Association of mandibular third molar positions, ramus height, and gonial angle on panoramic radiographs: a retrospective cross-sectional study

Background: The aim of this study was to investigate the relationship between the positions of impacted mandibular third molars and the gonial angle and ramus height, as measured on panoramic radiographs, according to the Pell and Gregory/Winter classifications. Methods: This retrospective study included panoramic radiographs of 700 patients (350 males and 350 females) aged 18–62 years, who presented with bilaterally impacted mandibular third molars. The gonial angle and ramus height were measured, and the position of the impacted third molars was categorized based on the Pell and Gregory/Winter classification systems. Results: The most common third molar impaction position observed was vertical, followed by mesioangular and horizontal positions. The study found that a high gonial angle was more frequently observed in males, while a low gonial angle was more common in females. No significant association was identified between the type of mandibular third molar impaction and the gonial angle or ramus height. Additionally, individuals with high gonial angles had lower ramus heights. Individuals with impacted teeth in the “other” position had statistically higher gonial angles (p < 0.05). Conclusion: The study concludes that there is no significant correlation between the gonial angle, ramus height, and the type of mandibular third molar impaction. However, individuals with impacted teeth in the “other” position were found to have higher gonial angles, which may increase the risk of mandibular fractures. These findings show that although certain impaction types are more prevalent, mandibular anatomical parameters such as gonial angle and ramus height do not appear to significantly influence impaction patterns when assessed on panoramic radiographs. © The Author(s) 2026.