Introduction: Presence of external root resorption in second molars associated with impacted mandibular third molars was not rare. The neglect of this issue may leads to penetration of the pulp and loss of the second molars. The aim of this study was to investigate the incidence and risk factors affecting the external root resorption in second molars associated with mandibular impacted third molars were inclined mesially and horizontally by Cone Beam Computer Tomography (CBCT) images.

Methods: In this cross sectional study the samples consisted of 231 scans with mesially and horizontally impacted mandibular third molars. Incidence of external root resorption of second molars and the effects of age, gender and clinical parameters such as location and intensity of external root resorption were considered. Moreover, depth and inclination of impacted mandibular third molar were evaluated by CBCT. The data were analyzed by Chi-square test.

Results: The overall incidence of external root resorption in the second molars was 22.08%. Incidence of external root resorption in second molars was significantly related to gender and inclination of third molar. The relations between external root resorption and impaction depth of third molar or the patient's age was not statistically significant. However, the relationship between external root resorption and the intensity or depth of impacted third molar and location of root resorption was statistically meaningful.

Conclusion: Patient’s gender and horizontal inclination of third molars are the most important factors affecting the presence of external root resorption in the second molars associated with mesially and horizontally impacted mandibular third molars.