[Downloaded free from http://www.joomr.org on Wednesday, January 5, 2022, IP: 182.1.148.

88]

Original Article

An evaluation of the relation between the

maxillary third molars and facial proportions
using cephalometric image
Sanaz Sadry, Ufuk Ok
Istanbul Aydin Universtiy, Dentistry Faculty, Department of Orthodontics, Istanbul, Turkey

A B S T R A C T

Objective: The aim of this study was to evaluate the position of the third molars and their relationship with pterygomaxillary fissure
vertical dimension patterns and on panoramic and cephalometric images. Materials and Methods: In the present retrospective
study, the third molar position classifications, third molar positions of patients with cephalometric and panoramic radiographs, and
their relationship with vertical skeletal growth and pterygomaxillary fissure were thoroughly investigated in the light of the preoperative
clinical and radiologic records from 200 patients with an indication of third molar extraction, who were admitted to İstanbul Aydın
University Faculty of Dentistry Oral, Dental and Maxillofacial Radiology Clinic and Department of Orthodontics due to various reasons.
Results: The obtained data were evaluated using SPSS (22.0) package program. Regarding the data analysis, Mann–Whitney
U‑test statistics was used for the analysis of two‑variable data. The vertical facial length’s relation with the maxillary third molars,
which had been examined on cephalometric and panoramic images, was identified as 50.3% for skeletal Class I, 42.1% for skeletal
Class II, 7.6% for skeletal Class III, 70.2% for unilateral, and 29.8% for bilateral. The upper impacted wisdom tooth being unilateral
or bilateral does not affect the vertical facial length (P = 0.386). The upper wisdom tooth being impacted unilaterally or bilaterally did
not exhibit any statistical difference with the parameters of upper‑lower and total anterior facial height and posterior facial height.
According to the Chi‑square analysis, the correlation between gender and pterygomaxillary fissure variable was found to be statistically
insignificant (P > 0.05). According to Mann–Whitney U‑test results, no variable was found to be statistically significant based on the
molar status (P > 0.05). Conclusion : In the light of this study, prior to treatment planning, if the relationship between the third molars
and anatomical formations is determined on cephalometric and panoramic radiographs and it is determined whether the impact of
upper wisdom teeth remains effective, consider the therapeutic mechanics used in orthodontic treatments and the complications that
may arise during surgical operations. It is emphasized that the necessary measures should be considered beforehand in order to
prevent these problems.

Key words: Cephalometric radiography, maxillary third molar, vertical growth

Introduction period of wisdom teeth varies based on parameters such

as genetic characteristics of the individual, feeding patterns,
functional involvement of the teeth, and racial variations,
The teeth that have failed to erupt into their place in normal
it usually takes place between the ages of 20–23 years
occlusion beyond the normal eruption period and are
in males and 21–22 years in females. The teeth that fail
completely or partially retained in the bone or soft tissue
are defined as “impacted tooth.” Although the eruption This is an open access journal, and articles are distributed under the
terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike
Access this article online 4.0 License, which allows others to remix, tweak, and build upon the
Quick Response Code: work non‑commercially, as long as appropriate credit is given and
Website: the new creations are licensed under the identical terms.
www.joomr.org
For reprints contact: reprints@medknow.com

DOI: Cite this article as: Sadry S, Ok U. An evaluation of the relation between
10.4103/jomr.jomr_24_19 the maxillary third molars and facial proportions using cephalometric image.
J Oral Maxillofac Radiol 2019;7:49-54.

Address for correspondence: Ms. Sanaz Sadry, Istanbul Aydin Üniversitesi Dis Hekimligi Fakültesi Ortodonti AD, Istanbul, Türkiye.
E‑mail: sanazsadry@aydin.edu.tr
Submission: 14-10-2019, Decision: 06-11-2019, Acceptance: 08-11-2019, Web Publication: 14-02-2020

© 2020 Journal of Oral and Maxillofacial Radiology | Published by Wolters Kluwer ‑ Medknow 49
[Downloaded free from http://www.joomr.org on Wednesday, January 5, 2022, IP: 182.1.148.88]
Sadry and Ok: Upper third molar relationship with vertical growth
to erupt into their normal position within the normal
eruption period the following period of 1 year are called
“impacted tooth.” The causes that lead to incomplete
eruption of wisdom teeth may include local factors such as
inadequate space, mechanical impediments (cysts, tumors,
tissue hyperplasias, local infections, etc.), traumas, and
persistence of postorthodontic treatment results, as well as
systemic factors such as vitamin deficiencies, malnutrition,
endocrine disorders, and certain specific syndromes
(cleidocranial dysostosis, achondroplasia, hydrocephalus,
etc.).[1-4] Panoramic radiographs are the first preferred
method for evaluating the relations of the third molars with
anatomic formations. Performing the necessary radiological
and clinical examinations and taking a thorough medical
history before the operation are essential to minimize
potential complications that may occur during the surgical
extraction of impacted teeth. Cephalometric images play a
part in cephalometric evaluation of craniofacial structures,
as well as orthodontic and surgical treatment planning.
They are used to evaluate the position of maxillary third
molars and their relation to anatomical formations, as they
provide more detailed information in identification of the
relationship between cephalometric measurements and
anatomic formations in the region, and offer more precise
data before surgical procedures.[5‑9] Vertical anomalies of
the face are caused by numerous factors affecting each
other during the growth period. These factors include
growth differences of the maxilla and mandible, tongue
and lip functions, thumb sucking, habits such as long‑term
use of pacifier and feeding bottle, environmental and
functional factors such as nasal airway obstruction, and
dentoalveolar development following the eruption of the
teeth.[10] Variations in the growth rate of both maxillary
sutures and mandibular condyles affect the occurrence of
vertical anomalies.[11] The direction of maxillary growth
has been reported to vary according to the patient’s growth
potential. The maxillary growth in patients with decreased
vertical dimension is reported to display a tendency toward
further forward growth compared to that of patients
with increased vertical dimension, given that the maxilla
and mandible continue their harmonious growth. [12]
It is difficult to determine whether the differences in
maxillary growth reflect the true impact of a treatment
or natural growth potential of two different face types.
Pterygopalatine fossa is an anatomical formation deeply
lodged in the central area of the face containing complex
vascular and neural structures. Fossa pterygopalatina is a
small pyramidal depression located under the apex of the
orbit on the lateral side of the skull.[13,14] Williams et al.[15]
evaluated the effect of midline deviation on smile esthetics
in different facial types (europrosopic, mesoprosopic, and
50 Journal of Oral and Maxillofacial Radiology / Volume 7 / Issue 3 / September‑December 2019
leptoprosopic), reporting that the facial type has an impact
on the perception of midline deviation degree. As a result,
in‑depth anatomical assessment of these structures before
dental procedures and surgical procedures, in particular,
ensures the safety of the treatment.
The aim of this study is to evaluate the vertical facial
dimensions, fissura pterygomaxillaris, the mandible–maxilla
relationship, and the relationship between the position of
the maxillary third molars and the vertical facial length on
cephalometric and panoramic images.
Materials and Methods
This study included of panoramic and lateral cephalometric
images from 200 asymptomatic patients between the ages
of 18 and 30 years with upper impacted wisdom teeth,
indication of surgical extraction, and physical status I
according to the American Society of Anesthesiologists,
who were admitted to İstanbul Aydın University Faculty of
Dentistry Orthodontics and Oral, Dental and Maxillofacial
Radiology Clinic for treatment between 2015 and 2018.
The study included patients with unilaterally and bilaterally
impacted teeth with complete bone retention. The teeth
were selected based on Archer’s impacted wisdom tooth
classification [Figure 1].[16] Accordingly, the teeth were
selected from Class 3 and Class C groups, namely from those
in vertical position and in a Crown-Neck relationship with
the second molar.[16] The study conducted on the patients
who were admitted to our orthodontic clinic to undergo
orthodontic treatment with the permission of Istanbul
Aydin University Faculty of Dentistry “Ethics Committee
on Non‑Interventional Clinical Research‑Research Not
Involving Pharmaceutics and Medical Devices” (Number:
B.30.2AYD.0.00.00‑50.06.04/67). Patients under 18 years
of age with a systemic disease, temporomandibular joint
disorder, or developmental‑acquired craniofacial or
neuromuscular deformity and a history of orthodontic
treatment and facial and dental trauma were not included
in the study. The data obtained from the patients who
suffered a trauma or injury in the head‑and‑neck region,
with a history of surgical operation on the sinus or skull
base, a systemic disorder or genetic disorder, syndrome,
or congenital anomalies (craniosynostosis and hemifacial
microstomy) presenting in the head‑and‑neck region,
were not included in the study. Volunteers between 18
and 30 years of age with bilateral upper impacted third
molars, no local factors leading to impaction of upper third
molars, and no loss of the third molar with incomplete
root development or adjacent second molar due to any
reason were included in the study. “Informed voluntary
[Downloaded free from http://www.joomr.org on Wednesday, January 5, 2022, IP: 182.1.148.88]

Sadry and Ok: Upper third molar relationship with vertical growth

consent form” and “patient follow‑up form” were drawn Class I was identified as 50.3%, skeletal Class II as 42.1%,
up for all the patients. All radiographs were taken using and skeletal Class II as 7.6% [Table 3].
the same cephalometry device (Planmeca 2011‑05 Proline
Pan/Ceph X‑ray brand X‑ray unit, Helsinki, Finland) with The evaluation revealed only the S‑GO (total posterior facial
the Frankfurt plane parallel to the ground, teeth in centric length) variable to be statistically significant based on molar
occlusion, and lips in resting position. Cephalometric status (Mann–Whitney U‑test). No difference in other
radiographs were evaluated by the same researcher using variables was observed based on molar status [Table 4].
the NemoCeph NX 9.0 software program (Nemotech, While ANS‑ME and N‑ANS variables differed according
Imaging and Management Solutions, Chatsworth, Madrid, to gender, no statistical difference was found between the
Spain). Skeleton classification was done according to ANB other variables.
angle, as shown in Table 1. The vertical facial length was
calculated by measuring the distance between N‑ANS, Discussion
ANS‑ME, N‑ME, and S‑GO values [Figure 2].
Teeth that failed to erupt into the dental ark in time and
Statistical analysis
take their place in normal occlusion and are completely
The data were analyzed on SPSS 22.0 (Statistical Package
or partially retained in the bone or soft tissue are defined
for the Social Sciences, Chicago, Illinois, USA) package
program. The ANOVA test was used in the comparison as impacted.[16‑19] Difficulty in wisdom teeth taking their
of the parameters. The Bonferroni test was utilized for place in the dental arch depends on inadequate space as
multiple comparisons. Analysis of the correlation between well as the fact that the dentition and eruption conditions
the variables was made using the Pearson test. Data and the distance and direction they have moved during
analysis was assessed using Chi‑square, Mann–Whitney
U, Wilcoxon, and Kruskal–Wallis tests. t‑test was used in Table 1: Classifiaction according to ANB angle
gender assessments. The significance level was considered Skeletal classification ANB angle
Skeletal class 1 ANB: 00‑40
statistically significant for P < 0.05. Skeletal class 2 ANB >40
Skeletal class 3 ANB <00
Results
Table 2: Relationship between third molar and gender
The study was conducted on 258 maxillary third molars (Chi‑square analysis)
from 99 female (49.5%) and 101 (50.5%) male patients, Molar P
with a total of 200. Of the 200 patients included in the 1.0 2.0
study, 58 had bilateral and 142 had unilateral maxillary third Number 72 27
1.0 % within Gender 72.7% 27.3%
molars. Of the 101 male patients, 31 (49.3%) had bilateral % within Molar 50.7% 46.6%
and 70 (53.4%) had unilateral maxillary third molars; of the Gender 2.0 Number 70 31 0.594
99 female patients, 27 (46.6%) had bilateral and 72 (50.7%) % within Gender 69.3% 30.7%
% within Molar 49.3% 53.4%
had unilateral maxillary third molars [Table 2]. Skeletal

Figure 1: Class 3 and Class C groups according to Archer (1975) classification Figure 2: Cephalometric drawing

Journal of Oral and Maxillofacial Radiology / Volume 7 / Issue 3 / September‑December 2019 51

[Downloaded free from http://www.joomr.org on Wednesday, January 5, 2022, IP: 182.1.148.88]

Sadry and Ok: Upper third molar relationship with vertical growth

eruption differ from other teeth. The upper wisdom teeth
do not fall within the scope of orthodontic theory, and
they complete the eruption process with a completely
opposite movement. The upper second molar erupts in
a downward and forward direction, whereas the upper
wisdom teeth can make a triple movement in downward,
backward, and outward directions. This complex movement
is often delayed in modern humans, and the completion
of the normal formation of tuber maxilla causes the
upper wisdom tooth to remain impacted. Even if there is
sufficient room for the wisdom tooth to erupt, some local
and systemic factors adversely affect the eruption of these
teeth into the occlusal plane.[20] However, no studies have
been conducted on the direct effect of vertical face length
on the bilateral or unilateral impact of the upper wisdom
teeth or any correlation between them.
Since the investigation in the basic design had been
performed according to vertical pattern, 200 patients
participating in the study were divided into three groups
according to their vertical skeletal development through
the joint evaluation of SN‑GoMe angle and Jarabak ratio
measured in their initial lateral cephalometric radiographs.
Cha et al. utilized the SN‑GoMe angle when classifying the
patient g roups according to their ver tical
dimensions.[21] Pavoni et al., on the other hand, based their
classification of the patients with Class III malocclusion
according to their vertical develop on the SN‑MP
angle.[22] Yoshida et al. classified the patients based on the
FMA angle,[12] whereas  Koh and Chung did so based on
Table 3: Frequency and percentage distributions
Parameters Sign Frequency Percentage
Gender 1.0 99 49.5
2.0 101 50.5
Sklt. Class 1.0 93 50.3
2.0 72 42.1
3.0 35 7.6
Molar unilateral 142 71.0
bilateral 58 29.0
the  FMA angle and lower facial height.[23] As facial height
can be easily affected by development or gender; it has
been reported that both the anterior facial heights and the
posterior facial heights should be taken into consideration
and that it would be optimal to use anterior/posterior facial
height ratios in the evaluation of facial patterns.[22] Since
SNGoMe angle too is affected by skull base plan, which
may vary between individuals, Jarabak ratio is also planned
to be included in the criteria. The vertical development
patterns of the face are examined in three
ways – hyperdivergent (high angle), hypodivergent (low
angle), and normodivergent (normal angle) – and these
patterns vary depending on various factors during the
developmental period. These factors include the
development of jaws, dentoalveolar development, eruption
of teeth, and the function of the lips and tongue .[12] If the
rate of vertical development in condyles is lower than the
rate of vertical development in the facial sutures (maxilla)
and/or alveolar processes, the mandible rotates clockwise
(hyperdivergent growth model). In the opposite case, that
is, if the rate of condylar development is higher than the
rate of vertical development in the facial sutures (maxilla)
and/or alveolar processes, the mandible rotates
counterclockwise (hypodivergent growth model). Moreover,
if the rate of condylar development is equal to the rate of
vertical development in the facial sutures (maxilla) and/or
alveolar processes, the mandible follows a normal growth
pattern. [24,25] The hyperdivergent growth model is
characterized by decreased posterior/anterior face height
ratio, increased lower face height, and mandibular angle,
whereas the hypodivergent growth model has direct
opposite characteristics.[26,27] The type and severity of
different skeletal patterns are often masked by facial soft
tissues. Although the general perception since the late 1950s
had been that the softtissue profile would passively follow
the hard tissue, later studies indicated that soft tissue
showed an independent developmental pattern. [28,29]
Tsunori et al.[30] argued that there was a link between the

Table 4: Comparison of the Measured Values Based on Molar Variable (Mann Whitney U Test)
Molar Age Co‑A ANS‑PNS ANS‑Me N‑ANS N‑ME S‑GO SNGoGn PTM HEIGHT‑PTM LENGTH‑PTM
1.0 n 142 142 142 142 142 142 142 142 142 142 142
Median 24.000 91.000 60.000 70.000 47.000 130.000 85.000 33.000 10.000 25.000 5.000
Mean 24.514 92.592 61.338 71.113 47.099 132.338 83.486 33.789 8.711 25.380 5.106
S.Deviation 3.9782 11.0049 5.6391 6.9518 2.4906 8.4752 4.7695 4.5255 1.6093 3.2523 1.0363
Minimum 19.0 70.0 50.0 52.0 42.0 110.0 70.0 25.0 5.0 20.0 4.0
Maximum 39.0 120.0 75.0 90.0 52.0 145.0 95.0 45.0 10.0 32.0 7.0
2.0 n 58 58 58 58 58 58 58 58 58 58 58
Median 25.000 90.500 60.000 71.500 47.000 130.000 85.000 35.000 10.000 27.000 5.000
Mean 25.897 92.190 61.500 72.569 47.466 133.793 85.379 34.914 9.138 26.293 5.190
S.Deviation 4.8038 15.2275 6.4380 6.8521 2.3337 7.5108 4.7307 4.5587 1.3436 3.1456 1.0835
Minimum 19.0 10.0 50.0 60.0 42.0 120.0 80.0 27.0 5.0 20.0 4.0
Maximum 39.0 115.0 75.0 90.0 55.0 150.0 100.0 45.0 10.0 30.0 7.0
p 0.087 0.764 0.955 0.312 0.426 0.386 0.020 0.105 0.091 0.068 0.641

52 Journal of Oral and Maxillofacial Radiology / Volume 7 / Issue 3 / September‑December 2019

[Downloaded free from http://www.joomr.org on Wednesday, January 5, 2022, IP: 182.1.148.88]
Sadry and Ok: Upper third molar relationship with vertical growth
maxillofacial complex development in vertical and
transversal dimensions and increased muscle activity. The
literature was reviewed for soft‑tissue thicknesses in
different vertical direction patterns. Macari and Hanna[31]
found that chin soft‑tissue measurements were lower in
hyperdivergent individuals compared to normal and
hypodivergent adults. Celikoglu et al.[32] similarly reported
that soft‑tissue thicknesses were lower in both male and
female high‑angle individuals. As a result of the  PTM fissure
evaluations based on the localizations of patients who were
categorized according to gender and presence of wisdom
tooth, the number of impacted upper wisdom teeth has
been detected to be higher in females compared to males
in the majority of cases, and the difference in question was
not found to be statistically significant (P > 0.05). This is
thought to be caused by one of the factors related to
vertical direction. However, it does not appear to be related
to PTM fissure. In their study assessing the relationship of
202 lower wisdom teeth with the mandibular canal,
Mahasantipiya et al.[33] reported narrowing of the canal in
135 cases (66.8%), stating that, although this may not cause
pericoronitis, it could still lead to neurovascular disorders
in the region. The literature reviews did not reveal any study
on the relationship between the upper wisdom teeth and
the PTM fissure. The studies by  Mahasantipiya et al.[31] do
not establish any relationship between upper wisdom teeth
and PTM fissure that is similar to the one with narrowing
of the canal, and this gives rise to the thought that it may
be caused by upper wisdom teeth among the causes of
vertical growth. The study by  Ghaeminia et al.[34] reported
a close relationship between mandibular wisdom teeth and
mandibular canal and a greater risk of complication in
impacted wisdom tooth surgery due to the changes in
wisdom tooth location and the mandibular canal trace.
Considering the close proximity of maxillary impacted
wisdom teeth to the PTM, the present study anticipates
that, similar to the relationship of mandibular wisdom teeth
with mandibular canal shown in the studies by  Ghaeminia
et al.,[34] the shape of the PTM too may be affected by
wisdom teeth. In the present study, evaluations revealed
no difference between the PTM widths and lengths and
the impacted wisdom teeth and genders. Based on the
results of the cephalometric analyses performed in our
study, the increase in upper anterior face height and S‑GO
length measurement in males is thought to be characterized
by the increase in maxilla skeletal unit. In their
three‑dimensional KIKT studies,   Costa et al.[35] recorded
findings indicating no correlation between the anterior face
height and the maxillary posterior vertical alveoli and
thereby PTM which is in contradiction with our
findings.   Rothstein and Yoon‑Tarlie,[36] on the other hand,
found in their longitudinal study a statistically positive
Journal of Oral and Maxillofacial Radiology / Volume 7 / Issue 3 / September‑December 2019
correlation between anterior face heights and maxilla
posterior heights of individuals between the ages of 10
and 12 years, which is also consistent with our findings.
This is thought to be caused by population differences.
Unlike our study, the researchers used lower facial
height (ANS‑Me) and anterior facial height (N‑Me)
measurements instead of SN/GoGn angle to identify the
vertical pattern. However, these measurements are not
sufficiently informative about vertical growth pattern.
Increased vertical facial dimension results in transversal
narrowing of the dental arcs. This is due to a heightened
pressure on the buccal tissue caused by the increased
vertical dimension. Personal treatment plan can lead to a
wider appearance of the maxillary arc in individuals with
a shorter face and a narrower appearance in individuals
with a longer face.[35] Vertical growth patterns play an
important role in the length of the maxilla and mandible.
Jaw length is associated with vertical growth patterns.
Individuals with a long face have smaller skeletal sagittal
dimensions, whereas individuals with a short face have
increased sectional dimensions.[37,38] Grippaudo et al.[39]
reported an increase in upper arc length in high‑angle
individuals and a decrease in low‑angle ones. Our study did
not find any difference between genders. In parallel with
other studies in the literature, Tuğsel et al.[40] also make no
mention of a difference in the distribution of impacted
teeth with regard to gender. In the study carried out by
Dural et al.,[41] the incidence of impacted teeth was found
to be higher in females than in males, and this was statistically
confirmed. Maxillary third molar teeth were most commonly
observed in mesioangular and vertical positions, whereas
the upper third molar teeth were most commonly seen in
vertical position in parallel with the findings of Tuğsel
et al.[40] They reported observing a smaller number of
distoangular positions and rarely horizontal positions.
Hattab and Alhaija noted that inadequate retromolar space
was notably related to tooth impaction and that even in
the case of sufficient retromolar space, an impaction rate
of 17% was observed nonetheless.[42]
Conclusion
This study demonstrated that there is a difference in the
impact of wisdom tooth depending on the anomalies, but
these have been found to be statistically insignificant. We
believe that studying vertical patterns on larger populations
to have a better understanding of their impact on upper
wisdom teeth will pave the way for early detection of
anomalies.
Financial support and sponsorship
Nil.
53
[Downloaded free from http://www.joomr.org on Wednesday, January 5, 2022, IP: 182.1.148.88]
Sadry and Ok: Upper third molar relationship with vertical growth
Conflicts of interest
There are no conflicts of interest.
References
1. Shepherd JP, Brickley M. Surgical removal of third molars. BMJ
1994;309:620‑1.
2. van der Linden W, Cleaton‑Jones P, Lownie M. Diseases and lesions
associated with third molars. Review of 1001 cases. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 1995;79:142‑5.
3. Mercier P, Precious D. Risks and benefits of removal of impacted third
molars. A critical review of the literature. Int J Oral Maxillofac Surg
1992;21:17‑27.
4. Lopes V, Mumenya R, Feinmann C, Harris M. Third molar surgery: An
audit of the indications for surgery, post‑operative complaints and
patient satisfaction. Br J Oral Maxillofac Surg 1995;33:33‑5.
5. Köseğlu BG, Gümrü O, Kocaelli HA. Lower third molar displaced in the
sublingual space. Dentomaxillofac Radiol 2002;31:393.
6. Walker L, Enciso R, Mah J. Three‑dimensional localization of maxillary
canines with cone‑beam computed tomography. Am J Orthod
Dentofacial Orthop 2005;128:418‑23.
7. Bouquet A, Coudert JL, Bourgeois D, Mazoyer JF, Bossard D.
Contributions of reformatted computed tomography and panoramic
radiography in the localization of third molars relative to the
maxillary sinus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2004;98:342‑7.
8. Hazza’a AM, Albashaireh ZS, Bataineh A. The relationship of the inferior
dental canal to the roots of impacted mandibular third molars in a
Jordanian population. J Contemp Dent Pract 2006;7:71‑8.
9. Quek SL, Tay CK, Tay KH, Toh SL, Lim KC. Pattern of third molar
impaction in a Singapore Chinese population: A retrospective
radiographic survey. Int J Oral Maxillofac Surg 2003;32:548‑52.
10. Tweed CH. Indications for the extraction of teeth in orthodontic
procedure. Am J Orthod Oral Surg 1944;42:22‑45.
11. Williams S, Melsen B. Condylar development and mandibular rotation
and displacement during activator treatment. An implant study. Am J
Orthod 1982;81:322‑6.
12. Yoshida I, Shoji T, Mizoguchi I. Effects of treatment with a combined
maxillary protraction and chincap appliance in skeletal class III patients
with different vertical skeletal morphologies. Eur J Orthod 2007;29:126‑33.
13. Choi J, ve Park HS. Topography of the third portion of the maxillary artery
via the transantral approach in Asians. J Craniofac Surg 2010;21:1284‑9.
14. Standring S. Gray’s Anatomy. 39th Edition - The Anatomical Basis of
Clinical Practice. Anatomy and Human Sciences, King’s College London,
London, UK, Elsevier 2008. p. 197-489.
15. Williams RP, Rinchuse DJ, Zullo TG. Perceptions of midline deviations among
different facial types. Am J Orthod Dentofacial Orthop 2014;145:249‑55.
16. Archer HW. Oral and Maxillofacial Surgery. 5th ed. Philadelphia:
Saunders; 1975. p. 311.
17. Song F, O’Meara S, Wilson P, Golder S, Kleijnen J. The effectiveness
and cost‑effectiveness of prophylactic removal of wisdom teeth. Health
Technol Assess 2000;4:1‑55.
18. Peterson LJ, Ellıs E, Hupp JR, Tucker MR. Contempory Oral and
Maxillofacial Surgery. 4th ed. America: Mosby an Affiliate of Elsevier
Science; 2013.
19. Türker M, Yücetaş Ş. Ağız diş çene hastalıkları ve cerrahisi. Özyurt
Matbaacılık İnş Taah San ve Ltd Şti. 2. Baskı. Ankara: 2004. p. 293.
20. Türker MN. Anadolu’da değişik devrelerde yaşamış insanlarda gömülü
20 yaş dişleri ve M3 mesafesinin değerlendirilmesi. Ankara Univ Hekim
Fak Derg 1981;8:37‑48.
21. Cha BK, Kim CH, Baek SH. Skeletal sagittal and vertical facial types and
electromyographic activity of the masticatory muscle. Angle Orthod
54 Journal of Oral and Maxillofacial Radiology / Volume 7 / Issue 3 / September‑December 2019
2007;77:463‑70.
22. Pavoni C, Masucci C, Cerroni S, Franchi L, Cozza P. Short‑term effects
produced by rapid maxillary expansion and facemask therapy in class III
patients with different vertical skeletal relationships. Angle Orthod
2015;85:927‑33.
23. Koh SD, Chung DH. Comparison of skeletal anchored facemask and
tooth‑borne facemask according to vertical skeletal pattern and growth
stage. Angle Orthod 2014;84:628‑33.
24. Arat ZM, Rübendüz M. Changes in dentoalveolar and facial heights
during early and late growth periods: A longitudinal study. Angle
Orthod 2005;75:69‑74.
25. Nielsen IL. Vertical malocclusions: Etiology, development, diagnosis
and some aspects of treatment. Angle Orthod 1991;61:247‑60.
26. Isaacson JR, Isaacson RJ, Speidel TM, Worms FW. Extreme variation in
vertical facial growth and associated variation in skeletal and dental
relations. Angle Orthod 1971;41:219‑29.
27. Schendel SA, Eisenfeld J, Bell WH, Epker BN, Mishelevich DJ. The long
face syndrome: Vertical maxillary excess. Am J Orthod 1976;70:398‑408.
28. Opdebeeck H, Bell WH. The short face syndrome. Am J Orthod
1978;73:499‑511.
29. Burstone CJ. Charles J. Burstone, DD , MS. Part 1 facial esthetics.
Interview by Ravindra Nanda. J Clin Orthod 2007;41:79‑87.
30. Tsunori M, Mashita M, Kasai K. Relationship between facial types
and tooth and bone characteristics of the mandible obtained by CT
scanning. Angle Orthod 1998;68:557‑62.
31. Macari AT, Hanna AE. Comparisons of soft tissue chin thickness in adult
patients with various mandibular divergence patterns. Angle Orthod
2014;84:708‑14.
32. Celikoglu M, Buyuk SK, Ekizer A, Sekerci AE, Sisman Y. Assessment of
the soft tissue thickness at the lower anterior face in adult patients
with different skeletal vertical patterns using cone‑beam computed
tomography. Angle Orthod 2015;85:211‑7.
33. Mahasantipiya PM, Savage NW, Monsour PA, Wilson RJ. Narrowing
of the inferior dental canal in relation to the lower third molars.
Dentomaxillofac Radiol 2005;34:154‑63.
34. Ghoneima A, Abdel‑Fattah E, Hartsfield J, El‑Bedwehi A, Kamel A, Kula K.
Effects of rapid maxillary expansion on the cranial and circummaxillary
sutures. Am J Orthod Dentofacial Orthop 2011;140:510‑9.
35. Costa HN, Slavicek R, Sato S. A computerized tomography study of the
morphological interrelationship between the temporal bones and the
craniofacial complex. J Anat 2012;220:544‑54.
36. Rothstein T, Yoon‑Tarlie C. Dental and facial skeletal characteristics
and growth of males and females with class II, division 1 malocclusion
between the ages of 10 and 14 (revisited)‑part I: Characteristics of size,
form, and position. Am J Orthod Dentofacial Orthop 2000;117:320‑32.
37. Meyer AH, Woods MG, Manton DJ. Maxillary arch width and buccal
corridor changes with orthodontic treatment. Part 1: Differences
between premolar extraction and nonextraction treatment outcomes.
Am J Orthod Dentofacial Orthop 2014;145:207‑16.
38. Wagner DM, Chung CH. Transverse growth of the maxilla and
mandible in untreated girls with low, average, and high MP‑SN angles:
A longitudinal study. Am J Orthod Dentofacial Orthop 2005;128:716‑23.
39. Grippaudo C, Oliva B, Greco AL, Sferra S, Deli R. Relationship between
vertical facial patterns and dental arch form in class II malocclusion.
Prog Orthod 2013;14:43.
40. Tuğsel Z, Kandemir S, Küçüker F, Evaluation of the burial status of third
molars in university students, Cumhuriyet Un. Dişhek F Der 2001;4:102‑5.
41. Dural S, Avcı N., Karabıyıkoğlu T., The incidence of impacted teeth,
their distribution according to the jaws and their reasons for burial,
Sağ Bil Arş Derg 1996;16:127-33.
42. Hattab FN, Alhaija ES. Radiographic evaluation of mandibular third
molar eruption space. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1999;88:285‑91.