Does the Relationship between Retained Mandibular Third Molar and Mandibular Angle Fracture Exist? An Assessment of Three Possible Causes (original) (raw)
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Complication rates in angle fractures with or without retaining third molars: A comparative study
IP innovative publication pvt ltd, 2020
Aim: The aim of this study is to assess whether the third molar in the line of mandibular angle fracture predisposes to post-operative infection, which further may lead to implant retrieval. Materials and Methods: Surgically rehabilitated cases of mandibular angle fracture at our center Sanjay Gandhi institute of trauma and orthopedics from 2016 to 2019 were considered in the study. During this period 49 cases were followed up for over a period of 6 months at 3 moths and 6months interval. All the cases were operated by the same surgeon using universal aseptic precautions using semi- rigid fixation. Results: Out of 49 cases, 20 cases the third molar was removed and in 29 cases the third molar was retained. The mean age group of the population of the study was 33.67 (18 to 60 years), out of which majority of the cases 93.9%(46) were male patients and 6.3%(3) were female patients. The main etiology of the cases were attributed to RTA. 96.3%. At the end of the 6 months follow up it was noted that 4 plates in case of retained group and 2 plates in removed group. In the 3 month follow up in 4 cases of the retained third molar was extracted due to signs of infection. When the tooth in question was removed, infection did not occur. At the 3rd to 6 month follow another 4 retained third molars were extracted along with implant retrieval. Statistically the relationship between the two groups were analyzed using Chi-square test bivariate statistics. A P ≤ 0.05 was taken as significant. Conclusion: In our study we could not provide any concrete evidence to form a protocol for the management for the third molar in the line of mandibular angle. Retaining the third molar in the line of fracture has an increased chance of post-operative infection. We would like to conclude that partially impacted tooth are best to be removed during the procedure for better outcomes provided the fractured segments stability is maintained. Until an algorithm is set for the management of the third molar in the line of fracture, the dilemma of retaining or removing still stays and varies from case to case and on the surgeon’s experience.
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2013
To evaluate whether the retention of lower third molars in the line of fracture of mandibular angle fractures adversely affects treatment outcomes. Methods: Data were collected on patients treated by intraoral open reduction and stable internal fixation for fractures of the mandibular angle during a 6-year period. 75% of patients had a third molar tooth in the line of fracture. Outcome variables were postoperative infection, delayed healing, nonunion, malunion, osteomyelitis, malocclusion and need for removal of bone plates. Data regarding patient demographics, cause of injury, associated fractures, time of treatment after injury, management of the third molar and postoperative complications were statistically analyzed. Results: Seventy five patients had sufficient follow-up for inclusion in the study. A tooth was present in the fracture line in 75% of the cases. Teeth in the fracture were removed in 34.6% of the cases. Postoperative complications occurred in 8% of the sample. Fractures not containing teeth at the time of fracture had a 10.5% rate of postoperative complication compared with 7.1% for patients who had teeth in the fracture (p = NS). For angle fractures with a tooth retained in the fracture line, the incidence of postoperative complications was 5.2%. When the tooth was removed, the incidence was 11.1% (p = NS). Conclusions: There is no statistically significant increase in risk for postoperative complications when a tooth is present in the line of fracture at the mandibular angle. Selective removal of these teeth may not decrease complication rates in angle fractures.
Oral and Maxillofacial Surgery, 2010
Background Angle fractures are quite common considering that the angle of the mandible forms an area of lower resistance which contains a thicker upper border, a thin basilar bone, and the presence of an impacted mandibular third molar. Common complications of mandibular third molar surgery include alveolar osteitis (dry socket), secondary infection, nerve dysfunction, and hemorrhage. Reports of mandibular fracture during and after third molar removal are uncommon. Purpose The purpose of this paper is to discuss the risk and predisposing factors that should be analyzed regarding the possibility of immediate and late mandibular angle fractures and their need for surgical treatment as a means through which to remove impacted molars. This study is based on a thorough review of the literature as well as on one immediate and one late mandibular angle fracture as described by the authors' own personal experience.
Relationship between Fractures of Mandibular Angle and the Presence of a Lower Third Molar
Objectives: In this retrospective study, we measured the relationship between the presences of a lower third molar and mandibular angle fractures. Patients &Methods: The records and radiographs of 50 patients with mandibular angle fracture were examined. The presence of a lower third molar were assessed for each patient and related to the occurrence of mandibular angle fracture. Results: Patients with presence of a lower third molar exhibited three times greater chance of a mandibular angle fracture than patients with absent lower third molar. There was a major variation in the risk for a mandibular angle fracture depending on presence of a lower third molar. Conclusion: The presence of third molar teeth provides an area of potential weakness of the mandible and predisposes the angle region to fracture & difficulty to achieve good reduction and exposes the fracture for many complications like postoperative infections and delayed healing. Fights accounted for the largest number of fr...
Late treatment of mandible fracture after third molar removal
Research, Society and Development, 2022
Surgical management of impacted third molars is a treatment performed by dentists and its indicated for various conditions, among the indications has the prevention of mandibular fracture, but this is a factor that has been discussed and is controversial. Fractures caused by a third molar can occur, and on the other hand, the fractures after or during the management of impacted third molar are a possible complication. Surgical planning as the indication to the surgery has to be performed to avoid complications as the fracture. Thus this study aims to report a case about a mandible fracture after third molar extraction, presenting edema, pain, and restriction in mandible mobility in 01-day follow-up. A 27-year-old female was referred to the oral and maxillofacial surgery service of the Santa Casa Hospital of Araçatuba (Araçatuba, Brazil), reporting dental history of third molar removal, with immediately chief complaints. In the assessment, the patient presented edema, pain, malocclus...
Mandibular fracture during mandibular third molar extraction
The Internet Journal of …, 2009
Pre-operative planning for the extraction of mandibular third molars is of fundamental importance, particularly in patients over the age of 40 years, in whom osteotomies and odontotomies procedures must be included to prevent mandibular fractures Conservative treatment of the mandibular fracture has advantages and disadvantages, and can present excellent results when well indicated and performed. The main aim of this article is to relate a case of fracture of the mandibular angle in a 40-year old patient, as a result of third molar extraction on the right side. The patient had two fracture lines favourable to reduction, reported feeling a difference in dental occlusion and was treated with intermaxillary fixation with an Erich bar for 45 days. The follow-up shows complete bone consolidation of the fracture traces after four years.
Frequency of Mandibular 3rd Molar Presence and Position on Risk of Mandibular Angle Fracture
Journal of Medicine, Physiology and Biophysics
Objective of study was to determine the frequency of mandibular third molar presence and position in mandibular angle fractures. Study Design: Cross Sectional Study Setting: This study was carried out in department of dentistry, Nishtar institute of dentistry, Multan. Duration of Study: This study was conducted from 1 st July 2016 to 31 st January 2017. Methadology: Study was started after taking informed consent from the patients and approval of ethical committee. Fracture side was diagnosed by history and examination. Status of mandibular third molar (erupted, un-erupted and impacted) on the side of fracture was evaluated through clinical and radio-graphical examination. Data was collected for basic demographics (Age, Sex and side of fracture).Patients from both gender with age range of 25-40 years having mandibular angle fracture of any side of < one month duration were included in this study. Patients with history of extraction of mandibular third molar and those with history of fracture from gunshot injury were excluded from the study.Data was collected for mandibular third molar presence and position and noted in especially designed proforma. Results: A total of 158 patients of both gender with mandibular angle fracture of any side were included. Age range in this study was from 25 to 40 years with mean age of 32.689 ± 3.28 years, mean height 1.612 ± 0.04 meters, mean BMI 23.929 ± 2.08 Kg/m 2 and mean duration of fracture was 11.354 ± 6.08 days. Majority of the patients (55.7%) belongs to 25-33 years age groups. While males were 90.5% as compare to females 9.5%. UnErupted Mandibular third molar was seen in 12.7% patients, Erupted 44.3% and Impacted was 43%. Conclusion: Conclusion of this study is that the absence of an impacted third molar decrease the prevalence of mandibular angle fractures.
A Study on the Impact of Mandibular Third Molars on Angle Fractures
Purpose: This study evaluated the relationship between the status and position of mandibular third molars and angle fractures. Materials and Methods: In a total of 2,033 patients with a mandibular fracture, 532 (26%) had angle fractures, and 1,466 (72%) had retained their lower third molars. The most frequent cause for mandibular fracture was road traffic accident (64%), followed by assault (19%). Results: Of 341 patients with an unerupted third molar, mandibular angle fracture was evident in 249 patients (73%). Only 62 patients (9.4%) with a completely erupted third molar had angle fractures, whereas 83 patients (17.6%) with partially erupted third molars had angle fractures. Conclusions: Our study confirmed an increased risk of angle fractures in the presence of a lower third molar, as well as a variable risk for angle fracture, depending on the third molar's position.
Unerupted lower third molars and their influence on fractures of the mandibular angle and condyle
British Journal of Oral and Maxillofacial Surgery, 2012
Our aim was to assess the influence of the presence and state of impaction of mandibular third molars on the incidence of fractures of the mandibular angle and condyle. We designed a retrospective study of patients who presented for the treatment of mandibular fractures from January 2006 to April 2011. The independent variables were the presence and degree of impaction of lower third molars, and the outcome variables were the incidence of fractures of the mandibular angle and condyle. The information was acquired from hospital records and panoramic radiographs. Personal data included age, sex, mechanism of injuries, and number of fractures of the mandibular angle and condyle. We studied 110 fractures of the mandibular condyle and 80 of the angle. The incidence of fractures of the mandibular angle was higher in the group with incompletely erupted third molars (37/80, p < 0.001) and that of condylar fractures was higher in the group without (67/110, p < 0.001). An incompletely erupted third molar reduces the risk of condylar fractures and increases the risk of fractures of the mandibular angle.
Evaluation of Teeth in Line of Mandibular Fractures Treated with Stable Internal Fixation
Journal of Maxillofacial and Oral Surgery, 2016
Purpose To determine whether retention or removal of teeth in line of mandibular fractures affects the incidence of postoperative complications. To evaluate the fate of teeth retained in mandibular fractures based on location of fracture line in relation to apical foramen and lateral periodontium of retained tooth. Method 51 mandibular fracture sites in 39 patients were treated by open reduction and internal fixation using miniplates. Teeth in line of fracture were removed if showed extensive caries, excessive mobility of tooth, or root fracture. Accordingly patients were divided into two groups, group I tooth removed (15 sites) and group II tooth retained (36 sites). Teeth retained in fracture line were classified based on position of the fracture in relation to apical foramen and the lateral periodontium of involved tooth estimated from preoperative panoramic radiograph into four types. Postoperative periodic follow up done for 1 year and seen for incidence of postoperative complications and fate of tooth in line of fracture. Results Out of 36 fracture sites in which teeth were retained 5 (13.89%) showed postoperative complications, and out of 15 fracture sites in which teeth were removed 3 (20%) showed postoperative complications. Out of 36 fracture sites in which tooth was retained we found in 3 cases fracture line passed through 2 adjacent teeth. Thus we had in total 39 teeth in fracture line out of them 26 required no treatment 9 required endodontic treatment and 4 teeth required extraction. Need for extraction and endodontic treatment was found more in type I and type III relation. Conclusion There is an increased risk for postoperative complications when a tooth is removed, although it is not statistically significant. Evaluation of fate of retained teeth showed better prognosis of teeth in type II cases than type III and type I cases. Results of this study leads to conclusions that teeth associated with mandibular fractures need not be removed on prophylactic basis.