What Are the Risk Factors for External Root Resorption of Second Molars Associated With Impacted Third Molars? A Cone-Beam Computed Tomography Study

J Oral Maxillofac Surg. 2019 Jan;77(1):11-17. doi: 10.1016/j.joms.2018.08.023. Epub 2018 Sep 4.


Purpose: In relation to an impacted third molar, which is the most frequently impacted tooth, external root resorption (ERR) or dental caries can be seen on the distal surface of the adjacent second molar. The purpose of this study was to investigate the risk factors for ERR in second molars associated with impacted third molars using cone-beam computed tomography (CBCT).

Materials and methods: In this cross-sectional study, the presence of ERR on the adjacent second molar was investigated retrospectively on sagittal and axial CBCT slices of patients who underwent CBCT examination for diagnostic reasons (surgical removal of third molars, orthodontic assessments, and so on) between 2013 and 2017 at the Necmettin Erbakan University Faculty of Dentistry, Konya, Turkey. The primary outcome variable was ERR (yes or no). Predictor variables included demographic (age and gender) and radiographic (impacted tooth angulation and tooth type) parameters. Given that there are multiple observations per patient (1 to 4 impacted teeth), 1 third molar per patient was selected at random for study inclusion. Statistical analysis was performed using descriptive statistics, the Mann-Whitney U test, and the Pearson χ2 test. Logistic regression analysis was used to determine the risk factors for ERR in second molars. The Cohen κ test was used to test intraobserver agreement. The significance level was set at P < .05.

Results: Two hundred patients were analyzed, and of the 200 impacted third molars evaluated, 42 (21%) showed ERR. The severity of resorption increased with aging (P < .05). Logistic regression analysis indicated that tooth type and inclination of the third molars could predict the occurrence of ERR associated with an impacted third molar (P < .05).

Conclusions: Mesioangular and horizontal inclinations and impacted mandibular third molars posed a greater risk of ERR lesions in adjacent second molars than other inclinations (distoangular and vertical) and maxillary third molars.

MeSH terms

  • Cone-Beam Computed Tomography
  • Cross-Sectional Studies
  • Dental Caries*
  • Humans
  • Molar / diagnostic imaging*
  • Molar, Third
  • Retrospective Studies
  • Risk Factors
  • Root Resorption*
  • Tooth, Impacted*