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Correlation of Pericoronitis and the Status of Eruption of Mandibular Third

Molar: A Clinico Radiographic Study

Article · April 2013

DOI: 10.5005/jp-journals-10011

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 JIAOMR
10.5005/jp-journals-10011-......................
Correlation of Pericoronitis and the Status of Eruption of Mandibular Third Molar: A Clinico Radiographic Study
ORIGINAL ARTICLE

Correlation of Pericoronitis and the Status of Eruption of

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

ABSTRACT mandibular third molars in contact with adjacent second

Objective: The purpose of this study was to analyze the molar, at or above the occlusal plane and partially covered
relationship between the status of eruption of mandibular third by soft or hard tissue.5
molar and pericoronitis. Treatment of pericoronitis runs from very conservative
Methodology: The sample consisted of 50 patients inclusive to slightly radical therapy.1If removal is postponed, there
of both the genders with pericoronitis. After clinical examination, may be surgical risk and morbidity increases with patient’s
radiographic assessment was done by taking OPG to assess
the mandibular third molar position. Radiographic assessment age. Removal of tooth may prevent the fear of infection
was done to analyze the angulations, height and encapsulation spread, which may result in severe complications. With the
of the mandibular third molar affected by pericoronitis following above knowledge, the purpose of the study is to explore the
Pell and Gregory and Winter’s classification. Comparison of the
relationship between the position of mandibular third molar
data was done between type of impaction and pericoronitis.
and pericoronitis which in turn can be applied in preventing
Results: In our study among the sample of 50 patients with
complications in high risk groups.
pericoronitis, 43(86%) cases of mandibular third molars were
partially erupted and 7(14%) cases were impacted. There was
an increased prevalence of position IA (42%) followed by IIB MATERIALS AND METHODS
(34%) and IIA (20%) was observed. Vertical and distoangular
impaction was slightly more prevalent when compared to The study group consisted of 50 patients between age group
other types. of 18-34 years of both the genders with symptoms of
Conclusions: The status of impacted third molar may be pericoronitis who reported to the department of oral
correlated to the development of pericoronal infection process medicine and radiology, MR Ambedkar dental college and
and their potential complications. Partially erupted, position IA, hospital, Bangalore.
vertical and distoangular impactions can be advised for
The patients were clinically examined after obtaining
prophylactic removal particularly to prevent surgical risks and
patients morbidity with age. an informed consent. Radiographic assessment was done
by taking Orthopantomograph to assess the mandibular third
Keywords: Mandibular third molar, Impaction, Pericoronitis.
molar status, following radiation protection protocol using
How to cite this article: Indira AP, Kumar M, David MP, the Kodak-8000C digital cephalometric system. The
Rajshekar VM, Shashikala. Correlation of Pericoronitis and
the Status of Eruption of Mandibular Third Molar: A Clinico
selected cases were examined clinically to assess the
Radiographic Study. J Indian Aca Oral Med Radiol 2013; presence or absence of teeth and encapsulation. According
25(2):0-0. to their clinical status, the unerupted teeth were divided into
Source of support: Nil 2 groups:
1. Completely unerupted mandibular third molars—i.e.,
Conflict of interest: None declared
teeth that had not perforated the oral mucosa.
2. Partially erupted mandibular third molars—i.e., teeth
INTRODUCTION
that had perforated the mucosa and were partially visible
In human dentition the third molar has the highest impaction in oral cavity.
rate among all teeth.1 Although impacted third molars may The captured image was assessed and traced for the
remain symptom free indefinitely, they usually produce status and angulation of mandibular third molar by using
local, regional, or systemic alterations of variable severity. Windows Trophy Dicom and Master view 3 software (Fig. 1
The most frequent problem being pericoronitis.2 Pericoronitis and 2). The Pell and Gregory classification2 (Fig. 1) was
is an infection of the soft tissue around the crown of a used to assess the ramus (horizontal) and occlusal (vertical)
partially impacted tooth and is the most common pathological position of mandibular third molar in relation to anterior
condition involving third molars that are most commonly border of ramus and distal aspect of second molar. Winter’s
found among young individuals between 18-24 years.3,4 This classification2 was used to assess angulation of mandibular
is by far the most common acute problem in third molars. third molar in relation to long axis of mandibular second
Previous studies have shown that the teeth at greatest and third molar.
risk in relation to acute pericoronitis are vertically erupted

Journal of Indian Academy of Oral Medicine and Radiology, April-June 2013;25(2):00-00 1

Indira AP et al

Fig. 1: Pell and gregory’s classification (adapted from checchi and monaco)

RESULTS
In the present study, in the total sample of 50 patients with
pericoronitis, 43 (86%) were partially erupted and 7 (14%)
were impacted (Table 1, Chart 1). According to the Pell
and Gregory’s classification of impacted third molars the
increasedprevalence of position IA (42%) was observed
followed by IIB (34%) and IIA (20%) (Table 2, Chart 2).
According to Winter’s classification vertical and distoangular
Fig. 2: Assessment of status of eruption of mandibular third molar impaction was more when compared to other types
(Table 2, Chart 3). In relation to the side pericoronitis was
Inclusion Criteria: observed slightly more on right side in 27 (54%) cases
• Patients with age 18 years and above. (Table 1).
• Those patients presenting with clinical symptoms-
associated with impacted mandibular third molars. DISCUSSION
Exclusion criteria:
• Patients under 18 years of age. Pericoronitis is the inflammation of the gingiva in relation
• Patients with a congenital disorder, cysts, and tumors to the crown of an incompletely erupted third molar. It is
associated with mandibular third molar. the most common pathological condition involving third
• Asymptomatic patients with impacted mandibular molars that is most commonly found among young
third molar. individuals between 18-24 years.3,4,6 The term impaction
was defined by Peterson as one that fails to erupt into the
dental arch within the expected time. The average age for

2
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Correlation of Pericoronitis and the Status of Eruption of Mandibular Third Molar: A Clinico Radiographic Study

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 information about the anatomic condition of the retromolar
Type of classification Status of third molar Percentage region.7 Pell and Gregory and Winter’s classification was
Pell and gregory Type IA 42
used in this study as it is simple, practical and easy to apply.
classification Type IB 2 The causes of impacted third molars include:
Type IC 0 • Reduced rate of growth in the length of the mandible,
Type IIA 20
Type IIB 34 in which there is insufficient increase in the length of
Type IIC 2 the mandible in proportion to the amount of tooth substance.
Type IIIA 0
• Vertical direction of the condylar growth, which is
Type IIIB 0
Type IIIC 0 associated with insufficient resorption at the anterior
Winters classification Vertical 28 ramus border.
Mesioangular 20
Distoangular 28
• Back-ward directed eruption of the dentition, which
Horizontal 24 cause a decrease in space for third molars to erupt.
• Retarded maturation of dentition is a fourth factor
contributing to incomplete eruption.8

Chart 1: Eruption status of mandibular third molars

the eruption of mandibular third molars in male is

Chart 2: Pell and gregory classification
approximately 3 to 6 months ahead of females. Pericoronitis
can develop from the moment that the crown of an erupting
third molar comesinto contact with the oral cavity. Once
the process has developed, it tends to become chronic and
recur intermittently until the tooth is fully erupted or
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 Chart 3: Winters classification

Journal of Indian Academy of Oral Medicine and Radiology, April-June 2013;25(2):00-00 3

Indira AP et al

In the present study, in the total sample of 50 patients REFERENCES

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Thereason could be because of the increased incidence of
associated with mandibular third molars subjected to removal.
mandibular third molar being impacted in this position. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:10-7.
In this study, according to winter’s classification vertical 11. Venta I, Turtola L, Murtomaa HY Lipaavalniemmi P. Third
(28%) and distoangular (28%) impaction was probably more molars as an acute problem in Finnish University students. Oral
prevalent when compared to other types.This finding Surg Oral Med Oral Pathol Oral Radiol Endod 1993;76:135-140.
wasconsistent with Leone,5 Knutsson K et al10 who have
showed that third molars inthe vertical position, or slightly ABOUT THE AUTHORS
distoangular with partialmucosal and bony coverage, are
Indira Ap (Corresponding Author)
the presentationsmost likely to cause pericoronitis.This is
because such positions have high frequency rate of impaction. Professor, Department of Oral Medicine and Radiology, Mr Ambedkar
Dental College and Hospital, Karnataka, India, Phone: 25463097
The risk of an acute problem was greatest for
e-mail: [email protected]
distoangular lower third molars. This may be explained by
accumulation of food and the occlusal surface of a Mahesh Kumar
distoangular third molar slope downward distally by occlusal
Senior Lecturer, Department of Oral Medicine and Radiology
movements. The amount of soft tissue surrounding a
Rajarajeshwari Dental College, Karnataka, India
distoangular third molar may be greater than with
mesioangular and horizontal impaction.11 Maria Priscilla David
Professor and Head, Department of Oral Medicine and Radiology
CONCLUSION
Mr Ambedkar Dental College, 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, 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, Karnataka, India

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