Radiographic assessment of impacted teeth and associated pathosis prevalence

ينب كلذل ةببسلما لماوعلاو ،نانسلأا راشحنا راشتنا ىدم مييقت :فادهلأا ىلع ًادامتعا كلذو ةيدوعسلا ةيبرعلا ةكلملماب ةرونلا ةنيدلما يف ينيدوعسلا .ةيمقرلا ةيمارونابلا ةعشلأا روص ،نانسلأا ةيلك ،مفلا صيخشت تادايع يف ةساردلا هذه تيرجأُ :ةقيرطلا ةرتفلا للاخ كلذو ةيدوعسلا ةيبرعلا ةكلملما ،ةرونلما ةنيدلما ،ةبيط ةعماج ًاركذ 359 ةساردلا تلمش دقو .م2015 رياربف ىلإ م2013 ربمسيد نم .ةيمارونابلا ةعشلأا مادختساب مهتلااح مييقت تمو ،تادايعلا ىلإ اوتأ نمم راشتنا ىدم ليلتح لجأ نم ةيعاعشلإا روصلا هذه ةساردب انمق اهدعبو لماوعلا ديدتح ىلإ ةفاضلإاب ،باينلأاو ،نحاوطلا نانسلأا راشحنا طانمأو .كلذل ةببسلما اًضيرم 124 ينب نانسلأا راشحنا روهظ ىلإ ةساردلا جئاتن تراشأ :جئاتنلا كفلاب ةثلاثلا نحاوطلا تناكو .ةساردلا مهتنمضت اًكراشم 359 لصأ نم اهيدل اهنم 77.6% ناك ثيح ًاراشتنا ةرشحنلما نانسلأا رثكأ يه يلفسلا يتلا يولعلا كفلا باينأ صخي اميفو .راشحنلاا طنم نم ةيناثلا ةجردلا 66% ينب نمو .ةيوازلا ةيسنإ اهنم 75% ناك دقف راشحنلاا اهيلع رهظ ناك دقف راشحنلاا اهيلع رهظ يتلا يولعلا كفلل ةثلاثلا نحاوطلا نم ىضرلما نم 5.8% ىناع دقف كلذ ىلإ ةفاضلإاب .ةثلاثلا ةجردلا نم 63.6% راشحنا نم 13.1% ىناع و ،نانسلأا نم رثكأ وأ 3 راشحنا نم ينيدوعسلا تحضتا دقلو .طقف دحاو نس راشحنا نم 15.6% ىناع اميف ،يننس يولعلا كفلا نحاوط نم 18.2% ىدل نانسلأا راشحنلا ةببسلما لماوعلا اندجو دقلو .ةثلاثلا يلفسلا كفلا نحاوط نم 31.5% ىدلو ،ةثلاثلا .نسلا يف مدقتلا عم نانسلأا راشحنا ثودح ضافخنا ىدل ةثلاثلا نحاوطلا نانسلأا راشحنا راشتنا نأب ةساردلا ترهظأ :ةتمالخا .ىرخلأا قارعلأا يف ةدوجولما كلتل ةهباشم تناك دق ينيدوعسلا ىضرلما مغرلا ىلعو .رمعلا يف مدقتلا عم دادزت ةدوقفلما لقعلا نانسأ ددع ناك دقلو ىلإ ةضفخنم تناك ةرشحنلما نانسلأاب ةطبترلما ةيضرلما تلاالحا ةبسن نأ نم نانسلأا ىلع ظافحلل نانسلأل يرود صحفب مايقلا يرورضلا نمف ،ريبك دح .ةديج ةحص يف ضارعأ ىلإ يدؤت مل يتلا ةرشحنلما Objectives: To assess the prevalence of both impaction and associated pathosis in a Saudi population in Al-Madinah, Saudi Arabia based on digital panoramic radiographs. Methods: This study was carried out from December 2013 to February 2015. Panoramic radiographs of 359 male patients attending the Oral Diagnosis Clinics, Faculty of Dentistry, Taibah University, Al-Madinah, Saudi Arabia were reviewed. All images were evaluated to determine the prevalence and pattern of impacted third molars and canines, and associated pathosis. Results: Among 359 panoramic radiographs examined, 124 patients had impacted teeth. The impacted mandibular third molars were the most prevalent impacted teeth, 77.6% had class II pattern of impaction. Among the impacted maxillary canines, 75% were mesioangular and among 66 impacted maxillary third molars, 63.6% had class C. Our study showed that 5.8% of Saudi patients had 3 or more impacted teeth, 13.1% had 2 impacted teeth, and 15.6% had one impacted tooth. Associated pathosis was found in 18.2% among impacted maxillary third molars, and 31.5% among impacted mandibular third molars. The incidence of impaction decreases with age. Conclusion: The prevalence and pattern of impacted third molars among Saudis are almost similar to other racial populations. The number of missing wisdom increases with age. Although the percentage of pathosis associated with impaction was considerably low, it is essential to carry you regular oral examinations to preserve asymptomatic impacted teeth in good health. Saudi Med J 2015; Vol. 36 (8): 973-979 doi: 10.15537/smj.2015.8.12204 From the Departments of Oral and Basic Clinical Sciences (El-Khateeb, Arnout), Public Health (Hifnawy), College of Dentistry, Taibah University, Al-Madinah Al-Munawarrah, Kingdom of Saudi Arabia, and the Department of Oral Medicine, Periodontology, Diagnosis and Oral Radiology (El-Khateeb, Arnout), Faculty of Dentistry, Ain Shams University, Cairo, and the Faculty of Medicine (Hifnawy), Beni-Suef University, Beni-Suef Governorate, Egypt. Received 26th April 2015. Accepted 24th June 2015. Address correspondence and reprint request to: Dr. Sara M. El-Khateeb, Department of Oral and Basic Clinical Sciences, College of Dentistry, Taibah University, Al-Madinah Al-Munawarrah, Kingdom of Saudi Arabia. E-mail: [email protected] OPEN ACCESS 973 www.smj.org.sa Saudi Med J 2015; Vol. 36 (8) Prevalence of impacted teeth among Saudi males ... El-Khateeb et al 974 Saudi Med J 2015; Vol. 36 (8) www.smj.org.sa A eruption is a complex process, therefore tooth retardation or failure of eruption may arise, so failure of permanent teeth eruption and subsequent impaction is a common dental anomaly.1 Previous literature reported that teeth impaction is a usual incident and many factors affect its prevalence including aging and eruption time.2 Genetic and environmental factors play a role in developmental disturbances. The incidence of impacted teeth is contradictory in different populations and ethnic groups.3 Complications associated with impaction may range from simple problems to serious life threatening problems. Hyperplastic follicular space, subsequent dentigerous cyst or odontogenic keratocyst are the most common simple problems with impaction.4,5 Serious complications involve malignant transformation of cystic wall into squamous cell carcinoma or mucoepidermoid carcinoma. Consequently, life threatening conditions maybe a chain of simple problem such as impaction, which if solved from the beginning would cost less, and would be simple to solve.6 Panoramic radiography is a simple tomographic technique that introduces the panoramic view of the maxillofacial region.7 Radiographic examinations are either digital imaging or conventional. Digital imaging has many advantages versus conventional, such as reduction of radiation exposure, feasibility of image manipulation and analysis, which improves sensitivity and diminishes errors.8 The United States guidelines state that the panoramic radiograph is one of the screening images for Adolescent with Permanent Dentition and Adult, Dentate or Partially Edentulous.9 During our daily oral examinations, we notice poor patient awareness of oral health and its implications in Saudi Arabia. Additionally, there is no present data on the prevalence of impacted teeth, and associated pathologies in the Saudi population in Al-Madinah, Saudi Arabia. The aim of the present study was to determine the prevalence and pattern of occurrence of impacted teeth at different ages based on digital panoramic radiograph. In addition, to report the radiographic features of associated pathologies in a Saudi male population, in order to correlate between impaction and associated pathosis Methods. This study was a retrospective observational study, which was implemented in the clinics of the College of Dentistry, Taibah University, Al-Madinah Al-Munawarrah, Saudi Arabia from December 2013 to February 2015. We included all male patients of Saudi nationality with an age range from 20-40 years; high quality digital panoramic radiographs were acquired for all patients. Patients were divided into 2 groups, the first group from 20-30 years, and the second group from 30-40 years. After assessment of the patient records, patients who displayed one or more of the following pathological situations were excluded from the study. Any conditions that may affect normal growth of permanent dentition as diseases or trauma of the jaw, also any syndromes or hereditary diseases, such as craniosynostosis, Down’s syndrome, or cleidocranial dysostosis. Digital panoramic radiographs were acquired by Care Stream CS9000, select 3D Extraoral Digital Imaging System (SM749, Rochester NY, USA). All patients panoramic radiograph were archived using Care Stream R4 (Special filing system software) Clinical and Practice Management database. All patients’ panoramic radiographs were examined carefully by 2 skilled Oral and Maxillofacial radiologists with experience of 8 and 12 years in order to detect impacted teeth and associated pathosis. Classification of impacted mandibular third molar level, position, and depth determined by panoramic radiograph according to the following classification: A) Pell and Gregory radiographic classification with respect to mandibular ramus into: Class I, Class II, and Class III;10 B) Pell and Gregory radiographic classification for the occlusal plane: Class A, Class B, and Class C;10 and C) based on winter’s classification: mesio-angular, distoangular, horizontal, vertical, buccal/lingual obliquity, and transverse.11 Classification of impacted maxillary third molar: Class A, Class B and Class C, and sinus approximation/no sinus approximation.12 Classification of impacted maxillary and mandibular canine level: A) Archer’s classification of impacted maxillary canines: Class I, Class II, Class III, Class IVm and Class V;13 B) Classification of impacted mandibular canines was classified into: mesioangular, distoangular, vertical, or horizontal Field and Ackerman Classification 1935;14 C) depth of the impactions were classified into: Level A, Level B, and Level C. Classification of associated pathologies with the impacted teeth included: 1. Caries of the impacted or adjacent teeth. 2. Widening of periodontal ligament space of the adjacent tooth. 3. Loss of lamina dura of adjacent teeth. 4. Root resorption of the adjacent tooth. 5. An increase in the follicular space around the impacted tooth. 6. Cyst formation or tumor associated with the impacted teeth or adjacent teeth. Ethical consideration. This study was approved by the Taibah University College of Dentistry Research Ethics Committee; a waiver of informed consent was approved for this retrospective study. Confidentiality of data was ensured by the commitment of the principal Prevalence of impacted teeth among Saudi males ... El-Khateeb et al 975 www.smj.org.sa Saudi Med J 2015; Vol. 36 (8) investigator, and by using codes for all study subjects included in this study. Statistical analysis. All the data were coded, collected, and tabulated. Statistical analysis was performed by Microsoft Office 2013 (Excel) and IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp, Armonk, NY, USA). The significant level was set at p≤0.05. Descriptive analysis was performed using simple frequencies and percentage. Data was presented as count and percentage. Chi square test was used for inferential statistics to compare between the groups. Results. Maxillary and mandibular third molars and canines from 359 panoramic radiographs were examined, of the 1436 jaw quadrants were inspected for impaction, only 212 missing canines and/ or third molars were found. Of the total 359 patients, 124 (34.5%) patients had impacted teeth and 235 (65.5%) patients had no impaction. One impacted tooth was detected in 56 patients (15.6%), 2 impacted teeth were detected in 47 patients (13.1%), 3 impacted teeth were detected in 12 patients (3.3%), and 4 impacted teeth were detected in 9 patients (2.5%). According to statistical analysis of our study, we found that the impacted mandibular third molars were the most prevalent impacted tooth. There were 98 patients (27.3%) that had impacted mandibular third molars, about 53 of them had unilateral impaction, and 45 had bilateral impaction. The total number of impacted mandibular third molars was 143. The second most prevalent impacted tooth was the maxillary third molar. There were 48 (13.4%) patients with impacted maxillary third molars, around 30 of them had unilateral and 18 had bilateral impaction, with a total of 66 impacted maxillary third molars. Six patients had impacted maxillary, and 2 patients had impacted mandibular canines. Among the impacted maxillary canines, 75% were mesioangular and the remaining were vertical with the majority of them having level B, and only 2 canines were associated with an increase in the follicular space around them. There were 2 impacted mandibular canines, which were distoangular, level B with one of them associated with pathosis. Among 66 impacted maxillary third molars, 63.6% had class C followed by class A then class B. Sinus approximation was noted in 71.2% of impacted maxillary third molars. The greater proportion had vertical angulations followed by oblique then mesioangular and horizontal. Associated pathosis was found in 18.2%, which varied from either loss of lamina dura of adjacent teeth or an increase in the follicular space around them (Table 1). Among 143 impacted mandibular third molars, 77.6% had class II followed by class I then class III. While 44.8% had position A, 44.8% had position B, and 15% had position C. The majority of impacted mandibular third molars had vertical angulation followed by horizontal, mesioangular, oblique, and the least prevalent was distoangular. Associated pathosis was represented in 31.5% (Table 2). The most common associated pathosis with impacted mandibular third molar was loss of lamina dura of adjacent teeth followed by widening of the periodontal ligament space of the impacted or the adjacent tooth, especially at the left side then caries of the impacted or adjacent teeth followed by increase in the follicular space around the impacted tooth. Cyst or tumor formation was not associated with any impacted third molar. Out of 124 patients with impaction, Table 1 The frequency and percentage of impacted maxillary third molar according to its crown position, level and angle. Pattern of impaction Frequency %