**1. Introduction**

62 Contemporary Approach to Dental Caries

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In oral and maxillofacial surgery removal of impacted teeth, especially third molars is one of the most performed surgical procedures. Several studies suggest that a millions of dollars are spend annually on the management of the impacted teeth (Edwards et al.,1999; Flick, 1999).

By definition, impacted or unerupted tooth is one that lying within the jaws and fails to erupt into the dental arch with the expected time (Jojić & Perović, 1990; Hupp et al. 2008). Detected clinically and radiographically, there are two types of impactions; completely and partially. Completely impaction means that the tooth is prevented from completely erupting into a normal functional position, covered by bone and mucosa, while partially impaction implies that the tooth is partially visible or in communication with oral cavity, but it has failed to erupt fully into a normal position (Jojić & Perović, 1990).

Any permanent tooth can become impacted (Gisakis et al.,2010). Impaction is an abnormality of development which predisposes to pathological changes and complications such as pericoronitis and /or orofacial infection, periodontitis, root resorption of adjacent teeth, caries, odontogenic cysts and tumors. Also orthodontic and prothetic problems including temporomandibular joint (TMJ) symptomes should not be neglected (Knutsson et al., 1996; Punwutikorn et al., 1999). Because of the mentioned, many authors to prevent these complications suggest so called "early or prophilactic removal of impacted teeth", although in cases of patients who are free of symptoms or associated, this necessity is under the question (Gisakis et al.,2010). Patients between 20 and 30 years of age are the most frequently affected with symptomatic impactions (Sasano et al.,2003; Knutsson et al. 1996). As age increases, the phenomen of impaction is reduced and after the age of 50 it is at range from 6-14% (Ahlqwist & Grondahl, 1991; Gisakis et al.,2010).

From the last 40 years, an incidence of impacted teeth is growing through different populations, due to living habits such as feading by a "soft food" and lower intensity of the use of the masticatory aparatus (Alling et al., 1993). Only a few decades earlier, Inuits and Latin American Indians through feading habits were described as the populations with no impacted teeth (Jojic & Perović, 1990). Also, some authors suggest that race and gender have an influence on occurrence of impactions, thus the impactions are more common in Whites

Impacted Teeth and Their Influence on the Caries Lesion Development 65

The practice suggests that horizontal and mesioangular positions are more critical to adjacent second molar, because impacted teeth in these positions may impige and resorb a

distal surface and root of the second molars (Knutsson et al.,1996).

**2.1 Winter classification of impacted lower third molars** 

Fig. 1. Mesioangular position of the lower third molar.

Fig. 2. Lower third molar in vertical position.

than Blacks (Brown et al., 1982), and females are more predisposed to this phenomenon than males (Jojic & Perović, 1990). However, by Haidar and Schalhoub (1986) in Saudi population, especially in cases of impacted third molars, male are more prone to have an impacted teeth than female patients.
