Molecular, Genetic and Clinical Perspectives on Third Molar Impaction: A Comprehensive Review

Impaction of the third molar is a frequently occurring developmental phenomenon, which is affected by such as anatomic boundaries, craniofacial patterns in growth and biological control. Insufficient retromolar space and deviant mandibular growth have been considered the major causes, but recently, genetic and molecular aspects have gained attention as significant etiological factors. Genetic variations in odontogenesis and bone remodeling-related genes such as MSX1, PAX9, AXIN2 and alteration of signaling pathways (WNT, BMP, FGF and RANK/RANKL/OPG) have been reported to affect eruption timepoint and its success. This review synthesizes current evidence on the clinical, radiologic, genetic, and molecular determinants of third molar impaction. The recent developments of cone beam computed tomography techniques have further enhanced diagnostic accuracy and surgical risk assessment, while the emerging molecular and genetic information offers possibilities for early risk prediction and personalized management. Integration of clinical examination into imaging and biological markers may further enable treatment planning with a view to minimizing complications and optimizing patient outcomes in impacted third molar management.