Skip to main content

Advertisement

SpringerLink
Log in

Characterizations of three-dimensional root morphology and topological location of mandibular third molars by cone-beam computed tomography

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to delineate three-dimensional (3D) root morphology and topological locations of mandibular third molars (MTMs) by cone-beam computed tomography (CBCT) in a Chinese adult dental population.

Methods

Adult patients with MTMs were retrospectively screened based on CBCT images at our institution between January 2018 and December 2019. Root morphology and spatial locations of these teeth were defined based on CBCT 3D images. Potential associations with epidemiological and clinical/radiological parameters were analyzed using Chi-square or Fisher exact test. Two-tailed P values less than 0.05 were considered statistically significant.

Results

A total number of 2680 eligible patients (male/female:0.74; 35 ± 10 years old) with 4180 MTMs were enrolled. The majority of MTMs had 2 roots 3064 (73.30%), followed by 800 (19.14%) 1 root, 302 (7.22%) 3 roots, and 14 (0.33%) 4 roots. More than half of one-rooted MTMs were convergent, followed by club-shaped and C-shaped. Among MTMs with 2 roots, 2860 (93.34%) were M–D (mesio-distal) types. Most MTMs with 3 roots were M–2D (one root in mesial, two roots in distal) types, followed by 2M–D (two roots in mesial, one root in distal) types, and B–2L (one root in buccal, two roots in lingual) types. The presence of root configurations was significantly associated with the angulation, depth, and width classification in two-rooted MTMs (P < 0.05).

Conclusions

Although the morphology and spatial locations of MTMs vary greatly, our results from a large dental population reconfirm that most MTMs have two roots with mesial–distal type of spatial distribution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of data and materials

The datasets generated during the current study are available from the corresponding author on reasonable request.

References

  1. Abella F, Patel S, Duran-Sindreu F, Mercade M, Roig M (2012) Mandibular first molars with disto-lingual roots: review and clinical management. Int Endod J 45:963–978. https://doi.org/10.1111/j.1365-2591.2012.02075.x

    Article  CAS  PubMed  Google Scholar 

  2. Alfadil L, Almajed E (2020) Prevalence of impacted third molars and the reason for extraction in Saudi Arabia. Saudi Dent J 32:262–268. https://doi.org/10.1016/j.sdentj.2020.01.002

    Article  PubMed  PubMed Central  Google Scholar 

  3. Araujo GTT, Peralta-Mamani M, Silva A, Rubira CMF, Honorio HM, Rubira-Bullen IRF (2019) Influence of cone beam computed tomography versus panoramic radiography on the surgical technique of third molar removal: a systematic review. Int J Oral Maxillofac Surg 48:1340–1347. https://doi.org/10.1016/j.ijom.2019.04.003

    Article  PubMed  Google Scholar 

  4. Bell GW, Rodgers JM, Grime RJ, Edwards KL, Hahn MR, Dorman ML, Keen WD, Stewart DJ, Hampton N (2003) The accuracy of dental panoramic tomographs in determining the root morphology of mandibular third molar teeth before surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95:119–125. https://doi.org/10.1067/moe.2003.16

    Article  PubMed  Google Scholar 

  5. Bouloux GF, Steed MB, Perciaccante VJ (2007) Complications of third molar surgery. Oral Maxillofac Surg Clin N Am 19(117–128):vii. https://doi.org/10.1016/j.coms.2006.11.013

    Article  Google Scholar 

  6. Carter JB, Stone JD, Clark RS, Mercer JE (2016) Applications of cone-beam computed tomography in oral and maxillofacial surgery: an overview of published indications and clinical usage in United States academic centers and oral and maxillofacial surgery practices. J Oral Maxillofac Surg 74:668–679. https://doi.org/10.1016/j.joms.2015.10.018

    Article  PubMed  Google Scholar 

  7. Carter K, Worthington S (2016) Predictors of third molar impaction: a systematic review and meta-analysis. J Dent Res 95:267–276. https://doi.org/10.1177/0022034515615857

    Article  CAS  PubMed  Google Scholar 

  8. da Silva SMB, Viana FLP, Cardoso CL, Vasconcelos MF, Vasconcelos MHF, Goncales ES (2018) Radiographic study of mandibular third molars: evaluation of the position and root anatomy in Brazilian population. Oral Maxillofac Surg 22:163–168. https://doi.org/10.1007/s10006-018-0685-y

    Article  Google Scholar 

  9. de Carvalho RWF, Vasconcelos BC (2018) Pernambuco index: predictability of the complexity of surgery for impacted lower third molars. Int J Oral Maxillofac Surg 47:234–240. https://doi.org/10.1016/j.ijom.2017.07.013

    Article  PubMed  Google Scholar 

  10. Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R (2012) 3D Slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 30:1323–1341. https://doi.org/10.1016/j.mri.2012.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gbotolorun OM, Arotiba GT, Ladeinde AL (2007) Assessment of factors associated with surgical difficulty in impacted mandibular third molar extraction. J Oral Maxillofac Surg 65:1977–1983. https://doi.org/10.1016/j.joms.2006.11.030

    Article  PubMed  Google Scholar 

  12. Hashemipour MA, Tahmasbi-Arashlow M, Fahimi-Hanzaei F (2013) Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population. Med Oral Patol Oral Cir Bucal 18:e140-145. https://doi.org/10.4317/medoral.18028

    Article  PubMed  Google Scholar 

  13. Huang C, Zhou C, Xu M, Zou D (2020) Risk factors for lingual plate fracture during mandibular third molar extraction. Clin Oral Investig 24:4133–4142. https://doi.org/10.1007/s00784-020-03286-5

    Article  PubMed  Google Scholar 

  14. Huang ZQ, Huang ZX, Wang YY, Hu WJ, Fan S, Zhang DM, Chen WL (2015) Removal of the residual roots of mandibular wisdom teeth in the lingual space of the mandible via endoscopy. Int J Oral Maxillofac Surg 44:400–403. https://doi.org/10.1016/j.ijom.2014.11.018

    Article  CAS  PubMed  Google Scholar 

  15. Kuzekanani M, Haghani J, Nosrati H (2012) Root and canal morphology of mandibular third molars in an Iranian population. J Dent Res Dent Clin Dent Prospects 6:85–88. https://doi.org/10.5681/joddd.2012.018

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lubbers HT, Matthews F, Damerau G, Kruse AL, Obwegeser JA, Gratz KW, Eyrich GK (2011) Anatomy of impacted lower third molars evaluated by computerized tomography: is there an indication for 3-dimensional imaging? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:547–550. https://doi.org/10.1016/j.tripleo.2010.06.010

    Article  PubMed  Google Scholar 

  17. Mohammadi Z, Jafarzadeh H, Shalavi S, Bandi S, Patil S (2015) Root and root canal morphology of human third molar teeth. J Contemp Dent Pract 16:310–313. https://doi.org/10.5005/jp-journals-10024-1681

    Article  PubMed  Google Scholar 

  18. Park JB, Kim N, Park S, Ko Y (2013) Evaluation of number of roots and root anatomy of permanent mandibular third molars in a Korean population, using cone-beam computed tomography. Eur J Dent 7:296–301. https://doi.org/10.4103/1305-7456.115413

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pell GJ, Gregory BTJDD (1933) Impacted mandibular third molars : classification and modified techniques for removal. Dent Digest 39:330–338

    Google Scholar 

  20. Rashid MO, Talabani RM, Baban MT, Gul SS, Salih RO, Abdulkareem BN, Abdulalttef DS (2019) Prevalence of impacted mandibular third molars and its association with distal caries in mandibular second molars using cone beam computed tomography. J Oral Res 8:66–73. https://doi.org/10.17126/joralres.2019.009

    Article  Google Scholar 

  21. Roy I, Baliga SD, Louis A, Rao S (2015) Importance of clinical and radiological parameters in assessment of surgical difficulty in removal of impacted mandibular 3rd molars: a new index. J Maxillofac Oral Surg 14:745–749. https://doi.org/10.1007/s12663-014-0731-8

    Article  PubMed  Google Scholar 

  22. Sidow SJ, West LA, Liewehr FR, Loushine RJ (2000) Root canal morphology of human maxillary and mandibular third molars. J Endod 26:675–678. https://doi.org/10.1097/00004770-200011000-00011

    Article  CAS  PubMed  Google Scholar 

  23. Szalma J, Vajta L, Lovasz BV, Kiss C, Soos B, Lempel E (2020) Identification of specific panoramic high-risk signs in impacted third molar cases in which cone beam computed tomography changes the treatment decision. J Oral Maxillofac Surg 78:1061–1070. https://doi.org/10.1016/j.joms.2020.03.012

    Article  PubMed  Google Scholar 

  24. Verweij JP, AnssariMoin D, Wismeijer D, van Merkesteyn JPR (2017) Replacing heavily damaged teeth by third molar autotransplantation with the use of cone-beam computed tomography and rapid prototyping. J Oral Maxillofac Surg 75:1809–1816. https://doi.org/10.1016/j.joms.2017.03.045

    Article  PubMed  Google Scholar 

  25. Wang D, He X, Wang Y, Li Z, Zhu Y, Sun C, Ye J, Jiang H, Cheng J (2017) External root resorption of the second molar associated with mesially and horizontally impacted mandibular third molar: evidence from cone beam computed tomography. Clin Oral Investig 21:1335–1342. https://doi.org/10.1007/s00784-016-1888-y

    Article  PubMed  Google Scholar 

  26. Wang Y, Zheng QH, Zhou XD, Tang L, Wang Q, Zheng GN, Huang DM (2010) Evaluation of the root and canal morphology of mandibular first permanent molars in a western Chinese population by cone-beam computed tomography. J Endod 36:1786–1789. https://doi.org/10.1016/j.joen.2010.08.016

    Article  PubMed  Google Scholar 

  27. Winter GB (1926) Impacted mandibular third molars. Med Book Co, St Louis

    Google Scholar 

  28. Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128. https://doi.org/10.1016/j.neuroimage.2006.01.015

    Article  PubMed  Google Scholar 

  29. Zhang R, Wang H, Tian YY, Yu X, Hu T, Dummer PM (2011) Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular molars in Chinese individuals. Int Endod J 44:990–999. https://doi.org/10.1111/j.1365-2591.2011.01904.x

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank all members of the Departments of Oral and Maxillofacial Surgery, Oral orthodontics, and Oral Radiography, Nanjing Medical University, for their work in data collection and discussion.

Funding

This work is financially supported in whole or in part, by the Healthy Committee of Jiangsu Province (M2020021), a project funded by Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD, 2018-87), China Oral Health Foundation (A2021-030).

Author information

Author notes

  1. Qiuping Jing and Hongcheng Song have contributed equally to this study.

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China

    Qiuping Jing, Hongcheng Song, Hong Huang, Yijin Shi, Jie Cheng & Dongmiao Wang

  2. Jiangsu Province Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, 210029, People’s Republic of China

    Qiuping Jing, Hongcheng Song, Hong Huang, Yijin Shi, Jie Cheng & Dongmiao Wang

  3. Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Jiangsu, 210029, People’s Republic of China

    Jie Cheng & Dongmiao Wang

Authors
  1. Qiuping Jing
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongcheng Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yijin Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jie Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dongmiao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DW: Project development, Manuscript writing. QJ: Project development, Data collection. HS: Project development, Data collection. HH: Data collection. YS: Data collection. JC Project development, Manuscript writing. All authors reviewed the manuscript.

Corresponding author

Correspondence to Dongmiao Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was reviewed and approved by the Ethics and Research Committee, Nanjing Medical University (Ethics approval number: 2022-088-001), and conducted in accordance with the tenets of the 1964 Declaration of Helsinki for research involving human subjects.

Informed consent

Written informed consent was not required for this study because all of the included patients in the present investigation were collected retrospectively.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jing, Q., Song, H., Huang, H. et al. Characterizations of three-dimensional root morphology and topological location of mandibular third molars by cone-beam computed tomography. Surg Radiol Anat 45, 527–536 (2023). https://doi.org/10.1007/s00276-023-03111-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-023-03111-0

Keywords

Search

Navigation