Third molar angulation during and after treatment of adolescent orthodontic patients

The purpose of this study was to analyse the effect of premolar extraction therapy on third molar angulation during active treatment, and to test the significance of such changes on subsequent impaction of the third molars. Lateral cephalograms made before (T1) and after (T2) treatment and at long-term follow-up (T3) of 157 patients treated non-extraction (non-ex) or with extraction of four premolars (ex), all accurately diagnosed for impaction versus eruption of at least one third molar at T3, were evaluated. Linear regression models demonstrated that the maxillary third molars uprighted more from T1 to T2 (P < 0.05) and were less distally angulated at T2 (P < 0.01) in the ex than in the non-ex patients. No such differences were detected in the mandible (P > 0.05). The regression models also showed similar uprighting of the maxillary and mandibular third molars from T1 to T2 and similar angulation of the maxillary third molars at T2 in those patients with subsequent eruption and impaction (P > 0.05), but more mesially angulated mandibular third molars at T2 in the impaction patients (P < 0.01). Chi square testing demonstrated a higher frequency of distal tipping of the maxillary third molars from T1 to T2 in the impaction patients (P < 0.01), while mesial tipping from T1 to T2 of the mandibular third molars occurred with similar frequency in the two patient groups (P > 0.05). Chi square analysis also showed a higher frequency of greater than 30 degree distal angulation as well as an amount mesial angulation of the maxillary third molars at T2 (P < 0.01), and a higher frequency of greater than 40 degree mesial angulation of the mandibular third molars at T2 (P < 0.01) in patients with impaction than in those with eruption.