Incidence and Pattern of Mandibular Third Molar Impaction: Single-Center Observation in the Javanese Population

doi:10.21203/rs.3.rs-1504720/v1

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Research Article

Incidence and Pattern of Mandibular Third Molar Impaction: Single-Center Observation in the Javanese Population

https://doi.org/10.21203/rs.3.rs-1504720/v1

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Background

Impaction of third molars is often found in dental practice. Since reported in history on the discovery of the mandible bone 13.000–15.000 BC, research on dental impaction continues to grow. In the modern population, the highest prevalence is found in the impaction of mandibular third molars. There is a limited study regarding the impact pattern of mandibular third molars.

Objective

To investigate the impact pattern of mandibular third molars in populations in Surabaya and the surrounding area in East Java, Indonesia.

Methods

A retrospective, cross-sectional study was conducted to investigate the impact patterns of mandibular third molars from the medical record data of patients at the Maxillofacial Oral Surgery Clinic of the Dental Hospital of Universitas Airlangga from July 2017-June 2019. Data were processed by age group, sex, angulation type, level position, complaint, indication was performed odontectomy and analyzed using chi-square significance of p-value ≤ 0.05.

Results

1057 cases of impacted third molar teeth with a prevalence of 72%. The highest group was found aged 20–24 years (42.5%) female (60.7%), mesioangular angulation type (41.9%), level of impacted IIA impacted teeth (66.9%), local pain complaint (86.3%), and pericoronitis as an indication for odontectomy (56.3%). There is a significant difference between sex and age with angulation of impacted tooth (p < 0.05)

Conclusion

Impaction of mandibular third molars was found in the young age group, most characteristics in women, mesioangular angulation, level IIA position with the complaint of local pain around impacted teeth and pericoronitis as an indication of odontectomy.

Trial Registration: Number 694/HRECC.FODM/X/2019.

Dentistry

Mandibular Third Molar Impaction

human health

Good Health and Well-being

Medicine

The mandibular third molars erupt in late adolescence or early 20 years old. This age is considered the "age of wisdom" is the age at which a person begins to be wise, so wisdom teeth in English are called "wisdom teeth". The earliest cases of impacted third molars were reported in human history when the mandibular bone was discovered 13.000–15.000 BC and continues to this day.¹

The development and growth of teeth often experience eruption disturbances, both in the anterior and posterior teeth. Impacted teeth are teeth whose eruption path is blocked by adjacent teeth or pathological tissues. Impaction is estimated clinically when the antagonist's tooth has erupted and when the tooth on the other side has erupted.^2,3

Teeth with the wrong location of the seed will cause abnormalities in the eruption, either in the form of eruptions outside the correct arch or even disturbances in the alignment of teeth in the anterior. The exact cause of impaction is not known, but it is suspected that the cause is multifactorial. Several conditions are suspected of causing impaction including pathological changes in the teeth, cysts, tissue hyperplasia, or local infection. In addition, based on the phylogenetic theory, impacted teeth occur due to the evolutionary process of decreasing jaw size as a result of changes in behavior and diet in humans.^1–4

In the modern population, the prevalence of impacted third molars is higher than in other teeth and mandibular third molars are the most frequently impacted teeth after maxillary third molars.^5,6 About 25% of adults do not erupt third molars but in the elderly, it is possible to still erupt. The prevalence of impacted third molars varies and is influenced by age, gender and ethnicity.⁷

In general, the classification of mandibular third molar impaction is based on George Winter, Pell, and Gregory.^8,9 The pattern of impacted third molars can be used to determine the general picture, level of difficulty and plan of action in surgery. In addition, several studies on determining age estimates based on dental radiographs have been carried out, but these studies are still few. Currently, in Indonesia, especially Surabaya, there are not many references to estimate the age of the radiological picture of the teeth. Furthermore, this study aim is to provide an overview of the impaction pattern of the mandibular third molars in the population in Surabaya and its surroundings at a single institution, the Oral and Maxillofacial Surgery Clinic, Dental Hospital, Universitas Airlangga in Surabaya and its surroundings from July 2017 to June 2019.

This study was a retrospective cross-sectional study by using patients' medical records as secondary data including an orthopantomogram in patients at the Oral and Maxillofacial Surgery Clinic, Dental Hospital, Universitas Airlangga from July 2017 to June 2019. Blind randomly purposive sampling was used to select the samples. All methods were performed in accordance with the relevant guidelines and regulations by Ethics Committee, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia (Number: 694/HRECC.FODM/X/2019).

The sample size was determined using the total sampling method. The samples were subjected to inclusion and exclusion criteria. Inclusion criteria was the patients were at least 18 years old, had a complete medical record and dental X-ray, impacted mandibular third molars with complete or incomplete root formation in cases of horizontal and transverse angulation types or predicted to be impacted. Exclusion criteria were not found craniofacial abnormalities, congenital abnormalities or syndromes, found impacted teeth involved cysts or tumors and the medical record is not complete.

This study uses impaction classification based on George Winter, Pell, and Gregory.^8,9 All patients received the option of odontectomy treatment. The impaction pattern was grouped based on age, gender, angulation, position level, and factors causing impacted teeth to undergo odontectomy. All data were processed using the Statistical Package for Social Science (SPSS) 25.0 version (IBM Corporation, Illinois, Chicago, US) and analyzed by chi-square with a p-value of significantly less than 0.05.

1057 out of 1114 cases were found after selection of inclusion and exclusion criteria, 52 cases were excluded from impacted mandibular third molars in patients younger than 18 years, and 5 cases involved paramolar teeth, tumors or cysts. Out of 1468 all surgical cases, the prevalence of impacted mandibular third molars was 72%. In this study, we found that most of the female patients have impacted mandibular third molar about 20–24 years old Partial impacted mandibular third molar was the most common tooth impaction type. The most commonly impacted tooth was #38. The most common position level and angulation of mandibular third molar were IIA mesioangular. Local pain was the most common chief complaint of the patient with mandibular third molar impaction. Most of the patients underwent the odontectomy on mandibular third molar impaction due to pericoronitis (Table 1). There was a significant difference in mandibular third molar impaction type with patient gender and age (Table 2). In the other hand, there was no significant difference in mandibular third molar impaction number (#38 or #48) with patient gender and age (Table 3). However, there was a significant difference in mandibular third molar impaction level position with patient age but not gender (Table 4). Lastly, there was a significant difference in mandibular third molar impaction angulation with patient age and gender (Table 5).

Table 1

Distribution of Patient with impacted mandibular third molars
Data Distribution	Total	(%)	Age Range	Age Mean	SD
Gender
Female	642	60.7	18–69	26.80	± 7.687
Male	415	39.3	18–68	26.74	± 7.811
Age
18–19	90	8.5	18–19	18.59	± 0.495
20–24	449	42.5	20–24	22.07	± 1.343
25–29	250	23.7	25–29	26.68	± 1.411
30–34	124	11.7	30–34	31.84	± 1.428
35–39	66	6.2	35–39	36.97	± 1.435
40–44	34	3.2	40–44	41.85	± 1.560
45–49	25	2.4	45–49	46.44	± 1.417
50–54	11	1.0	50–54	51.36	± 1.120
>= 55	8	0.8	55–69	64.00	± 4.598
Tooth Impaction Type
Partial	927	87.7	18–69	27.25	± 7.862
Total	130	12.3	18–60	23.37	± 5.693
Tooth Number
#38	542	51.3	18–69	27.01	± 7.735
#48	515	48.7	18–66	26.53	± 7729
Position Level
I A	104	9.8	18–68	29.46	± 10.756
II A	707	66.9	18–69	26.73	± 7.183
III A	17	1.6	18–39	22.53	± 5.558
I B	8	0.8	20–34	16.63	± 5.449
II B	194	18.4	18–65	25.61	± 7.140
III B	13	1.2	19–50	24.77	± 7.970
I C	0	0	-	-	-
II C	12	1.1	19–44	30.92	± 8.586
III C	2	0.2	26–60	43	± 24.042
Angulation
Vertical	226	21.4	18–69	25.43	± 7.556
Mesioangular	443	41.9	18–68	27.85	± 8.211
Distoangular	55	5.2	18–65	26.84	± 7.993
Horizontal	329	31.1	18–60	26.31	± 6.974
Bukoversion	4	0.4	21–23	21.75	± 0.957
Distoversion	0	0	-	-	-
Inverted	0	0	-	-	-
Chief Complaint
Local Pain	912	86.3	18–69	27.23	± 7.758
Atypical facial or neck pain	49	4.6	18–65	25.86	± 8.003
Cephalgia	15	1.4	18–60	28.07	± 12.792
No complaint	81	7.7	18–35	21.99	± 3.215
Etiology of odontectomy performed
Pericoronitis	595	56.3	18–69	26.25	± 7.473
Pulpoperiapical Infection	212	20.1	19–68	30.50	± 8.577
Endodontic Treatment	116	11.0	18–60	23.34	± 5.792
Periodontal disease	106	10.0	18–55	26.71	± 7.137
As prophylaxis treatment	28	2.6	18–38	24.21	± 4.685

Table 2

Cross tabulation of patient’s data on impacted mandibular third molars based on the age variable.
Group		Tooth Impaction Type				Total
		Partial		Total		Total
		Total	%	Total	%	Total	%
Gender	Female	544	84.7	98	15.3	642	60.7
	Male	383	92.3	32	7.7	415	39.3
	p-value = 0.001*
Age	18–19	67	74.4	23	25.6	90	8.5
	20–24	369	82.2	80	17.8	449	42.5
	25–29	236	94.4	14	5.6	250	23.7
	30–34	119	96.0	5	4.0	124	11.7
	35–39	60	90.9	6	9.1	66	6.2
	40–44	33	97.1	1	2.9	34	3.2
	45–49	25	100	0	0	25	2.4
	50–54	11	100	0	0	11	1.0
	>= 55	7	87.5	1	12.5	8	0.8
	p-value = 0.000*
Total		927	87.7	130	12.3
*information: significant at p < 0.05

Table 3

Cross tabulation of patient’s data on impacted mandibular third molars based on the Gender and Age group.
Group		Tooth Impaction				Total
		#38		#48		Total
		Total (%)		Total (%)		Total	%
Gender	Female	327	50.9	315	49.1	642	60.7
	Male	215	51.8	200	48.2	415	39.3
	p-value = 0.782
Age	18–19	46	51.1	44	48.9	90	8.5
	20–24	227	50.6	222	49.4	449	42.5
	25–29	124	49.6	126	50.4	250	23.7
	30–34	66	53.2	58	46.8	124	11.7
	35–39	35	53.0	31	47.0	66	6.2
	40–44	22	64.7	12	35.3	34	3.2
	45–49	14	56.0	11	44.0	25	2.4
	50–54	5	45.5	6	54.5	11	1.0
	>= 55	3	37.5	5	62.5	8	0.8
	p-value = 0.850
Total		542	(51.3)	515	(48.7)

Table 4

Cross tabulation of patient’s data on impacted mandibular third molars level position based on the Gender and Age group.
Variable		Level Position
		I A	II A	III A	I B		II B	III B	I C	II C	III C
		(%)	(%)	(%)	(%)		(%)	(%)	(%)	(%)	(%)
Gender	female	64	426	11	6		114	10	0	9	2
	female	10	66.4	1.7	0.9		17.8	1.6%	0	1.4	0.3
	male	40	281	6	2		80	3	0	3	0
	male	9.6	67.7	1.4	0.5		19.3	0.7%	0	0.7	0
	p-value = 0.666
Age	18–19	4	60	4	0	20		1	0	1	0
	18–19	4.4	66.7	4.4	0	22.2		1.1	0	1.1	0
	20–24	44	279	11	4	99		8	0	4	0
	20–24	9.8	62.1	2.4	0.9	22.0		1.8	0	0.9	0
	25–29	19	185	0	1	41		3	0	0	1
	25–29	7.6	74.0	0	0.4	16.4		1.2	0	0	0.4
	30–34	11	99	1	3	9		0	0	1	0
	30–34	8.9	79.8	0.8	2.4	7.3		0	0	0.8	0
	35–39	10	37	1	0	13		0	0	5	0
	35–39	15.2	56.1	1.5	0	19.7		0	0	7.6	0
	40–44	5	19	0	0	9		0	0	1	0
	40–44	14.7	55.9	0	0	26.5		0	0	2.9	0
	45–49	4	21	0	0	0		0	0	0	0
	45–49	16.0	84.0	0	0	0		0	0	0	0
	50–54 T	4	4	0	0	2		1	0	0	0
	50–54 T	36.4	36.4	0	0	18.2		9.1	0	0	0
	>= 55	3	3	0	0	1		0	0	0	1
	>= 55	37.5	37.5	0	0	12.5		0	0	0	12.5
	p-value = 0.000*
Total		104	707	17	8		194	13	0	12	2
Total		9.8	66.9	1.6	0.8		18.4	1.2	0	1.1	0.2
*Information: significant different at p-value ≤ 0.05.

Table 5

Cross tabulation of patient’s data on impacted mandibular third molars angulation based on the Gender and Age group.
Variabel		Tooth Angulation
		Vertikal	Mesio-angular	Disto-angular		Horizontal	Buko-versi	Linguo-versi	Inverted
		(%)	(%)	(%)		(%)	(%)	(%)	(%)
Gender	Female	149	268	39		182	4	0	0
	Female	23.2	41.7	6.1		28.3	0.6	0	0
	Male	77	175	16		147	0	0	0
	Male	18.6	42.2	3.9		35.4	0	0	0
	p-value = 0.021*
Age	18–19	34	25		4	27	0	0	0
	18–19	37.8	27.8		4.4	30	0	0	0
	20–24	108	176		23	138	4	0	0
	20–24	24.1	39.2		5.1	30.7	0.9	0	0
	25–29	41	106		15	88	0	0	0
	25–29	16.4	42.4		6.0	35.2	0	0	0
	30–34	22	62		6	34	0	0	0
	30–34	17.7	50		4.8	27.4	0	0	0
	35–39	8	32		5	21	0	0	0
	35–39	12.1	48.5		7.6	31.8	0	0	0
	40–44	5	15		1	13	0	0	0
	40–44	14.7	44.1		2.9	38.2	0	0	0
	45–49	5	15		0	5	0	0	0
	45–49	20	60		0	20	0	0	0
	50–54	1	9		0	1	0	0	0
	50–54	9.1	81.8		0	9.1	0	0	0
	>= 55	2	3		1	2	0	0	0
	>= 55	25.0	37.5		12.5	25.0	0	0	0
	p-value = 0.025*
Total		226	443		55	329	4	0	0
Total		21.4	41.9		5.2	31.1	0.4	0	0
*Information: significant different at p-value ≤ 0.05.

Impacted mandibular third molars are the most common impacted teeth.¹⁰ Studies on the prevalence of third molar impaction in the world vary widely, ranging from 30.3 to 68.6%.^11–13 In a previous study performed by Eshghpour et al. (2013) 60.87% of the 1433 panoramic views had at least one mandibular third molar impact with a prevalence of 48.74%.¹⁰ Compared with the study, the prevalence was found to be 44.3% in Southeastern Iran.¹⁴ Meanwhile, Hassan reported a lower prevalence of 40%.¹³ A higher prevalence was reported by Quek et al. (2003) 68.6% in Singaporeans.¹⁵ The results of the study were based on a single institution at the Oral and Maxillofacial Surgery Clinic, Dental and Oral Hospital, Universitas Airlangga, Surabaya, the prevalence was 72%. This variation can be explained because there are different races and ethnicities in different worlds. This affects the data on epidemiological characteristics in various populations. Data on patients who were less than 18 years old were excluded from the study subjects because human growth was still taking place at that age. In addition, at the age of 19 years and over, the formation of the root of the tooth has formed. The eruptive growth of impacted third molars continues until the root formation has formed.¹⁵

In this study, the age group of 20–24 years was 449 (42.5%) with an average age of 22.07 years, followed by the age group of 25–29 years, namely 250 (23.7%) with an average age of 26, 68 years. The prevalence in this study is high because that age group has attention to dental health, so patients are diagnosed early and receive prophylactic measures.¹⁶

A study stated that the frequency of mandibular third molar impaction is quite high with 84% in the 15–25 year age group, this may be due to at this age the eruption of mandibular third molars occurs and initial complaints are usually encountered during this eruption phase.¹⁷ Meanwhile, another study showed that most of the studied patients (60.8%) out of 2550 with a mean age of 33.5 years showed at least 1 case of impacted tooth. The age group 20–39 years showed a prevalence twice significantly compared to other age groups.¹

In this study, the prevalence of impacted mandibular third molars was higher in women than men by 60.7%. In addition, the type of partial and total impaction was found to be more common in women than men significantly different, according to various other studies.^14,15,18,19 Several studies also found that women have more impacted lower third molars than men.^10,20−22

Incidence is increased in women, the study found that women were earlier in the development of permanent roots of other teeth, whereas men were earlier in the case of third molars so that the female third molars erupted later than in men. In addition, physical growth in women stops earlier, resulting in smaller jaw growth compared to men.¹⁵ The initiation of the eruption of the mandibular third molar in women normally occurs after jaw growth in women is complete, but in men, jaw growth continues as the mandibular third molar erupts to provide more space for eruption.¹⁰ However, few other studies have shown higher scores in men.²³ Contrary to the results of the previous study, other studies showed no gender differences regarding the classification pattern of mandibular third molar impaction.^1,10

In this study, the investigators correlated the impacted teeth on the right and left sides of teeth #38 and #48 by sex and age group showing no trend in gender or age group. In various other studies, it was reported that there was no significant difference between the distribution of impacted mandibular third molars on the right and left sides.^10,14,20,24 In this present study, we found that the highest position level classification in this study is IIA 707 (66.9%), followed by IIB 194 (18.4%). Several studies also supported that level A and vertical angulation were found to be the most dominant, about 53.5% and 53.1%, respectively. Meanwhile, in other studies, mesioangular angulation type and level B were found to be the most dominant.^10,15,21 In this study, it was found that level A was the highest level, where the Cemento Enamel Junction (CEJ) impacted mandibular third molar was higher at the bone level and this was supported by a previous study found the dominant A level.¹⁴

Our study showed that the highest position level classification in this study is IIA 707 (66.9%), followed by IIB 194 (18.4%). Several studies showed that level A and vertical angulation were found to be the most dominant, about 53.5% and 53.1%, respectively. Meanwhile, in other studies, mesioangular angulation type and level B were found to be the most dominant.^10,15,21 In this study, level A was found as the highest level, where the CEJ impacted mandibular third molar was higher at the bone level and this was supported by other studies showing the dominant A level.¹⁴

The other studies showed that level B is more common than others classes.^13,15,25,26 Those differences might be occurred due to the different methods that have been used. Currently, the classification of the impaction level of the third molars uses the CEJ level compared to the alveolar bone level, indicating the A level as the highest. Meanwhile, other researchers used level classification by looking at the relationship between the occlusal third molars and the mandibular second molars. Class II classification is the most common where the crown of the impacted tooth is partially covered by the anterior ramus of the mandible.^14,25,26

Additionally, this study showed that the most common types of angulation of impacted teeth were mesioangular angulation (41.9%), horizontal (31.1%), vertical (21.4%), distoangular (55%) and bucoversion (0.4%). The classification pattern of mandibular third molar impaction in several studies in the world has variations. A previous study on the Jordanian population showed that the most type of angulation is vertical, while the least is mesioangular.²⁷ Studies in the Saudi population also showed vertical angulation as the most common type, which was 53.1% of 1354 cases and the second most was mesioangular angulation.¹ Study in the Libyan population, the distribution of mandibular third molar impaction classification in angulation showed that mesioangular impaction was the most common (78.5%) and distoangular (66.9%).²⁸ The results of the same study in Nepal showed that the distribution of impacted mandibular third molars based on the most angulation was mesioangular and the least was distoangular. This is in contrast to this study, with buccoversion as the least angulation.²⁹ In the Chinese and Korean populations, the most common type of angulation is mesioangular followed by horizontal and vertical.^14,15 Various studies, mostly showed mesioangular as the most common type in the population of Singapore, Saudi, Iran and similar to the results of this study.^13,20,23 Determination of the position and type of angulation of the impacted tooth is needed to determine the level of difficulty of odontectomy treatment.¹⁶

All cases of impacted mandibular third molars required definitive treatment, namely operculectomy or odontectomy. In this study, all respondents underwent odontectomy treatment, namely surgical extraction of impacted third molars. Before determining treatment, clinical and radiographic examinations are required based on the knowledge, training and experience gained.¹⁶ All cases of impaction should have a panoramic x-ray done. Panoramic is not only used to determine the diagnosis but can see globally and consider impacted teeth adjacent to vital structures.

In the Javanese population of Surabaya and the surrounding area, our study found the most common chief complaint of patients who came to the Oral and Maxillofacial Surgery Clinic of Dental Hospital, Universitas Airlangga related to impacted mandibular third molars were local pain in the tissue around the impacted mandibular third molar, namely 912 people (86.3%). This study showed indications for odontectomy were mostly due to pericoronitis, namely 595 people (56.3%), pulpoperiapical infection through caries 212 people (20.1%), orthodontic pre-treatment 116 people (11.6%), periodontal disease 106 people (10%). Our study result was supported by a retrospective study in Kenya, which showed that the main cause of impacted mandibular third molars undergoing odontectomy was recurrent pericoronitis followed by caries.³⁰ While in a study in Nepal, the main factor for patients coming to get treatment for impacted mandibular third molars was pain caused by caries around 41.26% and the lowest was pericoronitis 24.73%.²⁰ This is due to the low level of public awareness in Nepal on dental and oral health. Patients only come to the dental and oral health service center when they feel complaints of pain, swelling, often eating food caused by caries or pericoronitis. This is similar to a study in Kenya, where people seek treatment at dental and oral health care centers due to dental caries, which is around 46.6%.³⁰

The second most common reason for patients coming to the Oral and Maxillofacial Surgery Clinic Dental Hospital is patient who come without any complaints of pain but require odontectomy treatment in orthodontic treatment or prevention efforts, namely 81 people (7.7%). Prophylactic treatment of mandibular third molar odontectomy is an effort to improve dental health to reduce caries-related morbidity.³¹ At the age of the younger group, prefer to go to a dental health service center to get treatment. In addition, as a conservative effort for carious teeth in the third and second molars, odontectomy of the lower third molars can be performed as a prophylactic measure. In addition, the impacted mandibular third molars do not play a role in mastication function, distribution of chewing pressure, and bite occlusion, so the researcher thinks that prophylactic measures should be taken in the form of impacted odontectomy of the mandibular third molars. In the future, cooperation between various fields related to early diagnosis, dental conservation, and maxillofacial oral surgery needs to be increased. The initial diagnostic screening section which is the initial stage of examining the patient needs to pay special attention to the impaction of the mandibular third molar. However, patients generally avoid surgery due to fear of postoperative pain and swelling

Moreover, other complaints were obtained by atypical facial or neck pain, namely 49 people (4.6%) and cephalgia/cephalgia, namely 15 people (1.4%). Atypical odontalgia known as atypical facial pain is chronic pain in the teeth or gingiva with uknown etiology.³² Pain can be felt in the face area or the area around the ear but the pain does not cross the midline of the face. The atypical facial pain can be caused by impacted third molars that might be caused by dental problems. It should be noted that not all pain complaints are related to the impacted state of the third molars, the damage can occur unnoticed and accidentally found through dental X-rays. In addition, symptoms of pain or tenderness around the gums or jaws, headaches or neuralgia have been reported to be associated with impacted mandibular third molars.^4,32,34

The incidence of impacted mandibular third molars in the population of Surabaya and surrounding areas at the Dental and Oral Hospital, Airlangga University, is 72% with the most groups being aged 20–24 years, female, mesioangular angulation type, impacted tooth position level IIA with complaints of local pain. around impacted teeth and pericoronitis as the cause of odontectomy. There was a significant difference between sex and age with angulation of impacted teeth. Determination of the characteristics of impacted mandibular third molars was used to predict the level of difficulty and evaluate the risk of post-odontectomy complications as well as to determine the estimated age.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations by Ethics Committee, Faculty of Dental Medicine. Ethics Committee of Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia has approved this study (Number: 694/HRECC.FODM/X/2019). This study was a retrospective cross-sectional study by using patients' medical records as secondary data including an orthopantomogram in patients at the Oral and Maxillofacial Surgery Clinic, Dental Hospital, Universitas Airlangga from July 2017 to June 2019. Therefore, Ethics Committee of Faculty of Dental Medicine, Universitas Airlangga, Surabaya has waived informed consent for the study.

Availability of data and materials

The data that support the findings of this study are available from corresponding author, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of corresponding author.

Competing interests

The authors declare that they have no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

JWS drafted the manuscript,

JWS, AZR Collected the data, analyzed the data, interpreted the data

AMHB Interpreted the data, Wrote the report experiments

AR*, JWS, and NPMS planned the study and participated in the study design.

AR* and all coauthors contributed substantially to its revision. All authors read and approved the final version of the manuscript.

Acknowledgments

The authors would like to express their gratitude to the Rector, the Director of the Research and Innovation Center, and the Dean of Faculty of Dental Medicine, as well as Dental and Oral Hospital, Airlangga University who assisted in the completion of this study.

Consent for publication

Not applicable.

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No competing interests reported.

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Incidence and Pattern of Mandibular Third Molar Impaction: Single-Center Observation in the Javanese Population

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