Evaluation and Comparison of the Diagnostic Ability of Orthodontists and Oral and Maxillofacial Surgeons about the Eruptive Condition of Third Molar Teeth after Orthodontic Treatment

Aim: This study assessed and compared the diagnostic accuracy of orthodontists and maxillofacial surgeons in determining the condition of third molar tooth eruption following fixed orthodontic treatment. Methods: The research randomly used panoramic radiographs of 20 patients (40 mandibular third molar teeth) (10 of whom had undergone premolar extraction and 10 who had not) immediately after orthodontic treatment and after 2‒4 years of follow-up. The first radiographs were presented to 20 faculty members of the Mashhad Dental School, half of whom were orthodontists and the other half oral and maxillofacial surgeons. Their diagnoses concerning mandibular third molar eruption, recommended treatments, and rationales were recorded, particularly when suggesting tooth extraction. The kappa coefficient was used to measure the agreement level between the experts. The chi-squared test was used to examine intra-group and inter-group differences. The level of statistical significance was set at 0.05. Results: The orthodontists recommended monitoring in 48.25% of the cases and tooth extraction in 51.75%. Around 44.5% mentioned the potential for future tooth eruption as the reason for suggesting monitoring, while about 27% pointed to impaction risk as the reason for proposing extraction. Maxillofacial surgeons advised monitoring in 40.75% of the cases and tooth extraction in 59.25%. Approximately 53% of the surgeons recommending monitoring deemed it premature to finalize a treatment plan, while those favoring extraction predominantly noted impaction and caries risks, at approximately 15.5% and 15%, respectively. Notably, there was a lack of consensus between the groups for third molar treatment plans. Surgeons were significantly more likely to prescribe extraction for erupted teeth than orthodontists based on the radiographs immediately after the orthodontic treatment (87.8% vs. 68.33%; P<0.001). Regarding the rate of spontaneous eruption after treatment, 40% and 20% of the teeth erupted in patients with and without premolar extractions, respectively; this difference was not statistically significant (P=0.301). Although the result was not statistically significant, the trend suggests a possible clinical relevance that warrants further investigation, especially in cases where clinical decisions are borderline. Conclusion: The study revealed distinct differences in the treatment approaches recommended by orthodontists and maxillofacial surgeons for third molar teeth after orthodontic treatment, with surgeons more frequently advocating for extraction. Orthodontic treatment with or without premolar extraction did not affect the rate of spontaneous tooth eruption.