PurposeThird molar agenesis (TMA) is the most common craniofacial anomaly and has been associated with craniofacial patterns in different populations. Therefore, the aim of this retrospective cross-sectional study was to assess a possible association between craniofacial patterns and TMA in German orthodontic patients.MethodsPatients undergoing orthodontic treatment with dental records including anamnesis, pretreatment lateral cephalograms and orthopantomograms were evaluated. Cephalometric analyses were conducted digitally and lines, angles and proportions were measured to investigate craniofacial morphology. Skeletal classes were determined by the individualised Wits appraisal and ANB angle. The TMA was identified with the help of orthopantomograms. Patients showing agenesis of at least one third molar were included in the TMA group. Statistical analysis was performed to assess the association between TMA and craniofacial patterns (& alpha; of p & LE; 0.05).ResultsA total of 148 patients were included, 40 (27.0%) presented at least one missing tooth (TMA group) and 108 (73.0%) showed full dentition (control group). Skeletal class determined by the individualised Wits appraisal revealed statistical significance between the TMA and control groups (p = 0.022), in which TMA patients were 11 times more likely to present with an individualised skeletal class III (odds ratio 11.3, 95% confidence interval 1.7-139.5). Skeletal cephalometric analysis revealed no statistical differences between TMA and control groups for any further angular, linear and proportional parameters.ConclusionThird molar agenesis was associated with skeletal class III determined by the individualised Wits appraisal.