Eruption of third permanent molars after the extraction of second permanent molars. Part 1: Assessment of third molar position and size

The eruptive path of third molars after extraction of second molars was examined in 63 patients. Panoramic radiographs from the start and the end of active treatment and 3 or more years after treatment were assessed. Study models were used to compare the size of the second and third molars and to assess the final position of the third molars. All third molars erupted; none became impacted. During eruption, maxillary third molar crowns uprighted and maintained their angulation as they came into occlusion. Mandibular third molar crowns continued to upright significantly mesiodistally after active treatment, with space closure the result of horizontal translation rather than mesial tipping. Further uprighting occurred once occlusion was established, although few became as upright as the second molars they replaced. However, mandibular third molar roots were frequently curved distally, thus the third molar crown position was invariably better than the overall tooth angulation would suggest, by 16.5° on average. Model analysis (Richardsons' scoring system) showed 96% of mandibular and 99% of maxillary third molars erupted into a good or acceptable position. Limitations of this scoring system are discussed. The mesiodistal size of third molars was suitable to replace second molars; on average, mandibular third molars were 0.55 mm larger and maxillary third molars were 0.7 mm smaller than second molars. (Am J Orthod Dentofacial Orthop 2001;119:226-38)