Huang et al.

BMC Oral Health (2023) 23:138 BMC Oral Health

https://doi.org/10.1186/s12903-023-02843-0

RESEARCH Open Access

Three‑dimensional analysis
of the relationship between mandibular
retromolar space and positional traits of third
molars in non‑hyperdivergent adults
Yumei Huang1,2,3, Yunjia Chen1,2,3, Dan Yang1,2,3, Yingying Tang1,2,3, Ya Yang1,2,3, Jingfeng Xu1,2,3, Jun Luo1* and
Leilei Zheng1,2,3*

Abstract
Background The anatomical position of the mandibular third molars (M3s) is located in the distal-most portions of
the molar area. In some previous literature, researchers evaluated the relationship between retromolar space (RS) and
different classifications of M3 in three‑dimensional (3D) cone—beam computed tomography (CBCT).
Methods Two hundred six M3s from 103 patients were included. M3s were grouped according to four classification
criteria: PG-A/B/C, PG-I/II/III, mesiodistal angle and buccolingual angle. 3D hard tissue models were reconstructed by
CBCT digital imaging. RS was measured respectively by utilizing the fitting WALA ridge plane (WP) which was fitted
by the least square method and the occlusal plane (OP) as reference planes. SPSS (version 26) was used to analyze the
data.
Results In all criteria evaluated, RS decreased steadily from the crown to the root (P < 0.05), the minimum was at the
root tip. From PG-A classification, PG-B classification to PG-C classification and from PG-I classification, PG-II classifica-
tion to PG-III classification, RS both appeared a diminishing tendency (P < 0.05). As the degree of mesial tilt decreased,
RS appeared an increasing trend (P < 0.05). RS in classification criteria of buccolingual angle had no statistical differ-
ence (P > 0.05).
Conclusions RS was associated with positional classifications of the M3. In the clinic, RS can be evaluated by watch-
ing the Pell&Gregory classification and mesial angle of M3.
Keywords Retromolar space, M3 positional traits, The fitting WALA ridge plane, Occlusal plane

*Correspondence:
Jun Luo
500210@hospital.cqmu.edu.cn
Leilei Zheng
zhengleileicqmu@hospital.cqmu.edu.cn
Full list of author information is available at the end of the article

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Huang et al. BMC Oral Health (2023) 23:138 Page 2 of 11

Background Materials and methods

Molar distalization (MD) is a method for extending the Sample selection
length of dental arch [1]. Particularly in recent years, This study was approved by the Research and Ethics Com-
due to the popularity of invisible orthotics, the reali- mittee of the Affiliated Stomatology Hospital of Chong-
zation rate of molar distal movement has been greatly qing Medical University (CQHS-REC-2021(LSNo.045)).
improved [2, 3]. In the orthodontic clinic, orthodontists The sample included CBCT imaging of 103 subjects (52
always relieve mild or moderate crowding and adjust males and 51 females, mean age = 28.39 years, 206 M3),
the molar position relationship by MD [4, 5]. At this aged from 18 to 40 years. These subjects were selected
time, the question arises of where the boundary of the from the patients who were admitted for orthodon-
tooth movement is. tic treatment from 2019 to 2021 at the Department of
The limit of MD depends on the determination of Orthodontics, Affiliated Stomatology Hospital of Chong-
alveolar bone anatomical limit. The maxillary arch qing Medical University. The CBCT in this study was
incorporates a clear posterior limit—the maxillary taken due to the patient’s need to have the M3 removed
tuberosity [6, 7]. Hence, MD is commonly utilized and was taken prior to orthodontic treatment.
within the orthodontic process of the maxillary den- The inclusion criteria: (1) non-vertical facial dimen-
tition. The conventional way of MD mostly uses the sion (SN-MP° < 32°) and Class I or Class III malocclu-
skeletal anchorage system, face-bow, and temporary sion, (2) normal overjet and overbite, (3) crowding of less
skeletal anchorage devices, all of these can accomplish than 4 mm in the mandibular dental arch, (4) no signifi-
certain effect [8, 9]. cant alveolar bone loss, (5) no missing teeth in mandible
The mandible is composed of mandibular body and (including M3s), (6) no noticeable facial asymmetry and
mandibular ramus. It is a complex structure, with mas- deformation, (7) no tumors, fractures, cysts in mandi-
ticatory muscles attached and high bone density. MD in ble, (8) no diagnosed systemic disease, (9) no history of
mandible is difficult. With the popularity of cone-beam orthodontic treatment.
computed tomography (CBCT), increasingly scholars The exclusion criteria: (1) blurred CBCT imaging, (2)
have studied MD in mandible. incomplete CBCT imaging, (3) unmeasurable CBCT
Kim [10] selected the normodivergent facial type of imaging.
patients to study and proposed that the farthest lin-
gual cortical bone of the mandibular arch was the pos-
terior anatomical boundary and found the RS had the Construction of 3D models, reference planes
minimum at the root tip. In orthodontics, vertical facial and measuring lines
types include hypodivergent, normodivergent and CBCT images (KaVo Dental Gmb H, USA; 80 mA, 80
hyperdivergent types. We selected patients with non- kVp, and 8.9-s scan time) were procured. The data was
hyperdivergent adults, including hypodivergent and imported into Mimics 19.0 software (Materialise, Leu-
normodivergent patients. Choi et al. found that RS did ven, Belgium) in Digital Imaging and Communications
not differ significantly between class I and class III mal- in Medicine (DICOM) format to reconstruct the 3D hard
occlusion [11]. But in previous studies, the anatomic tissue models (Fig. 1A). Connecting the left and right
characteristics of the mandibular angle related to MD orbital points (Or-R, Or-L) and the right porion point
were not considered. Third molars (M3s) are the dis- (Po-R) as the Frankfort horizontal plane (FH). Connect-
tal structure of the mandibular dental arch, located at ing two mesiobuccal cusp points of the mandibular first
the turning point of the mandibular body and ramus. It molars (L6R-MB, L6L-MB) and the mesial contact point
has been reported that the positional traits of M3s can of the lower central incisor (LIE) as occlusal plane (OP)
affect the anatomical relationship of the transition area (Fig. 1B).
to a certain extent [12]. The shape, position and inclina- We constructed a new plane as a reference plane, which
tion of M3s are regularly utilized to assess the difficulty was a plane fitted by the most prominent bony WALA
of the extraction of M3 in maxillofacial surgery [13]. point at the boundary of the basal bone arch just below
Be that as it may, the relationship between distinctive 14 mandibular teeth. We got the coordinate points of
positional sorts of M3 and RS has not been thoroughly bony WALA ridge in Mimics software and imported the
analyzed. The purpose of this study is to quantitatively coordinate values into Matlab software (R2022a, Math-
measure RS of the mandible with CBCT, and test for an Works, U.S) [14] to complete the fitting of WP, and finally
association between RS and positional traits of the M3, imported WP into Mimics. The process was shown in
so as to assist orthodontists design treatment plans. Fig. 2.
To construct the reference lines. Connecting the bone
marker points of the WALA ridge of the mandibular
Huang et al. BMC Oral Health (2023) 23:138 Page 3 of 11

Fig. 1 Construction of 3D model, reference plane. A 3D hard tissue model and bone marker points of mandibular WALA ridge. B The
Frankfort horizontal plane (FH) and the occlusal plane (OP)

Fig. 2 The process of complete the fitting of WP

Huang et al. BMC Oral Health (2023) 23:138 Page 4 of 11

first and second molar as the WALA ridge line (WL) were measured by the projection on the sagittal section
(Fig. 3A). Connecting the mesial buccal cusps of the (Fig. 3A, Fig. 3B). Recording the mesiodistal angulation
mandibular first and second molar as the occlusion line (A angle: -10° ~ 100°), labiolingual angulation (B angle) of
(OL) (Fig. 3B). M3 in WP-based and OP-based reference frames, sepa-
rately. The detailed protocol of CBCT measurements
Variables and measurements described in Fig. 4.
The 3D hard tissue models were imported into the Meas- RS was measured on five different levels which were
ure and Analysis Module of Mimics for creating FH, parallel to the horizontal plane including levels 1–5 in
WP, OP, WL, and OL. The angles of FH with WP, WL, two reference frames (Table1, Fig. 5A). Levels 1–2 were
OP and OL were respectively recorded as < FH-WP, < F at the crown level. Levels 3–5 were at the root level. The
H-WL, < FH-OP, < FH-OL. These FH-related angulations distance from the distal protruding point of the crown of

Fig.3 The projected schematic diagram of reference plane, line and the FH-related angulations on the sagittal plane. A FH, WP, WL and
the < FH-WP, < FH-WL. B FH, OP, OL and < FH-OP, < FH-OL

Fig. 4 The detailed protocol of A, B angle measurements. Creating local 3D reference frames, the correlated planes were determined by intersected
guidelines with different colors, which were red for axial planes, green for sagittal planes, and orange for coronal planes. A WP-based reference
frame. Take WP as horizontal plane, project the bony WALA ridge marks of the first and second molars on the horizontal plane, connect the two
points as ­WLp, make the sagittal plane through ­WLp and perpendicular to the horizontal plane, and make the coronal plane through one mark and
perpendicular to the horizontal plane and sagittal plane. B OP-based reference frame. The method was the same as A, and the two landmarks were
replaced by the mesial buccal cusp of the first and the second molars. C Mesiodistal angle (A angle): Find the sagittal section of the longest tooth
axis of M3 and record the angle between this axis and the horizontal plane in the sagittal plane; labiolingual angle (B angle): Find the coronal or
horizontal section of the longest tooth axis of M3, record the angle between this axis and the sagittal plane in the coronal or horizontal plane
Huang et al. BMC Oral Health (2023) 23:138 Page 5 of 11

Table 1 Explanation the position of five levels

Level abbreviation Interpretation

Level 1 L1 The level parallel to reference plane through the most distal protruding point of the crown of the mandibu-
lar second molars
Level 2 L2 The level parallel to reference plane through the cement enamel-junction of the mandibular second molars
Level 3 L3 The level parallel to reference plane through the root furcation of the mandibular second molars
Level 4 L4 The level parallel to reference plane through the distal root of the mandibular second molars
Level 5 L5 The level parallel to reference plane through the apex of the distal root of the mandibular second molars

Fig. 5 levels 1–5, mandibular canal and measurements. A L1 to L5. B the mandibular canal. C the measurement diagram of RS in crown level. D the
measurement diagram of RS in the root level (The measurement method of RS on OP-based level by using O ­ Lp was consistent with this)

the mandibular second molar to the anterior wall of the According to Pell &Gregory classification (Depth: PG-A,
mandibular canal (MC) (Fig. 5B) was measured as RS at PG-B, PG-C; Ramus Relationship: PG-I, PG-II, PG-III)
the crown level [15] (Fig. 5C). The distance from the most (Fig. 6) [16, 17] and the angles of WP-based reference
lingual point of the distal root of the second molar to the frame to classify M3s (A angle: [A1: < 27°, A2:27 ~ 67°,
lingual cortical bone of the mandible which parallels the A3: > 67°]; B angle: [B1: < 14°, B2:14 ~ 24°, B3: > 24°]). WP-
measuring line (­ WLP or O­ LP) was measured as RS at the based reference system is the main reference system in
root level [10] (Fig. 5D). Data obtained by using WP or this study, and OP-based reference system was used as
OP plane as reference plane were recorded as WP group an auxiliary system. M3s were classified according to the
and OP group, respectively. A and B angles of the former. We divided the A angle
and B angle into the three classifications according to
Classifications and groups of third molars the trisection of a sample size to ensure the comparabil-
M3 positional traits and eruption space measurements ity between samples, individually. Additionally, all M3s
were recorded on CBCT derived panoramic radiographs. also were grouped according to the patient’s age, sex, and
Huang et al. BMC Oral Health (2023) 23:138 Page 6 of 11

and 4, Group5 and 6. One-way ANOVA was performed

to analyze RS differences between paired groups. Pair-
wise comparison between classifications was performed
by LSD test. 95% confidence intervals were set for all sta-
tistical analyses (P < 0.05).

Results
Classification, number and corresponding patient age
Table 2 showed the classification and number of the M3.
The number of each classification is similar. No statisti-
cally significant differences in corresponding age among
the compared classifications were found, except for age in
PG-I/II/III classification. The corresponding patient age
in PG-I classification was the largest, followed by PG-II
classification, and the smallest was PG-III classification
(P > 0.05) (Table 2).

The correlation of FH‑related angulations

For the face-face angle and the line-face angle, < FH-WP
showed a strong correlation with < FH-WL (r = 0.992,
P < 0.05), the corresponding standard deviation of the
Fig. 6 The classification criterion of Pell&Gregory. A Depth of two were 3.73 and 3.74. < FH-OP showed a weak cor-
Pell&Gregory Classification. PG-A: The highest part of the M3 was
relation with < FH-OL (r = 0.332, P < 0.05), the cor-
on the same level or higher than the occlusion plane of the second
molar. PG-B: The highest part of the M3 is below the occlusal plane responding standard deviation of the two were 6.99
of the second molar, but higher than the neck of the second molar. and 5.58. < FH-WP angle had strong correlations with
PG-C: The highest position of the M3 is below the neck of the the < FH-OP angle (r = 0.619, P < 0.05), < FH-WL angle
second molar. B Ramus relationship of Pell&Gregory Classification. was moderately correlated with the < FH-OL angle
PG-I: Sufficient space available between the anterior border of the
(r = 0.475, P < 0.05) (Table 3).
ascending ramus and distal side of second molar to accommodate
mesiodistal width of the crown of the M3. PG-II: The space available
between the anterior border of the ramus and the distal side of the Differences of different groups of RS, A angle and B angle
second molar is less than the mesiodistal width of the crown of the RS decreased gradually from the crown to the root, and
M3. PG-III: All or most of the M3 is embedded in the mandibular
the minimum was at the root tip (4.39 ± 1.95 mm in WP
ramus
group, 3.81 ± 1.54 mm in OP group). Significant statisti-
cal differences were found in the amount of RS between
groups WP and OP, in all levels (P < 0.05). In the WP
Angle malocclusion classification, respectively. Group 1 group, RS at the root level (level 3, 4, 5) was longer than
was for male, Group 2 was for female, Group 3 was for in the OP group, and RS at the crown level (level 1, 2)
class I malocclusion, Group 4 was for class III malocclu- was shorter. A, B angles had no statistical significance
sion, Group 5 was for 18–27 years old and Group 6 was between two groups (Table 4). For all measurements, no
for 28–40 years old. statistical difference existed between the right and left
sides (Table 4). Similarly, there was also no statistical dif-
Statistical analysis ference in sex and Angle’s classification. However, signifi-
The statistical analyses were performed on SPSS (version cant differences between different age groups in B angles
27.0, IBM Co, Armonk, NY USA). All measurement work and RS of level 5 were found (P < 0.05); Group 6 displayed
was done by the same researcher, and each measurement larger measurements than Group 5 (Table 5).
result was repeated 3 times, and the average value of the
3 measurement results was taken. Differences of RS across different third molars
All data were given as mean ± standard deviation (SD). classifications
Pearson correlation coefficient was used to analyze the In the WP group, almost all RS had statistical differences
correlations among the angle of line-line, line-plane. A in classification criteria of PG-A/B/C, PG-I/II/III and
paired t-test was performed to compare the measure- mesiodistal angulation (P < 0.05), except RS of level 2 in
ment in left and right independent t-test was performed PG-I/II/III. However, no statistical difference between
to compare the measurement in Group1 and 2, Group3 RS and B angle was found. In different Pell & Gregory
Huang et al. BMC Oral Health (2023) 23:138 Page 7 of 11

Table 2 Basic information of the third molars

Classification criterion Groups Number Corresponding ­agea Corresponding gender
male female

Depth
PG-A 85 29.08 ± 0.61 44 41
PG-B 60 27.00 ± 0.76 29 32
PG-C 61 28.82 ± 0.74 30 31
P Value 0.082
Ramus Relationship
PG-I 78 30.17 ± 0.65 41 37
PG-II 75 28.41 ± 0.66 40 35
PG-III 53 25.77 ± 0.70 21 32
P Value 0.000***
Mesiodistal angle
A1 68 28.65 ± 0.67 31 37
A2 69 27.80 ± 0.76 37 32
A3 69 28.75 ± 0.68 34 35
P Value 0.573
Labiolingual angle
B1 71 29.79 ± 0.59 37 34
B2 70 27.96 ± 0.69 36 34
B3 65 27.35 ± 0.80 29 36
P Value 0.056
Total n = 206 206 28.40 ± 0.40 102 104
a
One-way ANOVA of corresponding age in each three groups under different classification criteria
***
Significant difference at P < 0.05

Table 3 Pearson correlation coefficients of FH-related a 3D model and test for an association between RS and
angulations third molar positional traits.
Reference Face-face angulations Line-face angulations r Patients we included were adults aged 18 to 40 years
Mean ± SD (°) Mean ± SD (°) with non-vertical growth. Zhao Z et al. found RS had a
maximum in the hypodivergent group and was twice
WP/WL 11.50 ± 3.73(< FH-WP) 11.53 ± 3.74(< FH-WL) 0.992**
as large as in the hyperdivergent group [19]. Research
OP/OL 1.84 ± 6.99(< FH-OP) 10.30 ± 5.58(< FH-OL) 0.332**
reports the missing rate of M3 in patients with vertical
r 0.619** 0.475**
skeletal craniofacial pattern was higher, our patients were
Pearson correlation coefficients was labeled bold; **Significant difference at selected based on evidence found in the literature [20].
P < 0.05
In the current study, we found that with the increase in
average age, the M3 tends to PG-I within the classifica-
tion of ramus relationship. Possibly as a result of the
classifications, from PG-A to PG-C, PG-I to PG-III, a
eruption of the M3 increases the eruption space and pro-
gradual decrease in RS was seen (P < 0.05). In mesiodis-
motes the further growth of the mandibular angle [21].
tal angulation, from A1 to A3, RS showed an increasing
In addition, previous studies used OP to measure the
trend (P < 0.05) (Table 6).
amount of tooth movement [10, 11, 19]. The tooth move-
ment of malocclusion patients in orthodontic treatment
is likely to influence the position of OP [22]. The findings
Discussion
confirmed the WALA ridge arch can represent the alveo-
Recent findings have shown RS is a three-dimensional
lar arch [23]. The dental arch and WALA ridge arch have
spatial definition [10, 11]. The RS was analyzed in CBCTs
high matching [24]. In this study, the distance from the
to minimize measurement inaccuracies, such as the ones
WP plane fitted by least squares method to each point on
normally seen when utilizing conventional 2D radio-
WALA ridge arch has a minimum and the WALA ridge
graphs [18]. This study aimed to use CBCT to reconstruct
arch was fitted into a relatively stable plane to represent
Huang et al. BMC Oral Health (2023) 23:138 Page 8 of 11

Table 4 Comparison of data between groups in different levels

RS of Level 1–5 Groupa of different references Groupb of different sides
(mm)
WP groups OP groups WP VS OP Right (R) Left (L) R VS L
Mean ± SD (mm) Mean ± SD (mm) P Mean ± SD (mm) Mean ± SD (mm) P

L1 11.10 ± 2.30 11.49 ± 2.06 0.045 11.21 ± 2.11 11.39 ± 2.26 0.269
L2 10.62 ± 1.81 11.17 ± 1.57 0.001 10.92 ± 1.72 10.87 ± 1.72 0.704
L3 7.84 ± 1.87 7.02 ± 1.83 0.000 7.57 ± 1.86 7.24 ± 1.85 0.058
L4 6.48 ± 1.84 5.43 ± 1.69 0.000 6.03 ± 1.88 5.82 ± 1.70 0.075
L5 4.39 ± 1.95 3.81 ± 1.54 0.001 4.14 ± 1.63 3.98 ± 1.85 0.142
A angle 48.83 ± 32.57 41.85 ± 31.07 0.113 45.51 ± 32.35 43.17 ± 31.45 0.231
B angle 19.06 ± 15.07 16.63 ± 11.75 0.069 17.20 ± 14.47 18.50 ± 12.57 0.075
a b
Two-samples independent t-test and test for normality was significant (P < 0.05), A paired t-test and test for normality was significant (P < 0.05)
The significance level P < 0.05 was labeled bold

Table 5 Comparison of Measurements at Group1 and Group2, Group3 and Group4, Group5 and ­Group6a
Measurements (the sex(N) Angle’s classification(N) Age(N)
RS of level and angle)
Group1(208) Group2(204) P Group3(332) Group4(90) P Group5(216) Group6(196) P
Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD

L1 11.38 ± 2.30 11.22 ± 2.07 0.465 11.31 ± 2.21 11.27 ± 2.13 0.861 10.88 ± 2.26 11.36 ± 2.33 0.723
L2 10.81 ± 1.92 10.98 ± 1.49 0.314 10.93 ± 1.72 10.76 ± 1.70 0.410 10.61 ± 1.71 10.63 ± 1.93 0.322
L3 7.73 ± 1.88 7.13 ± 1.87 0.001 7.45 ± 1.89 7.37 ± 1.93 0.743 7.74 ± 1.77 7.95 ± 1.98 0.524
L4 6.02 ± 1.76 5.89 ± 1.92 0.490 5.95 ± 1.85 5.95 ± 1.82 0.980 6.21 ± 1.81 6.78 ± 1.83 0.058
L5 3.94 ± 1.82 4.26 ± 1.73 0.066 4.06 ± 1.78 4.23 ± 1.77 0.425 3.97 ± 1.87 4.85 ± 1.95 0.000
A angle 43.61 ± 31.78 45.06 ± 32.06 0.645 44.35 ± 31.37 44.31 ± 33.88 0.990 45.72 ± 32.04 48.06 ± 33.27 0.541
B angle 17.30 ± 13.49 18.39 ± 13.62 0.418 17.96 ± 14.37 17.45 ± 10.13 0.704 16.10 ± 14.30 21.75 ± 15.31 0.000
a
Independent sample T-test of measured values under different genders, different Angle’s classification, and different ages
The significance level P < 0.05 was labeled bold

the bony alveolar arch plane, namely the WP plane [25]. is an innovative method, hoping to help the follow-up
Hence, this study fitted the WP as a reference plane. It orthodontic research work.
was also the innovation of this study. We found that WP Because of a certain angle between the reference
had high stability in the present study by comparing the planes, it had noticeable differences in RS which were
standard deviation of < FH-WP and < FH-OP. It is sug- obtained by OP and WP in this study. The consistent
gesting that WP can be the reference plane. WL and WP results with Kim were that RS at the crown level was
were highly correlated and the result was supported by longer than at the root level and RS had a gradual reduc-
Gupta [24]. This may reflect the fact that the selected tion from the crown to the root tip [10]. Thus, the dis-
measurement datum line is also scientific. In our study, tally-induced movement of roots is a clinical procedure
the OP was used as an auxiliary to illustrate the reliability that merits concern. During distal movement, the molars
of the results obtained by the WP. will tilt when the root tip touches the cortical bone. This
In recent years, three-dimensional digital technology is consistent with many previous studies [2728]. Oth-
with high efficiency, high accuracy, and high maneuver- erwise, RS had no significant difference in gender and
ability can help dentists to simulate orthognathic surgery, Angle’s classification. In the age classification, the older
three-dimensionally reconstruct the airway structure, group has larger RS (especially in the root tip) and B
analyze organizational change in orthodontic treatment angle. The finding by Choi [11] that the available space
and provide effective means for personalized orthodontic at the posterior boundary of molars is influenced by age
treatment [26]. With the development of digital ortho- supports our results. From this, the influence of age on
dontics, digital models as well as invisible and person- RS should be considered in orthodontics. The influence
alized appliances have been widely used. In this study, of age on RS may be caused by periodontal disease or
digital technology was also used to fit the plane, which physiological alveolar ridge absorption [29].
Huang et al. BMC Oral Health (2023) 23:138 Page 9 of 11

Table 6 Comparison of RS under different classifications of the third molars in WP ­groupsa

Classification Classification The RS of Level 1–5(mm)
criterion
L1 L2 L3 L4 L5

Depth
PG-A 12.55 ± 1.86 10.74 ± 1.68 8.51 ± 1.67 6.94 ± 1.72 5.01 ± 1.77
PG-B 10.95 ± 1.87 11.04 ± 1.68 7.87 ± 1.63 6.11 ± 1.92 4.19 ± 2.07
PG-C 9.25 ± 1.83 10.03 ± 1.99 6.86 ± 1.96 6.19 ± 1.79 3.7 ± 1.81
P Value 0.000 0.006 0.009 0.000 0.000
Ramus Relationship
PG-I 12.51 ± 1.87 10.88 ± 1.91 8.61 ± 1.61 7.26 ± 1.73 5.22 ± 1.87
PG-II 10.83 ± 2.05 10.60 ± 1.70 7.66 ± 1.92 6.32 ± 1.81 4.28 ± 1.75
PG-III 9.44 ± 1.94 10.24 ± 1.78 6.94 ± 1.73 5.56 ± 1.57 3.33 ± 1.80
P Value 0.000 0.144 0.000 0.000 0.000
Mesiodistal angle
A1 9.38 ± 1.86 9.95 ± 1.68 7.51 ± 2.02 6.52 ± 1.99 4.15 ± 1.98
A2 11.03 ± 1.94 10.6 ± 1.88 7.51 ± 1.76 6.06 ± 1.79 4.09 ± 1.99
A3 12.89 ± 1.57 11.15 ± 1.65 8.49 ± 1.67 6.85 ± 1.65 4.93 ± 1.79
P Value 0.000 0.000 0.002 0.037 0.018
Labiolingual angle
B1 10.81 ± 2.38 10.68 ± 1.89 8.17 ± 1.71 6.95 ± 1.78 4.51 ± 2.06
B2 11.28 ± 2.39 10.61 ± 1.67 7.79 ± 1.91 6.33 ± 2.00 4.34 ± 2.15
B3 11.24 ± 2.11 10.54 ± 1.90 7.52 ± 1.87 6.12 ± 1.60 4.30 ± 1.58
P Value 0.406 0.911 0.127 0.051 0.804
a
ANOVA of RS in each three groups under different classification criteria
The significance level P < 0.05 was labeled bold

The connection between M3 and RS is controversial. findings could be used to help some primary hospitals
Previous studies [11, 19] analyzed the RS with or with- without large dental facilities predict RS by observing
out the M3 and found no notable difference. However, panoramic or lateral radiograph, which will be benefi-
previous studies reported that the existence of the M3 cial to the design of orthodontic plans to induce molar
would increase the available space of the posterior seg- distalization.
ment of the dental arch [30]. But these scholars did not Finally, I want to summarize the main data of this
classify M3s in detail. Therefore, this study conducted study. A strong correlation (r = 0.992) between < FH-WP
an in-depth classification study and found that RS was and < FH-WL. A strong correlation (r = 0.619)
significantly different across distinct classifications. In between < FH-WP angle and < FH-OP angle, too. Rs
Pell-Gregory classifications, the RS presented a gradual has a minimum value of 4.39 ± 1.95 mm at the root tip
reduction from PG-A to PG-C. Similarly, RS gradually in WP group. Comparison results of variance analysis
decreased from PG-I to PG-III. With respect to angle of RS under different M3 classifications: P < 0.05 in Pell
classification, the smaller the A angle is, the shorter is & Gregory classifications and mesiodistal angulation
the RS. No significant difference existed in the B angle classification.
classification. In this study, we also confirmed significant
differences in the mesial tilt degree of M3 in PG-A/B/C Conclusions
and PG-I/II/III classification. B angle has no significant 1. Compared with the occlusal plane, the fitting WALA
difference across Pell-Gregory classifications. In agree- ridge plane had higher stability; the fitting WALA ridge
ment with our results, Tsai H confirmed that posterior plane can be used as an innovative plane for orthodontic
molar space was related to the M3 mesial angle [31]. clinical scientific research.
Consequently, an association indeed exists between RS 2. The retromolar space at crown level was longer than
and M3 depth, the degree of mesial tilt and the distance at the root level, and only minimally present at the root
between the anterior edge of mandibular ramus and the apex. Therefore, special attention should be paid to the
second molar. RS can be initially estimated by observing initial retromolar space at the apical level when inducing
the depth, mesial angle, or posterior space of M3. Our molar distalization.
Huang et al. BMC Oral Health (2023) 23:138 Page 10 of 11

3. The current study found that retromolar space was References

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