment with a spring fixed in a vertical lingual sheath, push coil springs, interarch vertical elastics, a removable appliance with an uprighting spring, and miniscrews/miniplates have all been used for the uprighting of impacted molars. ,, Most of the aforementioned methods, however, have limitations in the approach of deeply impacted teeth or in the site of installation. The impacted angle plays an important role during treatment planning. In the present study, the angle of impacted tooth was calculated using a method proposed by Evans.  The angle ranged from 19° to 80°, similar to that of other population. 
The proper time to treat impacted second molars is when the patient is 11-14 years old, whereas second molar root formation is still incomplete and before the third molars complete their development in close proximity to the second molars. , Once the chance of self-correction has been ruled; the various treatment options must be discussed. However, the early detection and appropriate correction helps in certain cases.
| Conclusions|| |
The prevalence of impacted mandibular second molars in South Indian population was low but slightly higher than the previous published reports in other populations. Although the occurrence is rare, it is crucial to diagnose early for optimal treatment time and reduction of complications.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Raghoebar GM, Boering G, Vissink A, Stegenga B. Eruption disturbances of permanent molars: A review. J Oral Pathol Med 1991;20:159-66.
Sawicka M, Racka-Pilszak B, Rosnowska-Mazurkiewicz A. Uprighting partially impacted permanent second molars. Angle Orthod 2007;77:148-54.
Valmaseda-Castellón E, De-la-Rosa-Gay C, Gay-Escoda C. Eruption disturbances of the first and second permanent molars: Results of treatment in 43 cases. Am J Orthod Dentofacial Orthop 1999;116:651-8.
Grover PS, Lorton L. The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol 1985;5:420-5.
Varpio M, Wellfelt B. Disturbed eruption of the lower second molar: Clinical appearance, prevalence, and etiology. ASDC J Dent Child 1988;55:114-8.
Johnsen DC. Prevalence of delayed emergence of permanent teeth as a result of local factors. J Am Dent Assoc 1977;94:100-6.
Davis PJ. Findings from 1163 panelipse radiographs taken of 12-year-old children living in Hong Kong. Community Dent Health 1988;5:243-9.
Cassetta M, Altieri F, Calasso S. Etiological factors in second mandibular molar impaction. J Clin Exp Dent 2014;6:e150-4.
Cassetta M, Altieri F, Di Mambro A, Galluccio G, Barbato E. Impaction of permanent mandibular second molar: A retrospective study. Med Oral Patol Oral Cir Bucal 2013;18:e564-8.
Fu PS, Wang JC, Wu YM, Huang TK, Chen WC, Tseng YC, et al.
Impacted mandibular second molars. Angle Orthod 2012;82:670-5.
Shapira Y, Finkelstein T, Shpack N, Lai YH, Kuftinec MM, Vardimon A. Mandibular second molar impaction. Part I: Genetic traits and characteristics. Am J Orthod Dentofacial Orthop 2011;140:32-7.
Shapira Y, Borell G, Nahlieli O, Kuftinec MM. Uprighting mesially impacted mandibular permanent second molars. Angle Orthod 1998;68:173-8.
Andreasen JO, Petersen JK, Laskin DM. Textbook and Color Atlas of Tooth Impactions. Copenhagen, Denmark: Munksgaard; 1997. p. 199-208.
Suri L, Gagari E, Vastardis H. Delayed tooth eruption: Pathogenesis, diagnosis, and treatment. A literature review. Am J Orthod Dentofacial Orthop 2004;126:432-45.
Frazier-Bowers SA, Simmons D, Koehler K, Zhou J. Genetic analysis of familial non-syndromic primary failure of eruption. Orthod Craniofac Res 2009;12:74-81.
Frazier-Bowers SA, Simmons D, Wright JT, Proffit WR, Ackerman JL. Primary failure of eruption and PTH1R: The importance of a genetic diagnosis for orthodontic treatment planning. Am J Orthod Dentofacial Orthop 2010;137:160.
Kokich VG, Mathews DP. Surgical and orthodontic management of impacted teeth. Dent Clin North Am 1993;37:181-204.
Eckhart JE. Orthodontic uprighting of horizontally impacted mandibular second molars. J Clin Orthod 1998;32:621-4.
Lang R. Uprighting partially impacted molars. J Clin Orthod 1985;19:646-50.
Freeman RS. Mandibular second molar problems. Am J Orthod Dentofacial Orthop 1988;94:19-21.
Kurol J. Impacted and ankylosed teeth: Why, when, and how to intervene. Am J Orthod Dentofacial Orthop 2006;129 4 Suppl: S86-90.
Magnusson C, Kjellberg H. Impaction and retention of second molars: Diagnosis, treatment and outcome. A retrospective follow-up study. Angle Orthod 2009;79:422-7.
McAboy CP, Grumet JT, Siegel EB, Iacopino AM. Surgical uprighting and repositioning of severely impacted mandibular second molars. J Am Dent Assoc 2003;134:1459-62.
Motamedi MH, Shafeie HA. Technique to manage simultaneously impacted mandibular second and third molars in adolescent patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:464-6.
Majourau A, Norton LA. Uprighting impacted second molars with segmented springs. Am J Orthod Dentofacial Orthop 1995;107:235-8.
Giancotti A, Muzzi F, Santini F, Arcuri C. Miniscrew treatment of ectopic mandibular molars. J Clin Orthod 2003;37:380-3.
Evans R. Incidence of lower second permanent molar impaction. Br J Orthod 1988;15:199-203.
Department of Conservative Dentistry and Endodontics, Sri Venkateswara Dental College and Hospital, Dr. MGR Medical University, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]
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