IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):173–179

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IP Indian Journal of Orthodontics and Dentofacial Research

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Original Research Article

The effects of erupting mandibular 3r d molar on the dental arch: A FEM study

Avinash Kumar1, *, Meghna Bhandhari1 , MD Baba Fareeduddin2

1 Dept. of Orthodontics & Dentofacial Research, Rajiv Gandhi University of health sciences, Kalaburgi, Karnataka, India
2 Dept. of Orthodontics, ESIC Dental College and Hospital, Gulbarga, Karnataka, India

ARTICLE INFO ABSTRACT

Article history: Introduction: Role of Erupting Mandibular 3r d molars as a cause of incisor crowding in the lower
Received 11-06-2022 arch continues to be controversial. The relation between 3r d molar and dental crowding has not been
Accepted 13-07-2022 established.
Available online 27-10-2022 Aims and Objectives: To determine the area of stress distribution and tooth displacement during eruption
of mandibular 3r d molar in mesioangular and horizontal impaction.
Materials and Methods: Three dimensional finite element models were generated based on computed
Keywords: tomography scan data. From computed tomographic scans of a human mandible two additional finite
Mesio-angular impaction
element models were generated: a mandibular model with mesioangular impaction and second model with
Horizontal impaction
horizontal impaction. To investigate the stress distribution to the mandible, and tooth displacement eruptive
Finite element study force of 10 grams was applied.
Stress distribution Results: High concentration of stresses was seen at the inferior border of the mandible and lowest
Tooth displacement.
concentration of stress was present at symphysis for both the models. The tooth displacement for both
mesio-angular and horizontal impaction caused mesial tilting of all the teeth i.e. from 2 nd molar to central
incisor; with greatest tilting of 2 n d molar. Along the vertical plane, there was extrusion seen with 2 n d
molar with mesio-angular impaction and extrusion in 2 n d molar and 1 s t molar with horizontal impaction
And all the teeth exhibited buccal flaring in case of both impaction.
Conclusion: There is significant level of tooth displacement from 2 nd molar towards the incisors. These
changes occurring along the dental arch must be taken into consideration while planning for prophylactic
extraction of third molars.
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1. Introduction clinicians were tempted to conclude a “cause and effect”

relationship between these two phenomena. At a simplistic
Lower arch crowding is an ongoing source of controversy
level, it was reasoned that vector forces from erupting 3r d
and concern in orthodontics. The role of 3r d molars as
molars were pushed against second molars, causing mesial
a cause of incisor crowding, especially in the lower arch
migration of the posterior teeth. The result was loss of
continues to be controversial. From the early beginning of
available space and crowding. The relation between 3r d
orthodontics as a specialty, the presence of 3r d molars was
molar and dental crowding has not yet been established.
believed by orthodontists to be responsible for late crowding
Clinicians have always been divided between supporters and
of the lower anterior teeth. Because this was frequently
opponents of anterior dental crowding caused due to the
observed coincident with the timing of 3r d molar eruption,
force generated by the 3r d molar eruption. For the same
* Corresponding author. reason, the surgical prophylactic approach for 3r d molar has
E-mail address: dr.avinashsajjan@gmail.com (A. Kumar).

https://doi.org/10.18231/j.ijodr.2022.030
2581-9356/© 2022 Innovative Publication, All rights reserved. 173
174 Kumar, Bhandhari and Baba Fareeduddin / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):173–179

always been seen as the cure by the former and a ‘placebo’ establishing the location, magnitude, and direction of an
by the latter. 1 applied force, as it may also assign stress points that can
Late crowding of the lower incisor teeth is frequently be theoretically measured. Further, as it does not affect the
observed after the eruption of the 3r d molars, inciting physical properties of the analyzed materials it is easily
the clinicians to deliberate a cause-and-effect relationship repeatable. Thus, finite element-three dimensional analysis
between the two events. The hypothesis is presumed that gives more accurate, adaptable and clear picture of the areas
the mesial component of the forces created by the erupting of tooth displacement and stress effects of erupting 3r d
3r d molars, transmitted through the dental arch, can create molars on lower anterior crowding. Thus, the study aims
a mesial migration of the teeth culminating in the area of in determining the areas of stress distribution and tooth
the incisors. The result is the inaugural loss of available displacement caused by erupting 3r d molar.
space and crowding. Lower arch crowding that develops
or increases after establishment of the permanent dentition 2. Materials and Methods
during the teenage period, can be best described as post-
FEA has been developed into a branch of applied
adolescent crowding. The role of erupting 3r d molars as
mathematics for numeric modelling of physical systems,
a compel of such dental crowding has been the subject of
which is used in many engineering disciplines. In its
controversy over the years.
simplest mathematical terms, this numerical technique is
Various theories have been proposed that account for used to find approximate solutions for partial differential
late lower arch crowding which includes late mandibular and integral equations through the generation of meshes of
growth, anterior component of force, lack of attrition in the a continuous domain for a set of discrete sub domains or
modern population which may possibly cause mesial tilting elements. Numerical methods are then used to predict the
of these teeth. This mesial axial inclination of permanent behaviour of the object in question in various situations, for
teeth gives rise to anterior component of force. Anterior example, under conditions of loading. 7
component of force is an occlusal force dissipated axially The external forces and the mechanical
and in the mesial direction, i.e. towards the frontal region properties/geometry are used to calculate the nodal
of the mouth. This force is transmitted through the proximal displacements; the differentiation of the displacement field
tooth contacts of teeth, anterior to the mesially tilted 3r d yields the strain distribution; and the stress distribution is
molars. This force produced by 3r d molar has a possible role determined mathematically.
in mesial migration of teeth anterior to it. Subsequently, this The mandibular model was developed from a patient
might be the reason of malalignment of anterior teeth and without any gross defects or discontinuity in the anatomy.
crowding. In the year 1961, Bergstorm 2 was among one of The model had a set of permanent dentition with normally
the first authors to analyze the influence of 3r d molars in the erupted teeth, without any crowding or spacing and
developing dental arch crowding and reported that there was impacted 3r d molar on one side and a normally erupted 3r d
a relationship between wisdom teeth and incisor crowding. molar on the other side. Computed tomographic (CT) scan
Bishara et al 3 evaluated changes in the dental arches images of the mandible were made in the axial direction at
between 25 and 45 years of age and concluded that both 0.5mm intervals in the horizontal plane. The study aimed
sexes experienced a significant increase in dental crowding to determine the stresses and displacements exerted by the
in both the dental arches, however the severity was more mandibular 3r d molar.
pronounced in the lower arch especially in the lower anterior In this study, CT scan of the mandible will be used
segment. Later, Vego’s 4 study concluded that the eruption to build a 3 – dimensional FEA model. There were 2
of lower 3r d molars exerted a force on neighbouring teeth finite element models constructed, the first one with mesio-
as well. On the contrary to this, Broadbent 5 supported the angular impaction and the other with a horizontal impaction.
opposite theory, that the presence of 3r d molars had no As mentioned in the literature, the eruptive force of tooth
influence on crowding. Sidlauskas 6 also reported that there was found to be between 5-10 grams, 8–12 the models using
is no co-relation between 3r d molar and anterior crowding. 10 grams of force will be taken into account for determining
The finite element analysis (FEA) is an upcoming and the areas of maximum stress and tooth displacement. The
significant research tool for biomechanical analyses in software used for geometric modeling was Solid Works.
biological research. It is an ultimate method for modeling Individual CT scan sections will be imported into the
complex structures and analyzing their mechanical Solidworks and traced, taking care so as not to distort the
properties. FEA has now become widely accepted as a non- anatomy of the region. Each traced sections will be then
invasive and excellent tool for studying the biomechanics placed one above the other to give a mandibular model
and the influence of mechanical forces on the biological in Solidworks. These blocks will be imported into Altair
systems. It enables the visualization of superimposed HyperMesh. The software which will be made use in present
structures, and the stipulation of the material properties study is Hyperworks 13.0, Altair, Troy, Michigan, United
of anatomic craniofacial structures. It also allows in States.
 Kumar, Bhandhari and Baba Fareeduddin / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):173–179 175

2.1. Generation of CAD Model stresses were generally distributed throughout the mandible,
a high concentration of stresses was present at the inferior
The geometric model obtained is converted to finite element
border of the mandible and lowest concentration of stress
model using Altair HyperMesh software. FEM has been
was present at symphysis for both the models. The stresses
applied successfully to study stress and strain in the field of
were also concentrated in the body of the mandible, inferior
engineering and in living structure. The FEM is composed
border of the mandible, anterior border of ramus and the
of an aggregate of small elements that are sufficient to
retro molar area (Table 3).
describe the geometry of the subjects. This is called
‘creating the mesh or meshing’. The mesh intersections
are called nodes. The contour data of the profiles created
by surface scanning were transformed into the x, y and
z co-ordinate points and read by Finite element program
HyperWorks. Connecting these coordinate points gave line
geometry also called as wire frame modeling. Connecting
the lines of each section gave surface geometry.

2.2. Generation of finite element model

The finite element modelling is the representative of
geometry in terms of finite number of elements and nodes. Fig. 1: a: FEM model 1- Mesioangular impaction; b: FEM model
This process is called discretization. The main idea behind 2- Horizontal impaction.
discretization is to improve the accuracy of the results.
Subdivide i.e. discretize the complex geometry into suitable
set of smaller “elements” of finite dimensions (2D or 3D).
The points connecting two or more discrete elements are
called as nodes or nodal points. The corner nodes are called
primary external nodes. The additional nodes which occur
on the sides of the elements are called secondary external
nodes. The secondary nodes have fewer displacements than
corner nodes. For this study Tetrahedron elements were
used. Images of the Mesh are as shown (Figure 1).
Number, size and type of element are decided. Practical
knowledge and judgement are needed to limit the number
of elements to minimum amount conductive to acceptable
Fig. 2: Stress distribution in the mandible – Buccal view; a: Mesio-
results (Table 1). The material properties of the bone and
angular impaction; b: Horizontal impaction.
teeth in the model were defined according to experimental
data from previous studies (Table 2).
The boundary conditions are defined to simulate how
the model is constrained and to prevent it from free body
motion. Restrains will be established at all nodes lying at the
lower border of the mandibular bone lying on the symmetric
plane and appropriate boundary conditions are imposed.

2.3. Loading configuration

For determining the changes, 10 grams of force in both the
horizontal and mesio-angular impaction of mandibular 3r d
molar will be used.
Fig. 3: Stress distribution in the mandible – Lingual view. a)
3. Results Mesio-angular impaction. b) Horizontal impaction.
3.1. Stress distribution
When the eruptive forces were applied on the mandible, the
stresses were observed at symphysis, body of the mandible,
inferior border of the mandible, anterior border of ramus
and the retro molar area in both models. Even though the
176 Kumar, Bhandhari and Baba Fareeduddin / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):173–179

Table 1: Meshing details

Model Mesioangular. Horizontal.
Component. No. of nodes. No. of elements. No. of nodes. No. of elements.
Teeth. 23287 107429 23287 107429
Periodontal Ligament. 69774 104827 69824 106443
Alveolar bone. 55622 286750 56551 292497

Table 2: Material property data representation.

Material Young’s Modulus (Newton/Mm2) Poisson’s Ratio
Teeth 20.3 × 103 0.30
Compact bone 13.7× 103 0.30
Cancellous bone 79 ×102 0.30
Periodontal ligament 68.9 0.45

Table 3: Tabular presentation of stress distribution in mandible.

Areas of Mandible. Mesioangular Impaction. Horizontal Impaction.
Symphysis. 2.0E-004. 2.0E-004.
Body of mandible. 8.2E-004. 7.5E-004.
Angle of mandible. 9.3E-004. 8.2E-004.
Retromolar area 1.5E-003. 1.4E-003.
Anterior border of ramus. 1.4E-003. 7.1E-004.
Inferior border of mandible. 2.1E-003. 2.1E-003.

Table 4: Displacement of teeth in all three axis.

Teeth Mesioangular Impaction Horizontal Impaction.
X-axis. Y-axis. Z-axis. X-axis. Y-axis. Z-axis.
Central Incisor 1.80E-07 -1.60E-07 -5.70E-08 1.80E-07 -1.40E-07 -4.80E-08
Lateral Incisor 2.00E-07 -2.60E-07 -8.90E-08 2.20E-07 -2.50E-07 -7.30E-08
Canine 2.80E-07 -4.00E-07 -4.00E-08 4.20E-07 -5.20E-07 -1.82E-07
1st Pre-Molar 5.30E-07 -7.00E-07 -2.10E-07 5.10E-07 -6.90E-07 -2.20E-07
2nd Pre Molar 9.50E-07 -9.00E-07 -1.20E-07 9.50E-07 -8.90E-07 -1.10E-07
1st Molar 1.60E-06 -1.30E-06 -2.70E-07 1.60E-06 -1.20E-06 6.80E-09
2nd Molar 2.10E-06 -1.60E-06 1.30E-07 2.00E-06 -1.60E-06 9.90E-08

Fig. 4: Tooth displacement in three planes of axis. Fig. 5: Tooth displacement in Y and Z axis.

3.2. Tooth displacement (X-axis) directions (Figure 4; Table 4).The displacement

brought about by 10 grams of force for both mesio-angular
The present study also determines the amount of and horizontal impaction caused mesial tilting of all the
tooth displacement caused by mesio-angular and teeth i.e. from 2nd molar to central incisor; with the greatest
horizontally impacted 3r d molar on the adjacent teeth. tilting of 2nd molar. (Figure 5)
The displacements in both the impactions were registered in A line passing from the long axis of impacted third
sagittal plane (Y-axis), vertical plane (Z-axis), buccolingual molar (mesio-angular and horizontal) and second molar is
 Kumar, Bhandhari and Baba Fareeduddin / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):173–179 177

4. Discussion
It is important to understand the stress distribution of
erupting 3r d molar, as it helps in determining, the cause
of dental crowding that has been a subject of controversy
over the years. The use of FEA in this study has described,
about the stress distribution in three-dimensional pattern.
The study of tooth movements in all three planes is being
introduced for the first time. Even the smallest changes are
being detected using the finite element model, which was
not possible in all the previous clinical studies. 8–12
In this study, it is observed that stress is distributed
Fig. 6: Mesioangular impaction- Angular changes before and after along the symphysis, body, and angle, inferior border of the
force application. mandible, anterior border of ramus and the retro molar area
in both the model. Highest concentration of stress is present
at the inferior border of the mandible (2.1E-3MPa) and
lowest concentration of stress is at symphysis (2.0E-4MPa).
However, when comparing the two models, higher areas of
stresses are seen with mesio-angular impaction (Table 4)
which might be due to a smaller area of contact as compared
to horizontal impaction. This is valuable information as
mesio-angular impaction, are the most common impaction.
The tooth displacements in both impactions are
registered in sagittal, vertical and, buccolingual direction.
According to Sakuda et al., 13 crowding can cause
displacement at any interproximal contact, with the highest
incidence of contact between cuspids and lateral incisors.
Along the sagittal plane, greater tilting of 2nd molar is seen
Fig. 7: Horizontal impaction- Angular changes before and after
and gradually reducing to incisors, all the teeth exhibited
force application.
mesial tilting, which is consistent with the finding of
Richardson 14 which states that late anterior crowding is
associated with mesial movement of teeth rather than lower
incisor retroclination. According to Sumitra et al. 15 anterior
component of occlusal force (ACF) is important in the
discussion of late lower arch crowding. This is because
it’s possible role in causing mesial migration of teeth and
subsequent dental mal-alignment. The axial inclination of
permanent teeth is such that the forces of mastication
produce a mesial resultant through the contact points of
teeth. ACF is thought to result from axial inclination of
posterior teeth which causes these teeth to tip forward
Fig. 8: Tooth displacement in X-axis. during occlusal loading. This tendency of teeth to move
forward varies greatly according to the angulations of teeth
and by the steepness of occlusal plane.
In case of mesio-angular impaction there is a mesial
constructed. The angle at the point of intersection of both inclination of the 3r d molar towards the long axis of 2nd
the long axis was measured before and after the application molar at an angle of 0.027 degrees (Figure 6) whereas,
of force. For mesio-angular impaction an increase of 0.027 in case of horizontal impaction the angle is 0.025 degrees
degrees of angle, whereas in horizontal impaction a decrease (Figure 7), which is supported by study conducted by
of 0.025 degrees of angle is seen (Figures 6 and 7). Artun et al., 16 which showed higher frequency of mesial
When seen along the vertical plane, there was extrusion angulation of 3r d molar in patients with impactions. But
seen with 2nd molar with mesio-angular impaction and these studies are contrary to the study of Pirttiniemi et.
extrusion in 2nd molar and 1st molar with horizontal al., 17 who concluded by his study that there is a slight distal
impaction (Figure 5). And all the teeth exhibited buccal drift of 2nd molar with no significant change in the lower
flaring in case of both impactions (Figure 8; Table 4). incisor region. The present study describes about the stress
178 Kumar, Bhandhari and Baba Fareeduddin / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):173–179

distribution in mesio-angular and horizontal impaction 5. Along the bucco-lingual axis, buccal flaring of the
which was not mentioned in the previous studies. 8–12 teeth is seen.
In vertical plane, there is extrusion with 2nd molar
whereas all the other teeth exhibited intrusion in case of From our finite element study data, it can be concluded that
mesio-angular impaction, whereas in case of horizontal there are significant level of tooth displacement from 2nd
impaction extrusion is seen with 2nd molar and 1st molar molar towards the incisor after application of mandibular
and intrusion with all the other teeth. Along the buccolingual third molar eruptive force. These changes occurring along
direction, in both the impaction all the teeth exhibited buccal the dental arch must be taken into consideration while
flaring in which highest flaring is seen with 2nd molar planning for prophylactic extraction of third molars.
(Table 4). This is similar to the result by Richardson who
concluded that mesial inclination of lower canine is usually 6. Source of Funding
considered to be a sign of buccal segment moving forward.
None.
However, this finding is against the suggestion by Southard
et al., who measured mesial force exerted by unerupted 3r d
7. Conflict of Interest
molar using a technique similar to measuring the anterior
component of occlusal force. The mesial force increases None.
tightness of all the proximal tooth contacts with no flaring
and that surgical removal of 3r d molar will relieve the References
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study. IP Indian J Orthod Dentofacial Res 2022;8(3):173-179.

Author biography
Avinash Kumar, Professor