Dental Traumatology 2016; doi: 10.1111/edt.

12260

Association between eruption state of the

third molar and the occurrence of
mandibular angle fractures

Roman K. Rahimi-Nedjat1, Keyvan
Sagheb1, Collin Jacobs2, Christian
Walter1
1
Department of Oral and Maxillofacial Surgery,
University Medical Center of the Johannes
Gutenberg University; 2Department of
Orthodontics, University Medical Center of the
Johannes Gutenberg University, Mainz,
Germany
Key words: mandibular angle fractures; third
molar; risk of fracture; third molar removal
Correspondence to: Roman Kia Rahimi-
Nedjat, Department of Oral and Maxillofacial
Surgery, University Medical Center of the
Johannes Gutenberg University,
Augustusplatz 2, 55131 Mainz, Rheinland-
Pfalz, Germany
Tel.: (0049)6131 175086
Fax: (0049)6131 176602
e-mail: roman.rahimi-nedjat@unimedizin
mainz.de
Accepted 8 December, 2015
Abstract – Background/Aim: Fractures of the mandible, especially the
mandibular angle, are one of the most frequent types of injuries of the
facial skeleton. In many cases, a retained third molar can be found in the
line of the fracture. However, it remains unclear whether a relationship
between third molars and mandibular angle fractures exists. Materials and
Methods: Patients with isolated or combined fractures of the lower jaw
between January 2001 and December 2007 were analyzed retrospectively.
Electronic health records were investigated regarding the types of mandibu-
lar fractures, and panoramic radiographs were reviewed concerning the
existence of third molars. In addition, a systematic review was performed
to compare the findings of this study with existing data. Results: Six hun-
dred and thirty-two patients were treated for mandibular fractures within
the time frame. Two hundred and sixty-seven had a mandibular angle frac-
ture. In 461 patients, panoramic radiographs were available, of which
45.6% did not have a third molar. About 3.8% were edentulous. There is
a significant relationship between the existence of unerupted third molars
and the occurrence of mandibular angle fractures (P < 0.001). No correla-
tion exists for erupted third molars. Conclusions: Fractures of the
mandibular angle are more likely to appear in patients with retained third
molars which might be due to the reduced bone mass. Once the wisdom
teeth have erupted, the bone structure is more solid and more resistant to
external forces and the development of fractures.

In clinical practice, patients with fractures in this

Introduction
Fractures of the facial skeleton can occur in isolation
or in combination with injuries of other body parts
such as the cranium, spine, and upper and lower
extremities (1). While the causes of maxillofacial trau-
mas vary depending on gender and the geographical
region between different countries and even regions in
between a country (2), most authors agree on the zygo-
matic bone and the lower jaw as the most frequent
fracture sites within the maxillofacial area (1, 3–6) due
to its exposed position within the face. As the mandible
is the only mobile bone of the facial skeleton, devia-
tions from normal occlusion and movement as a result
of even minor dislocated fractures are usually recog-
nized by the patients (7, 8).
Most frequent localizations of mandibular fractures
are the condyle, the mandibular angle and the corpus
and can occur in isolation or in combination. The pro-
portion of fractures of the mandibular angle is approxi-
mately 25–33% (9). The characteristic shape of the
angle of the mandible with the horizontal, tooth-bear-
ing part and the edentate vertical ramus (10) might be
especially susceptible to fractures (11).
region often present with a third molar within the line
of the fracture (12). Therefore, in addition to other risk
factors such as the presence of soft tissue bulk, differ-
ences in bone density, mass and its anatomical struc-
ture (7), the existence of a third molar has been
discussed as a further risk factor (13–16).
The aim of this study was to investigate the relation-
ship between the third molar and mandibular angle
fractures.
Materials and methods
In a retrospective study, all patients of the Oral and
Maxillofacial Surgery of the University Medical Center
of the Johannes Gutenberg University of Mainz, Ger-
many, who were admitted for inpatient treatment due
to maxillofacial fractures between January 2001 and
December 2007 were analyzed regarding the existence
of mandibular fractures.
Patients with isolated or combined mandibular frac-
tures were comprised, and electronic health records and
electronic panoramic radiographs were analyzed.
Patients referred to our department with CT scans

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1
2 Rahimi-Nedjat et al.
usually do not receive further panoramic imaging
before initial operative treatment; therefore, these
patients were excluded from further investigation to
allow for optimal comparability of the radiological
findings unless there was an existing external electronic
panoramic radiograph. The fracture of the angle of the
mandible was defined as any fracture located posterior
to the second molar and located at any point on the
curve formed by the corpus and the ascending ramus
(16). Data obtained from the radiographs were the
presence or absence of the third molar or the stage of
development. When a third molar was present, it was
further distinguished according to the Pell & Gregory
classification. The vertical position was classified based
on the highest portion of the crown as (Fig. 1):
1 Class A: level with or above the occlusal plane
2 Class B: between the cementoenamel junction of the
adjacent second molar and the occlusal plane
3 Class C: below the cementoenamel junction of the
adjacent second molar
The horizontal position was described based on the
amount of space for eruption between the second
molar and the anterior border of the vertical ramus as
follows (Fig. 2):
(A) (B)
Fig. 1. Vertical position of third molar according to Classes A–C.
I II
Fig. 2. Horizontal position of third molar according to Classes I–III.
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
1 Class I: adequate space available (crown completely
situated anterior to the ramus)
2 Class II: inadequate space available (crown half cov-
ered by the ramus)
3 Class III: located all or mostly within the vertical
ramus (crown fully covered by the ramus). (14, 17)
Correlations between the third molar position and
mandibular angle fractures were analyzed using the
chi-squared test, and an odds ratio was calculated.
Considering the fact that the lower jaw does not always
contain a third molar on both sides, further calcula-
tions were performed on the mandibular halves sepa-
rately.
Additionally, a systematic review on the topic of
third molars and the relation to mandibular angle frac-
tures was performed. A search of PubMed was con-
ducted for articles published between 1990 and 2013
that contained the term ‘third molar mandibular frac-
ture’ and related terms. To be included in the review,
studies had to have a cohort design and analyze any
kind of mandibular fracture that used the Pell & Gre-
gory classification to calculate odds ratio for mandibu-
lar angle fractures in comparison with other
mandibular fractures with or without a third molar.
(C)
III
 Third molar and mandibular angle fractures 3

The exclusion criteria were as follows: letters, case female [35.0 years
21.3 SD]). In 45.6% (n = 420) of
reports, case series, reviews, analyses not based on the the 922 mandibular halves, no third molar could be
Pell & Gregory classification, and studies that focused found with a nearly equal distribution to both sides of
only on special types of mandibular fractures such as the mandible. Twenty-four of these patients were eden-
bilateral fractures. To achieve comparable data, third tulous (10.4%), and 1% (n = 9) showed radiographic
molar positions and odds ratio in some studies were signs of a preceding osteotomy. About 54.4% (n = 502)
recalculated. of the mandible halves contained a third molar: 7.1%
(n = 67) buds, 231 (25.1%) non-erupted, and 204
erupted fully grown third molars (22.1%).
Results
A third molar (erupted and unerupted) on one side
Altogether, 1219 patients were treated for maxillofacial with a missing one on the contralateral side was existed
fractures in the analyzed period [average age in 61 cases. Of these, 32 patients had an angle fracture
32.5 years
19.3 standard deviation (SD), 75.1% male which occurred 78.1% (n = 25) of the time on the half
(30.0 years
16.8 SD) and 24.9% female patients with the existent third molar. All other patients showed
(40.0 years
24.0 SD)], of which 3.8% were edentu- similar findings on both sides of the lower jaw.
lous. Among 205 mandibular angle fractures, an existent
Six hundred and thirty-two of the 1219 patients had erupted or unerupted third molar was found in 159
either an isolated or combined fracture of the mandible halves (Table 1). About 22.4% (n = 46) did not have a
[average age 28.5
17.5 SD, 78.0% male (27 years
third molar. Patients with other types of mandibular
15.8 SD) and 22% female (35 years
21.9 SD)]. Alto- fractures (717 mandibular halves) showed a third molar
gether, the 632 patients had 966 mandibular fractures, in 47.8% (n = 343) of cases and none in 52.2%
most frequently localized in the mandibular condyle (n = 374) of cases.
(n = 315), paramedian (n = 313), or at the mandibular The detailed investigation of third molar positions
angle (n = 267). The remaining 71 fractures included 36 according to Pell & Gregory shows the highest portion
median fractures, 24 fractures located at the alveolar for class A (n = 217) and II (n = 208 [Table 2]). A
and 11 at the coronoid process. highly significant relationship between third molar
Four hundred and sixteen fractures were located on position and manidbular angle fractures can be seen
the right and 490 on the left side of the mandible; these for class B position (P < 0.001) and class II position as
broke down as follows: 108 right and 159 left mandibu- well (P < 0.001). Fully erupted wisdom teeth show no
lar angle fractures, 137 right and 178 left condyle frac- significant impact on mandibular angle fractures
tures, and 165 right and 148 left paramedian fractures. (Table 3). Odds ratio of third molar presence and the
The fracture in the angle of the mandible occurred sta- risk of mandibular angle fracture is 3.8.
tistically significantly more often on the left hand side In addition, no significant impact of third molar
(P = 0.036) and the paramedian fractures more often position on fractures of the mandibular condyle could
on the right hand side (P = 0.002). There was no sig- be found here (Table 3).
nificance for the fractures of the condyle.
In most cases, the mandibular fractures were the
consequences of falls (n = 145, 22.9%) and assaults Table 2. Distribution of the third molar positions in the
(n = 142, 22.5%). Other reasons were bicycle accidents panoramic tomograms according to the Pell & Gregory
(n = 61, 9.7%), sports-related injuries and iatrogenic classification
causes (n = 31 res. n = 31, both 4.9%). The 142
assault patients showed 216 mandibular fractures, Third molar
position
located most often in the paramedian (n = 77) and
(Pell & Gregory) Right Left Total
angle region (n = 80). All causes of mandibular angle
fractures showed an equal distribution to the right N (%) 221 (49.66) 224 (50.34) 445
and left mandible halves except assaults, where 70% A 103 (46.6) 114 (50.89) 217 (48.76)
(n = 56) affected the left side and only 30% (n = 24) B 78 (35.29) 82 (37.10) 160 (35.96)
the right. C 30 (13.57) 28 (12.67) 58 (13.03)
In 461 of the 632 patients, panoramic radiographs I 96 (43.43) 104 (47.06) 200 (44.94)
II 101 (45.70) 107 (48.42) 208 (46.74)
were accessible (average patient age 29.0 years
17.2 III 14 (6.33) 13 (5.88) 27 (6.07)
SD, 79.4% male [27.0 years
15.6 SD] and 20.6%

Table 1. Distribution of mandibular angle fractures and presence of third molars

Angle fractures
Right side Left side Total
Third molar Present Absent (with # on left side) Absent Present Absent (with # on right side) Absent Present Absent

Present 58 84 103 101 41 115 159 343 502

Absent 27 24 165 19 32 153 46 374 420
Total 85 108 268 120 73 268 205 717 922

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
4 Rahimi-Nedjat et al.

Table 3. Comparison of mandibular angle and condyle

Odds
ratio

6.6
2.6
2.8
2.6
2.3
2.8
2.8
1.1
5.8

3.8
2.7
10.1
fractures and third molar positions (chi-squared test)
Mandibular angle Mandibular condyle
fractures fractures

68
604
884

354
268
463
102

720
917
2167

1501

8462
Total
Other mandibular fractures
Third molar position
(Pell & Gregory) Right Left Right Left

Number
without

molars
A 0.887 0.340 0.795 0.819

98

15

25
250
316
803
138

164

429

380
374
3063
third
B <0.001 <0.001 0.105 0.008
C 0.077 0.004 0.041 0.522

Number
I 0.883 0.108 0.688 0.812

molars
<0.001 <0.001

87

43
354
568

216
170
299

340
343
1364

1072

5199
third
II 0.024 0.059

with
Mandibular fractures and third molars
III 0.275 0.005 0.322 0.370

2656
82
99

52

33
166
326
733

152

532

200
205
Total
Mandibular angle fractures
Systematic Review

Number
without

molars
Table 4. Systematic review of the literature about the relationship between third molars and the incidence of mandibular angle fractures

third

128

138

483
3

3
16
57

16
20
25

20
46
The search delivered 182 results, of which 38 articles
dealt with mandibular fractures and third molars. Ten

Number with
studies met the inclusion criteria (10, 14, 16, 18–25).

third molars
Altogether, 7528 patients were investigated (Table 4).
The most frequent causes were road traffic accidents,

66
79

49

30
150
269
605

127

394

180
159
2173
followed by assaults. Studies with road traffic accidents
originated in Middle Eastern, South Asian, and Afri-

8.01
7.74

9.62

1.40

6.07
14.09

14.18
16.80

10.10

19.00

10.70
Horizontal third molar
can countries, and those with assaults came from Wes-

n/a
III
tern countries such as the USA and Germany. In the

43.06
28.19
29.13
34.04
20.40
32.86

23.94
30.10
36.00
46.74
32.45
present study, falls are the most frequent cause, but

n/a
with only 0.4% more compared to assaults. The third

II
position
molar was present in 69.22% (54.4%–88.3%) of cases,

8.16
42.86
63.79
63.13

62.70
57.51

65.96
68.50
45.00
44.94
52.26
most often located in position AI according to the Pell

n/a
I
& Gregory classification. The overall odds ratio of a
Third molar position in %

8.33

7.45

2.70
18.70
19.49

13.90
11.27

20.50

20.00
13.03
13.54
third molar being present at the time of the mandibular

n/a
fracture is 2.7 (range 1.1–10.1).
C
Vertical third molar

32.34
17.90
17.49
34.75
15.10
39.44

34.86
17.80
38.00
35.96
28.36
n/a
Discussion
B
position

59.33
63.67
63.03
14.18
70.90
49.30

44.61
79.50
42.00
48.76
53.53
Six hundred and thirty-two patients with mandibular

n/a
fractures were analyzed retrospectively to investigate
A

the relationship between mandibular third molars and

Incidence of
third molar

fractures of the mandibular angle. This study’s odds

ratio of 3.8 suggests a higher risk for mandibular frac-
65.45
69.17
67.24
64.68
67.85
69.27
88.30
72.10
72.30
56.52
54.40
68.57
tures when a wisdom tooth is present in the mandible
at the moment of traumatization.
road traffic accidents
road traffic accidents
road traffic accidents

road traffic accidents

However, a further look and categorization illus-
mandibular fracture

trates that this does not apply to every third molar.

Main cause for

assaults / falls

The Pell & Gregory classification is frankly not the

only existing method (9, 19, 21), but it is quite an easy
assaults
assaults

assaults

one to describe the position of the third molar in two

falls
n/a
n/a

layers: the horizontal and vertical. Retained third

molars belong to classes B, C, II, and III, while only
Patients

AI classifies a fully erupted tooth.

385

218
437
615
154

105
460
461
1210
1450

2033

7528

This study0 s results show a highly significant influ-

(n)

ence of third molars belonging to Class B or Class II

Germany

Germany

(Table 3). Classes C and III show lower significance

Year / Country

Jordan
Korea

India
India

India
USA
USA

USA

USA

for the left mandible and none for the right. A reason
for this difference might be the high number of assault-
/
/
/
/
/
/
/
/
/
/
/
2010
2002
2004
2005
2000
2000
2009
2009
1995
2010
2014

related fractures. These forces cause an unequal distri-

bution of energy to the mandible, resulting in fractures
generally at the site of the impact (26).
Thangavelu et al.
Subhashraj et al.
Tevepaugh et al.
Rajkumar et al.

Classes A and I show no significance at all. This is

Current study
Fuselier et al.
Halmos et al.

Ma’aita et al.
Choi et al.

in accordance with the majority of authors who claim

Iida et al.
Lee et al.

that the tooth-related reduction of bone mass at the

Author

overall

mandibular angle is the main reason for fractures in

this area. (20, 27)

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

An ex vivo study on vervet monkey mandibles
demonstrated that mandibles with a not completely
erupted third molar break at significantly lower forces
than those without (28). However, this accounts for only
the difference between impacted and fully erupted teeth.
The difference in the impact of third molars belonging
to Class B or II and Class C or III could be attributed
to the different bone structures. The mandibular angle
has an area of tension at the superior border and an
area of compression at the inferior border caused by the
inserting muscles (13). Furthermore, the mandible can
be compared to a hollow bone, which gets its stability
primarily through the cortical bone rather than through
the medullary bone (9, 10). The deeply impacted class C
third molar does not disrupt the continuity of the corti-
cal bone, and this seems to be the reason for the lower
impact of this position on angle fractures. In accordance
with this, there is no significant correlation between
third molar buds and angle fractures as these teeth usu-
ally leave the upper cortical border intact (14).
While earlier studies suggested the removal of
retained third molars to prevent angle fractures (16,
20), authors have recently frequently claimed that the
absence of wisdom teeth leads to a higher risk for
mandibular condyle fractures. Considering its challeng-
ing operative restoration, they recommend leaving
these teeth for fracture prevention (24, 29). In this
study, the impact of the third molar on condyle frac-
tures showed a lower significance than on the mandibu-
lar angle (Table 3); indeed, as mentioned at the
beginning, the third molar is only one factor in addi-
tion to bone characteristics, trauma force, and soft tis-
sue alterations. This is underlined by the high number
of edentulous patients in mandibular angle fractures
(10.4%) compared to the total sample of 1219 patients
(3.8% edentulous patients). Further to this argumenta-
tion, it is important to take into account that retained
teeth can cause not only second molar pathology such
as distal caries and incident dental bone loss but also
further complications such as cysts and abscesses and,
based on those alterations, even carcinomas (30–35).
It can be concluded that there is no universally valid
advice for the handling of third molars. Third molar
extraction remains one of the most frequent surgical
procedures by dentists and oral surgeons (36). Extrac-
tion of retained third molars should be considered in
particular for young patients who do contact sports
(37). Fully retained teeth such as in classes CIII can be
left, but require a thorough explanation to the patient
regarding regular radiological check-ups for early iden-
tification of any cystic development or infection. Class
A third molars do not need to be removed preventively
in terms of fractures of the mandibular angle since
there is no correlation.
References
1. Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H. Cranio-
maxillofacial trauma: a 10 year review of 9,543 cases with
21,067 injuries. J Craniomaxillofac Surg 2003;31:51–61.
2. Rahimi-Nedjat RK, Sagheb K, Walter C. Concomitant dental
injuries in maxillofacial fractures - a retrospective analysis of
1219 patients. Dent Traumatol 2014;30:435–41.
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Third molar and mandibular angle fractures 5
3. Arangio P, Vellone V, Torre U, Calafati V, Capriotti M, Cas-
cone P. Maxillofacial fractures in the province of Latina,
Lazio, Italy: Review of 400 injuries and 83 cases. J Cran-
iomaxillofac Surg 2014 Jul;42:583–7.
4. Bakardjiev A, Pechalova P. Maxillofacial fractures in South-
ern Bulgaria - a retrospective study of 1706 cases. J Cran-
iomaxillofac Surg 2007;35:147–50.
5. Fasola AO, Lawoyin JO, Obiechina AE, Arotiba JT. Inner
city maxillofacial fractures due to road traffic accidents. Dent
Traumatol 2003;19:2–5.
6. Oikarinen K, Lahti J, Raustia AM. Prognosis of permanent
teeth in the line of mandibular fractures. Endod Dent Trau-
matol 1990;6:177–82.
7. Abbasi MM, Abbas I, Khan N, Shah SM, Hameed H, Shad
S et al. Frequency of unerupted mandibular third molar in
mandibular angle fractures. J Ayub Med Coll Abbottabad
2012;24:30–2.
8. Zhou HH, Ongodia D, Liu Q, Yang RT, Li ZB. Dental
trauma in patients with single mandibular fractures. Dent
Traumatol 2013;29:291–6.
9. Meisami T, Sojat A, Sandor GK, Lawrence HP, Clokie CM.
Impacted third molars and risk of angle fracture. Int J Oral
Maxillofac Surg 2002;31:140–4.
10. Fuselier JC, Ellis EE 3rd, Dodson TB. Do mandibular third
molars alter the risk of angle fracture? J Oral Maxillofac Surg
2002;60:514–8.
11. Boffano P, Roccia F. Bilateral mandibular angle fractures:
clinical considerations. J Craniofac Surg 2010;21:328–31.
12. Duarte BG, Assis D, Ribeiro-Junior P, Goncales ES. Does
the Relationship between Retained Mandibular Third Molar
and Mandibular Angle Fracture Exist? An Assessment of
Three Possible Causes. Craniomaxillofac Trauma Reconstr
2012;5:127–36.
13. Duan DH, Zhang Y. Does the presence of mandibular third
molars increase the risk of angle fracture and simultaneously
decrease the risk of condylar fracture? Int J Oral Maxillofac
Surg 2008;37:25–8.
14. Halmos DR, Ellis E 3rd, Dodson TB. Mandibular third molars
and angle fractures. J Oral Maxillofac Surg 2004;62:1076–81.
15. Iida S, Nomura K, Okura M, Kogo M. Influence of the
incompletely erupted lower third molar on mandibular angle
and condylar fractures. J Trauma 2004;57:613–7.
16. Tevepaugh DB, Dodson TB. Are mandibular third molars a
risk factor for angle fractures? A retrospective cohort study. J
Oral Maxillofac Surg 1995;53:646–9; discussion 9-50.
17. Pell G, Gregory G, Impacted mandibular third molars, classi-
fication and modified technique for removal. Dent Digest
1933;39:330.
18. Choi BJ, Park S, Lee DW, Ohe JY, Kwon YD. Effect of
lower third molars on the incidence of mandibular angle and
condylar fractures. J Craniofac Surg 2011;22:1521–5.
19. Iida S, Hassfeld S, Reuther T, Nomura K, Muhling J. Rela-
tionship between the risk of mandibular angle fractures and
the status of incompletely erupted mandibular third molars. J
Craniomaxillofac Surg 2005;33:158–63.
20. Lee JT, Dodson TB. The effect of mandibular third molar
presence and position on the risk of an angle fracture. J Oral
Maxillofac Surg 2000;58:394–8; discussion 9.
21. Ma’aita J, Alwrikat A. Is the mandibular third molar a risk
factor for mandibular angle fracture? Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2000;89:143–6.
22. Rajkumar K, Ramen S, Chowdhury R, Chattopadhyay PK.
Mandibular third molars as a risk factor for angle frac-
tures: a retrospective study. J Maxillofac Oral Surg
2009;8:237–40.
23. Subhashraj K. A study on the impact of mandibular third
molars on angle fractures. J Oral Maxillofac Surg
2009;67:968–72.
24. Thangavelu A, Yoganandha R, Vaidhyanathan A. Impact
of impacted mandibular third molars in mandibular angle
6 Rahimi-Nedjat et al.
and condylar fractures. Int J Oral Maxillofac Surg 2010;
39:136–9.
25. Ugboko VI, Oginni FO, Owotade FJ. An investigation into
the relationship between mandibular third molars and angle
fractures in Nigerians. Br J Oral Maxillofac Surg
2000;38:427–9.
26. Anyanechi CE, Saheeb BD. Mandibular sites prone to frac-
ture: analysis of 174 cases in a Nigerian tertiary hospital.
Ghana Med J 2011;45:111–4.
27. Inaoka SD, Carneiro SC, Vasconcelos BC, Leal J, Porto GG.
Relationship between mandibular fracture and impacted
lower third molar. Med Oral Patol Oral Cir Bucal 2009;14:
E349–54.
28. Reitzik M, Lownie JF, Cleaton-jones P, Austin J. Experimen-
tal fractures of monkey mandibles. Int J Oral Surg
1978;7:100–3.
29. Patil PM. Unerupted lower third molars and their influence
on fractures of the mandibular angle and condyle. Br J Oral
Maxillofac Surg 2012;50:443–6.
30. Werkmeister R, Fillies T, Joos U, Smolka K. Relationship
between lower wisdom tooth position and cyst development,
deep abscess formation and mandibular angle fracture. J
Craniomaxillofac Surg 2005;33:164–8.
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
31. Balkwill F, Mantovani A. Inflammation and cancer: back to
Virchow? Lancet 2001;357:539–45.
32. Eversole LR. Malignant epithelial odontogenic tumors. Semin
Diagn Pathol 1999;16:317–24.
33. Nunn ME, Fish MD, Garcia RI, Kaye EK, Figueroa R,
Gohel A et al. Retained asymptomatic third molars and
risk for second molar pathology. J Dent Res 2013;92:
1095–9.
34. Mollaoglu N, Cetiner S, Gungor K. Patterns of third molar
impaction in a group of volunteers in Turkey. Clin Oral
Investig 2002;6:109–13.
35. Yamalik K, Bozkaya S. The predictivity of mandibular third
molar position as a risk indicator for pericoronitis. Clin Oral
Investig 2008;12:9–14.
36. Guerrero ME, Botetano R, Beltran J, Horner K, Jacobs R.
Can preoperative imaging help to predict postoperative out-
come after wisdom tooth removal? A randomized controlled
trial using panoramic radiography versus cone-beam CT. Clin
Oral Investig 2014;18:335–42.
37. Yamada T, Sawaki Y, Tohnai I, Takeuchi M, Ueda M. A
study of sports-related mandibular angle fracture: relation to
the position of the third molars. Scand J Med Sci Sports
1998;8:116–9.