Distribution of indications for third molar extraction according to tooth angulation (winter classification): a single-centre retrospective cross-sectional study

Third molar angulation is thought to influence which clinical problem prompts extraction, but contemporary regional data remain limited. This study aimed to describe the indications for third molar extraction in a Turkish population according to Winter angulation, taking eruption status into account. In this single-centre retrospective cross-sectional study, records and panoramic radiographs of 2,000 patients who underwent third molar extraction between June 2025 and June 2026 were screened. After excluding 254 patients with incomplete data, 1,999 third molars from 1,746 patients were analysed. Two calibrated observers assessed eruption status and angulation, applying Winter’s angular criteria descriptively to all teeth (inter-observer κ = 0.90 for angulation and 0.86 for eruption status). A single primary indication was recorded for each tooth. Associations were tested with the Fisher–Freeman–Halton exact test, Cramér’s V and Bonferroni-corrected residuals, overall and stratified by eruption status; generalised estimating equations adjusted for eruption status, jaw, age and sex. Vertical angulation predominated (74.3%), followed by mesioangular (15.1%), distoangular (6.2%) and horizontal (4.5%) angulations; 64.8% of the teeth were fully erupted. The most frequent primary indications were third molar caries (52.5%), pericoronitis (20.0%) and pressure on the adjacent second molar (12.7%). Indication distribution differed across angulation groups ( p < 0.001; Cramér’s V = 0.42): caries was concentrated in vertical (63.3%), pressure on the second molar in horizontal (66.7%) and mesioangular (53.5%), and pericoronitis in distoangular (58.5%) teeth. Caries was recorded mainly in fully erupted teeth (77.1% vs. 7.2%), did not differ by angulation among incompletely erupted teeth, and its vertical excess was largely attenuated after adjustment. Among incompletely erupted teeth, pericoronitis was most frequent in distoangular (72.5%) and vertical (65.2%) teeth; pressure on the second molar remained concentrated in horizontal and mesioangular teeth in both strata. The distribution of documented extraction indications differed according to Winter angulation. The excess of caries among vertically angulated teeth largely reflected eruption status, whereas the association between mesioangular or horizontal angulation and pressure on the second molar persisted across eruption strata. As only extracted teeth were studied, the findings describe the distribution of indications rather than risk or causal relationships.