Retention of Asymptomatic Impacted Third Molars: Effects on Alveolar Bone at the Distal Surface of Second Molars over Time

<b>Objective:</b> To assess radiographic changes in the alveolar bone on the distal aspect of the second molars (2Ms) over time, while impacted third molars (ITMs) remain present across two timepoints. <b>Methods:</b> This retrospective observational study aimed to assess radiographic changes between two timepoints (T0 and T1). Both Orthopantomogram (OPG) and Periapical (PA) X-rays were utilized, with three measurements taken on the distal surface of 2Ms using EMAGO 6.1 software. Statistical significance was defined as a <i>p</i>-value < 0.05. <b>Results:</b> A total of 51 patients met the inclusion criteria, with a mean age of 45 years (SD ± 13). Sixty-eight second molars were assessed at baseline (T0) and follow-up (T1), with a mean interval of 20 months (SEM ± 62 days). No significant changes were found in vertical, oblique, or angular bone levels between T0 and T1. Gender significantly affected the cementoenamel junction (CEJ)-base of defect (BD) measurements (<i>p</i> = 0.022) and defect angles at T0 (<i>p</i> = 0.048), but not at the adjusted T1 (<i>p</i> = 0.292). Other variables, including medical history, smoking, and ITM angulation, showed no influence. Patient age was borderline significant in relation to intrabony defect angle (<i>p</i> = 0.047). <b>Conclusions:</b> Considering its limitations, this analysis does not provide evidence to support the hypothesis that prophylactic extraction of ITMs yields significant bone-sparing benefits. Furthermore, it does not establish that prolonged retention of ITMs consistently results in short-term bone alterations in adjacent 2Ms. Consequently, further research is warranted to more accurately assess the medium- to long-term implications of ITM retention on the bone levels of 2Ms.