Radiographic Predictors of Extraction and Impaction Patterns of Third Molars among Adults in Saudi Arabia: a Retrospective Radiographic Study.

Background: Third molar impaction is a prevalent dental condition with varying clinical presentations across populations. This retrospective study evaluated radiographic predictors and treatment outcomes of third molar impactions among adults in Saudi Arabia. Materials and methods: A total of 791 panoramic radiographs obtained from patients referred to the Oral and Maxillofacial Surgery units at Dammam Medical Complex and Riyadh Elm University Hospital between 2018 and 2022 were analyzed. The angulation and level of impaction were assessed using the Pell and Gregory classification system. Statistical analyses, including logistic regression and chi-square tests, were performed to identify significant predictors of extraction. Results: The study cohort had a mean age of 35.3 ± 11.8 years, with females representing 53.1% of cases. Vertical impaction was the most common type (49.3%), followed by mesioangular (27.7%) and horizontal (14.8%). Tooth #48 (mandibular right third molar) was the most frequently extracted (43.7%), followed by tooth #18 (33.3%) and tooth #28 (31.6%). Logistic regression revealed that age 31-45 years, referral for extraction based on radiographic evaluation, impaction of tooth #48, Pell and Gregory Class II and Position B were significant predictors of extraction (p < 0.05). Conclusion: Overall, 36.7% of cases required surgical extraction, whereas 63.3% were managed conservatively with periodic follow-up. These findings underscore the clinical value of early radiographic evaluation and individualized treatment planning to minimize complications associated with third molar impactions.