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When a tooth fails to erupt within its expected time window, it is called as impaction. Impaction of tooth can be due to multiple local and generalized reasons. Generalized factors are associated with multiple systematic disorders and syndromes including cleidocranial dysostosis, Down’s syndrome, amelogenesis imperfecta, osteopetrosis and achondroplasia. Local factors involved in the failure of eruption include lack of space, supernumerary teeth, odontogenic cysts and tumors, odontoma, ankylosis, existence of alveolar cleft and idiopathic factors such as primary failure of eruption. Mechanical obstruction are most frequently associated with the failure of eruption of permanent teeth. Most common impacted tooth is mandibular third molar which makes 98% of all types of impacted teeth1 followed be maxillary third molar, maxillary canine and mandibular second premolars. Mandibular third molars removal is performed due to multiple reasons including pain, swelling and other complications during and after eruption. Its extraction requires proper planning according to the angulation and position to avoid post-operative complication. The goal of the present study is to estimate patterns of mandibular impaction in patients from twin cities of Pakistan. So that surgeons can plan the surgery according to the patterns of impactions. A prospective survey was executed on patients visiting oral surgery section of Islamic International Dental Hospital, Islamabad from April 2018 to Feb 2019. Sample size was of 50 patients. Chosen Classifications were Pell and Gregory and Winters classification. Data examination was done through SPSS 23. The most frequent type of impaction is mesioangular in patients of twin cities. Third molar impaction is a public health concern. The most predominant category of impaction was level B and class 2, mesioangular impaction with a slight male prediction in twin cities of Pakistan. This study can help surgeons plan according to data and avoid complications.