Risk factors for external root resorption of maxillary second molars associated with third molars

Purpose: This study aimed to evaluate the diagnostic performance of panoramic images compared to cone-beam computed tomography (CBCT) imaging for maxillary third molar (M3)-associated external root resorption (ERR), and to identify the risk factors of ERR on panoramic images. Materials and Methods: The study population was composed of all patients who underwent panoramic imaging at Dankook University Dental Hospital from May to October 2019. In total, 397 cases of maxillary M3s in 247 patients (147 men and 100 women) were included. The diagnostic accuracy of ERR in panoramic images compared to CBCT images was evaluated using the chi-square test. To identify risk factors for ERR, dental records and panoramic findings were evaluated by logistic regression analysis. Results: The diagnostic accuracy of ERR on panoramic images was 0.79 compared to CBCT images (P <0.05). Superimposition of M3s onto second molars (M2) was associated with an approximately 33 times higher risk of ERR than separated M3s (P<0.05). Impacted M3s showed a 5 times higher risk of ERR than erupted M3s (P<0.05). Conclusion: ERR related to M3s is a common clinical condition, and superimposition of M3 onto M2 on panoramic images was the most important risk factor for ERR. It seemed that CBCT examinations for maxillary M3s might be indicated for ERR diagnosis especially if panoramic radiographs show superimposition of M3 onto M2. Impaction itself was also a risk factor, and it should be carefully examined.