Influence of the Incompletely Erupted Lower Third Molar on Mandibular Angle and Condylar Fractures

Assessment of the relationship between the three-dimensional precise location of the mandibular third molar and the volume ratio of the impacted mandibular third molar to the mandibular angle, and the patterns of mandibular angle fracture: A retrospective study

This study aimed to evaluate the relationship between the precise three-dimensional location of the third molar (M3) and mandibular angle fracture (MAF) patterns and to assess the effect of the volume ratio occupied by M3 in the mandibular angle on fracture patterns. The location of M3 was assessed in 218 patients with MAF using computed tomography reconstruction. The bone volume of the mandibular angle and the bone volume occupied by M3 were measured to calculate the volume ratio of M3 to the mandibular angle (M3/MA). MAF patterns were categorized into simple fracture (Type I), displaced fracture (Type II), and comminuted fracture (Type III) based on fracture severity. The results showed that the location of M3 significantly influenced MAF patterns (vertical position: P = .001; horizontal position: P = .002; angulation: P = .027, respectively) and the volume ratio of M3/MA was significantly higher for Type III fracture than Types I and II (P < .001). Regression analysis showed that the horizontal position and angulation of M3 and the volume ratio of M3/MA were the main predictors for comminuted MAF. A larger volume ratio (odds ratio [OR], 1.201; 95% confidence interval [CI], 1.037-1.391; P < .014), Class III position (OR, 7.978; 95% CI, 1.275-49.910; P < .026), and horizontal angulation (OR, 7.212; 95% CI, 1.028-50.581; P < .047) of the M3 were more prone to comminuted MAF than simple fracture. Our findings indicate that the location of M3 significantly affects MAF patterns, and that M3 may weaken the mandibular angle by occupying more bone space, thereby increasing the risk of a comminuted fracture.

A finite element analysis on the indication for extracting partially impacted mandibular third molars considering mandibular trauma

BACKGROUND

Patients presenting with partially impacted lower third molars (M3) have a higher likelihood of experiencing angle fractures while simultaneously decreasing the risk of condylar fractures. However, the specific biomechanical mechanism responsible for this occurrence remains unclear. Moreover, there is an ongoing debate regarding whether the removal of M3s might actually increase the risk of condylar fractures. This study aimed to evaluate how the presence of M3s influences mandibular fractures resulting from blows to the symphysis and lateral mandibular body, and to determine the indication for extracting M3s in such cases.

METHODS

Models of the mandible with a partially M3-impacted model (M3I), M3-extracted model (M3E), and M3-absent model (M3A) were generated using a computer. A traumatic blown force of 2000 N was applied to the symphysis and the right body of the mandible. Von Mises and principal stresses were analyzed, and failure indexes were determined. Two cases of mandibular linear fractures were chosen for model verification and interpretation.

RESULTS

When force was applied to the symphysis, the condylar region exhibited the highest stress levels, while stress in the mandibular angle region was much less regardless of the M3 state. On applying the force to the right mandibular body, stress in the condylar region decreased while stress in the mandibular body increased, especially in the blown regions. Impacted tooth or cavity formation post-M3 extraction led to uneven stress distribution on the blown side of the mandible, increasing the risk of mandibular angle fractures. In cases where M3 was absent or the extraction socket had healed, stress from lateral traumatic blown force was evenly distributed along both the inner and outer oblique lines of the mandible, thereby reducing the risk of mandibular fractures.

CONCLUSIONS

The reduced risk of condylar fractures in patients with partially impacted lower M3s and mandibular angle fractures is mainly due to lateral blows on the mandible, which generate less stress in the condylar region than blows on the mandibular symphysis, rather than being caused by the M3 itself. Extraction of the lower M3 can decrease the risk of mandibular fractures, with a minor influence on condylar fractures.

Does the Impacted Mandibular Third Molar Increase the Risk of Angle Fracture to Prevent the Incidence of Condylar Fracture? - A Retrospective Analysis

Introduction

This study aimed to retrospectively analyse the influence of the presence or absence of third molars and its position on the incidence of angle and condylar fractures of mandible.

Methodology

A retrospective cross-sectional analysis of 148 patients with mandibular fractures was done. A complete analysis of their clinical records and their radiological data was done. The primary predictor variable was the presence or absence of third molars and their positional status (Pell and Gregory's classification) if present. The outcome variable was the type of fracture and other predictor variables included age, gender and fracture aetiology. Data were subjected to statistical analysis.

Results

We observed that out of 48 patients with angle fractures, third molar was present in 67.34% and in 51.35% of 37 patients with condylar fractures, and there existed a positive correlation between the both. A significant association between the position of the teeth (Class II, III and Position B), angle fractures and (Class I, II, Position A) and condylar fractures was observed.

Conclusion

Angular fractures were associated with superficial and deep impactions and condylar fractures were associated with superficial impactions. No association was observed with the age, gender or mechanism of injury to the pattern of fractures. Impacted mandibular molars increase the risk of angle fracture, thereby preventing the force transmission to the condyle, and the absence or a fully erupted tooth increases the risk of condylar fractures.

The wisdom behind the third molars removal: A prospective study of 106 cases

Purpose

This paper aims to evaluate the decision-making of wisdom teeth extractions (M3s extraction) and the epidemiological profile in the targeted population.

Materials and method

This was a prospective analysis study of 106 patients at our hospital august 20, 1953 specialist hospital, which is a referral center between January 1, 2020 and January 1, 2021. The patients are divided into 2 groups according decision-making of wisdom teeth removal based on scientific evidence if it's right or wrong.

Results

There was no statistically significant difference between the groups regarding sex (P = 0.478), educational level (P = 0.718), or working status (P = 0.606). Furthermore, there was no statistically significant difference between the groups regarding general co-morbidity (P = 1.00) or oral history (P = 0.28). The mean age of the sample was 32.12 years (SD = 11.337 years, range = 17–70 years, median = 30 -years). We reported that only 28% of the third molars were surgically extracted. We included in Group (I), 81 patients who were treated for third molars removal which the decision-making was justified. In Group (II), 25 patients were treated for third molars removal which the decision-making was unjustified. Group (I) comprised 30 men and 51 women with a mean age of 30 years. Group (II) comprised 7 men and 18 women with a mean age of 27 years. The assessment of surgical outcomes (operating time, blood loss, hospital stay) showed no difference between groups.

Discussion

Monitoring asymptomatic wisdom teeth appears to be an appropriate strategy. Regarding retention versus prophylactic extraction of asymptomatic wisdom teeth, decision-making should be based on the best evidence combined with clinical experience.76.4% had a reason for extraction that was justified. The reasons why extraction of the wisdom tooth was not justified in our study population was either: extraction for prophylaxis or in the case of asymptomatic non-pathological third molars; without scientific evidence.

Conclusion

This subject, which is perpetually debated, requires updating dental health authorities by evaluating new conservative procedures.

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Third molars are a major focus of interest in dentistry.

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Preliminary indication and wrong decision-making for teeth extraction have resulted in many healthy teeth being sacrificed.

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Debate continues about the best strategies for the management of wisdom teeth.

Impacted lower third molar relationship with mandibular angle fracture complications

INTRODUCTION

Mandibular angle fractures are very common and are associated with the highest risk of complications. The aim of this study is to evaluate the correlation between impacted lower third molar and mandibular angle fracture complications.

MATERIAL AND METHODS

All patients presenting with a mandibular angle fracture and at least 2 months follow up were retrospectively included. The following complications were recorded: post-traumatic malocclusion, mouth opening limitation, inferior alveolar nerve hypoesthesia, infection, delayed union, hardware loosening. The patients were divided in two groups: impacted lower third molar or erupted/absent lower third molar.

RESULTS

A total of 68 patients were included, lower third molar was impacted in 36 cases and erupted/absent in 32 cases. 40 complications were recorded in 27 patients at 2 months. No statistically significant difference could be found about malocclusion, mouth opening limitation and inferior alveolar nerve hypoesthesia. A lower rate of persistent inferior alveolar nerve hypoesthesia (p = 0.0557) in patients with impacted lower third molar (19.4%) was observed compared to patients without impacted lower third molar (40.6%). There was no occurrence of delayed union and hardware loosening in impacted lower third molar group, whereas 5 delayed unions and 4 hardware loosening were recorded in erupted/absent lower third molar group. Finally, the rate of patients with at least one of the 6 complications is significantly higher in the erupted/absent lower third molar group (17/32, 53.1%) than in the impacted lower third molar group (10/36, 27.8%), p = 0.033.

DISCUSSION

The risk of overall complication is decreased when lower third molar is impacted in mandibular angle fracture. This supports the idea of a role of the impacted lower third molar in fracture reduction and stability.

Impact of mandibular third molars on angle fractures: A retrospective study

BACKGROUND

Previous studies have shown that the position and presence of mandibular third molars is associated with a high risk of mandibular angle fractures. The aim of this study was to assess the relationship between the position and presence of mandibular third molars and mandibular angle fractures.

MATERIAL AND METHODS

A retrospective study consisting of 256 patients who were admitted for treatment of mandibular fractures between January 2016 and January 2018 was undertaken. Patients' data and orthopantomogram radiographs were obtained from their medical record. The predictor variable was the presence and position of mandibular third molars. The position of the third molars was grouped based on the Pell and Gregory classification. The outcome variable was the presence of an angle fracture. Other study variables included age, gender, mechanism of injury, and fracture location.

RESULTS

Patients with mandibular third molars had a 2.7 times greater chance of an angle fracture than patients without third molars. Patients with their third molars present at occlusal position C and ramus position level 3 had a higher risk of angle fracture in comparison with other groups. There was a statistically significant variation in the risk of an angle fracture, depending on mandibular third molar position (P < .001).

CONCLUSION

Patients with mandibular third molars have an increased risk of angle fractures. The risk for an angle fracture varied depending on the third molar position.

The Influence of Mandibular Gonial Angle on Fracture Site

PURPOSE

The mandibular angle is influenced by multiple codependent morphologic dynamic factors, such as osseous anatomy, forces exerted by the muscles of mastication, occlusal loading patterns, and anatomic structures. These factors can influence the presence of a fracture in this area. Our research aimed to investigate a potential correlation between the risk of angle fractures and age, gender, fracture etiology, gonial angle size, presence of mandibular third molars, or presence of occlusal support.

MATERIALS AND METHODS

This retrospective cohort study was composed of patients treated for mandibular fractures between 2007 and 2018. The primary predictor variable was the gonial angle, and the primary outcome variable was the fracture site. Other study variables included demographic data, fracture etiology, third molar status, and presence of occlusal support. Appropriate univariate, bivariate, and multivariate statistics were applied, and statistical significance was set at P < .05.

RESULTS

Of 332 isolated mandibular fractures included, 109 were angle fractures; 165, condylar; and 58, body or symphysis. The mean age of patients with angle fractures was 25.5 years, compared with 31.3 years and 32.7 years for those with condylar fractures and body or symphysis fractures, respectively. The mean gonial angle was 125.4° in patients with angle fractures compared with 120.9° and 120.2° in those with condylar fractures and body or symphysis fractures, respectively. The variables that were found predictive of angle fractures were a wider gonial angle and the presence of third molars.

CONCLUSIONS

Third molars and the gonial angle are predictors of the location of mandibular fractures. Wide gonial angles and the presence of third molars are predictors of mandibular angle fractures.

Association Between Third Molar Impaction Status and Angle or Condylar Fractures of the Mandible: A Retrospective Analysis

PURPOSE

The aim of our study was to evaluate the correlations between mandibular third molar impaction status and mandibular angle and condylar fractures.

MATERIALS AND METHODS

This retrospective cross-sectional study included patients with unilateral and isolated angle or condylar fractures. Patient records and panoramic radiographs were evaluated. The predictor variables included the presence, impaction status (Pell and Gregory [P&G] classification), and angulation (Winter classification) of the third molar. The outcome variable was the type of fracture, whereas other predictor variables included demographic factors such as age, gender, and fracture etiology. Bivariate (χ² test) and logistic regression analyses were conducted to estimate the associations between variables and the outcome.

RESULTS

The sample was composed of 164 angle fracture (mean age, 31.6 ± 12.3 years; 83.5% male) and 115 condylar fracture (mean age, 41.9 ± 16.8 years; 76.5% male) patients. A third molar was present in 72.6% of the angle fracture group and 54.8% of the condylar fracture group (P = .002). Deep impactions (classes IC, IIC, IIIB, and IIIC) exhibited an odds ratio (OR) of 3.60 for angle fractures (P < .001). No association was found between tooth angulations and the type of fracture. According to logistic regression analysis, older age (adjusted OR, 1.05; 95% confidence interval [CI], 1.03 to 1.07), P&G class I impaction (OR, 1.86; 95% CI, 1.09 to 3.20), and P&G class A impaction (OR, 1.91; 95% CI, 1.12 to 3.24) were significantly associated with condylar fractures whereas the presence of a third molar (OR, 0.46; 95% CI, 0.28 to 0.76) or P&G class B impaction (OR, 0.287; 95% CI, 0.12 to 0.69) was associated with angular fractures.

CONCLUSIONS

P&G class II or III and class B impaction status was significantly associated with angle fractures, whereas missing or fully erupted (class IA) third molars significantly correlated with condylar fractures.

Anatomical and Radiological Investigation of Dry Bone Adult Mandibles Having Impacted Third Molar Teeth

OBJECTIVE

To investigate the incidence of the impacted mandibular third molars in dry bones adult mandibles.

METHODS

The 198 dry bones adult mandibles gathered from the bone collections in Laboratory of the Anatomy Department of Dokuz Eylul University School of Medicine were macroscopically examined for the presence of impacted mandibular third molars. The genders of the adult bones were unknown. The adult mandibles having impacted third molars were photographed with Canon 400B (55 mm objective). The mandibles having impacted third molars were also radiographically examined with orthopantomography (a dental radiographic technique, kV 60, mA 2.0) in radiology unit of Faculty of Dentistry, Ege University. The impacted teeth were grouped according to their position and degree of impaction.

RESULTS

The each of 2 of 198 adult mandibles (2/198; 1.01%) was having an impacted 3rd molar teeth. These 2 molar teeth were belonged to class 1, B and partially buried, vertically oriented. The first impacted 3rd molar teeth was located on the left side of the one mandible and the second one on the right side of the other mandible.

CONCLUSION

The present study provides information about impacted mandibular 3rd molar in dry bones.

Does an Association Exist Between the Presence of Lower Third Molar and Mandibular Angle Fractures?: A Meta-Analysis

PURPOSE

The current data suggest that the presence of lower third molars predisposes the patient to a greater risk of mandibular angle fracture. Thus, the present review sought to determine whether an association exists between the presence of a lower third molar and the occurrence of a mandibular angle fracture in adults and to assess the influence of third molar position according to the Pell and Gregory classification.

MATERIALS AND METHODS

The present study was a systematic review and meta-analysis of analytical observational studies. The present review included all reports of the relationship between mandibular angle fractures and lower third molars. No restriction regarding year, language, or publication status was used. The review protocol was registered at the PROSPERO database (registration no. CRD42016047057). Electronic searches unrestricted for publication period and language were performed in the PubMed, Scopus, SciELO, and Latin American and Caribbean Health Sciences databases. Google Scholar and OpenGrey databases were used to search the "gray literature," avoiding selection and publication biases. The entire search was performed by 2 eligibility reviewers. Association and proportion meta-analyses were planned for the studies with sufficient data. The primary predictor variable was the relationship between the presence of a lower third molar and the development of mandibular angle fractures. The secondary outcome variables were the vertical and horizontal positions of the lower third molar, according to the Pell and Gregory classification and their relationship to the susceptibility to developing a mandibular angle fracture.

RESULTS

The search strategies resulted in 411 studies, from which 16 were selected for qualitative and quantitative review. The association meta-analysis included all the selected studies and showed that patients with lower third molars are 3.16 times more likely to develop mandibular angle fractures. The proportion meta-analysis included 5 studies and showed that the overall rate of mandibular angle fractures was 51.58% and that positions III and C are more likely to result in fracture, with a rate of 59.84 and 63.67%, respectively.

CONCLUSIONS

The results of the present study have shown that the presence of impacted third molars increases by 3.16 times the risk of mandibular angle fractures in adults, with the greatest risk present when third molars are classified as IIIC according to Pell and Gregory. The available evidence is not sufficiently robust to determine whether third molar presence or the level of impaction is the main causative factor for the occurrence of mandibular angle fractures.

How Is Third Molar Status Associated With the Occurrence of Mandibular Angle and Condyle Fractures?

PURPOSE

Third molars (M3s) have been hypothesized to be associated with the risk of mandibular angle fracture and mandibular condylar fracture. The authors systematically estimated the relative risk (RR) of M3 status for the development of mandibular angle fracture and mandibular condylar fracture through a meta-analysis of cohort studies.

MATERIALS AND METHODS

In this systematic review, the PubMed, EMBASE, and Cochrane Library databases were searched from inception to October 2016. The predictor of risk was the presence or absence of M3s. The primary outcome was the RR of mandibular angle or condylar fracture. A fixed- or a random-effects model was applied to evaluate the pooled risk estimates. Sensitivity analysis also was performed to identify the potential sources of heterogeneity. Publication bias was assessed by the Begg and Egger tests.

RESULTS

Overall, 13 retrospective cohort studies were included. Of these, 13 reported the association between M3s and mandibular angle fracture, and 5 reported the association with mandibular condylar fracture. Patients with M3s had an increased risk of mandibular angle fractures (RR = 2.63; 95% confidence interval [CI], 2.15-3.21) but a decreased risk of mandibular condylar fractures (RR = 0.47; 95% CI, 0.25-0.86). Substantial heterogeneity in the risk estimates was found. No evidence of publication bias was found.

CONCLUSION

The present meta-analysis provides further evidence associating the presence of M3s with an increased risk of mandibular angle fractures and a simultaneously decreased risk of mandibular condylar fracture. Because of potentially more serious complications associated with condylar fracture, clinicians should carefully consider the decision to remove M3s to decrease the risk of mandibular angle fracture.

Influence of third molars in mandibular fractures. Part 1: mandibular angle-a meta-analysis

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars on angle fractures. An electronic search was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and VHL databases, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 35 studies were included in the systematic review and 28 in the meta-analysis. Twenty studies presented a score of ≤6 stars in the Newcastle-Ottawa scale assessment, indicating a risk of bias in the analysis. The presence of a mandibular third molar increases the chance of an angle fracture (case-control and cross-sectional studies: odds ratio (OR) 3.83, 95% confidence interval (CI) 3.02-4.85, I²=83.1%; case-control studies: OR 3.27, 95% CI 2.57-4.16, I²=81.3%). The third molar positions most favourable to angle fracture according to the Pell and Gregory classification are class B (OR 1.44, 95% CI 1.06-1.96, I²=87.2%) and class II (OR 1.67, 95% CI 1.36-2.04, I²=72.4%). Class A (OR 0.60, 95% CI 0.45-0.81, I²=87.1%) and class I (OR 0.51, 95% CI 0.37-0.71, I²=89.4%) act as protective factors for angle fracture. The results suggest that the presence of the third molar increases the chance of angle fracture by 3.27 times and that the most favourable positions of the third molar for angle fracture are classes B and II, whilst classes A and I act as protective factors.

Influence of third molars in mandibular fractures. Part 2: mandibular condyle-a meta-analysis

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle-Ottawa scale assessment. The presence of a mandibular third molar decreased the probability of condylar fracture (cross-sectional and case-control studies: odds ratio (OR) 0.26, 95% confidence interval (CI) 0.17-0.40, I²=87.8%; case-control studies: OR 0.30, 95% CI 0.16-0.58, I²=91.6%). The third molar positions most favourable to condylar fracture according to the Pell and Gregory classification are class A (OR 1.32, 95% CI 1.09-1.61, I²=0%) and class I (OR 1.37, 95% CI 1.05-1.77, I²=32.8%). Class B (OR 0.69, 95% CI 0.49-0.97, I²=56.0%) and class II (OR 0.71, 95% CI 0.57-0.87, I²=0%) act as protective factors for condylar fracture. The results suggest that the presence of a mandibular third molar decreases the chance of condylar fracture and that the positions of the third molar most favourable for condylar fracture are classes A and I, with classes B and II acting as protective factors.

Relation of Lower Last Molar Teeth With Mandibular Fractures

OBJECTIVES

The objectives of this study were to study and investigate the relation between the state of the lower last molar teeth eruption and the site of the mandibular fractures.

METHODS

Adult patients with traumatic mandibular fractures were included in this study. Panorama and computed tomography was performed for all patients. The relation between the state of the lower last molar eruption and criteria of the fracture was analyzed.

RESULTS

In 106 patients who had 168 mandibular fractures, impacted lower third molar teeth were found to significantly increase the incidence of mandibular angle fracture while they had nonsignificant effect on incidence of other sites of mandibular fractures.

CONCLUSION

Impacted lower third molar teeth significantly increase the incidence of mandibular angle fracture but did not have the same effect on other sites of mandibular fractures.

Correlation of Third Molar Status with Incidence of Condylar and Angle Fractures

The mandibular angle and condylar regions are most prone to fractures and this has been attributed to the presence/absence or the position of the third molars. This retrospective study was undertaken to analyze the correlation between the third molars and incidence of condylar and angle fractures in 104 patients treated for these fractures during the period from June 2009 to December 2013. Clinical and radiographic records of these patients were studied to look for the presence and position of third molars and their relation to incidence of condylar or angle fractures. There was a definite positive relation to impacted third molars and increased incidence of angle fractures. The condylar fractures were more commonly seen when the third molars were fully erupted or missing. Third molar impactions predispose to angle fractures and missing or fully erupted third molars predispose to condylar fractures.

A multi-centre retrospective study of mandibular fractures: do occlusal support and the mandibular third molar affect mandibular angle and condylar fractures?

This retrospective study was performed to investigate the influence of occlusal support and the presence, state, and position of mandibular third molars on the incidence of mandibular angle and condylar fractures. The following variables were investigated: age, sex, cause of fracture, presence and state (impaction, angulation, and the number of roots) of the mandibular third molars, site of the mandibular fracture, presence of occlusal support, duration of intermaxillary fixation, and postoperative complications. Various risk factors for mandibular angle and condylar fractures were investigated by univariate analysis. The risk of mandibular angle fracture was significantly higher in patients with occlusal support and mandibular third molars. The risk of condylar fracture was significantly higher in patients without occlusal support or mandibular third molars. The position and angulation of the mandibular third molars were not significant risk factors in mandibular angle and condylar fractures. This study demonstrated the influence of occlusal support and the presence of mandibular third molars on the incidence of mandibular angle and condylar fractures. The presence of occlusal support may be a more important factor affecting mandibular angle or condylar fractures than the position of the mandibular third molars.

Influence of the impacted mandibular third molars on fractures of the mandibular angle and condyle - A prospective clinical study

AIMS

This study was set out to evaluate the relationship between the presence and absence of unerupted mandibular third molar and fracture of mandibular angle/condyle, and to analyse if prophylactic removal of symptom-free unerupted mandibular third molar is beneficial.

METHODS

Hundred patients of mandible fracture were selected randomly irrespective of age, sex, caste, creed and socio-economic status. Data were collected from the patients on the basis of history, clinical examination and radiographs for the following information: age, sex, aetiology of fracture, presence and status of the mandibular third molar and location of mandible fracture.

RESULTS

In group A (partially/completely unerupted mandibular 3rd molar), the incidence of angle and condylar fracture was 44.44% and 13.33%, respectively, whereas in group B (fully erupted/missing mandibular third molar), the incidence of angle fracture was 14.45% and the incidence of condylar fractures was 31.77%.

CONCLUSION

Practice of prophylactic removal of mandibular third molar and resultant strengthening of angle region should be reconsidered, as it increases the risk of fracture at condylar region which is difficult to treat and associated with more morbidity.

Isolated bilateral mandibular angle fractures: an extensive literature review of the rare clinical phenomenon with presentation of a classical clinical model

Bilateral angle fractures are a rare clinical phenomenon in contrast to the incidence of unilateral angle fractures. However, the rarity has garnered less attention in spite of the uniqueness of fracture pattern and distinctive biomechanics. This article is a detailed review on the etiology, clinical presentation, and management of bilateral angle fractures with the presentation of an interesting case. The bilateral angle fracture reported is a untreated, malunited fracture representing an ideal clinical model to study its biomechanics. The clinical features were anterior open bite, increased facial height, and temporomandibular joint tenderness. The management included osteotomy at the malunion and miniplate osteosynthesis. Bilateral angle fracture presents mandible in three independent fragments (left angle, right angle, and intermediate corpus), each with strong muscles acting in different vectors. This makes the fracture vulnerable to severe displacing forces and unfavorable to achieve the optimal reduction, stability, and healing. This necessitates comprehension of the biomechanical forces involved to avoid malunion following fixation. The article details the complex biomechanics of mandibular angle and its clinical implications in the rare event of bilateral angle fractures. It describes the necessity for a systematic approach and ideal osteosynthesis principles to achieve maximal treatment outcomes and minimal complications.

Elderly patients with maxillofacial trauma: study of mandibular condyle fractures

BACKGROUND/AIM

The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities.

PATIENTS AND METHODS

Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted.

RESULTS

A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed.

CONCLUSIONS

The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals.

Does the presence or position of lower third molars alter the risk of mandibular angle or condylar fractures?

PURPOSE

The purpose of this study was to determine whether a relation exists between the presence of mandibular third molars (M3s) and mandibular angle and condylar fractures and whether the risk of these fractures varies with M3 position.

MATERIALS AND METHODS

A retrospective cohort study was conducted in patients with mandibular fractures presenting to the oral and maxillofacial surgery service from April 2007 to March 2012. Data sources were patients' hospital charts and panoramic radiographs. Predictor variables were the presence and position of M3s. M3 position was based on the Pell and Gregory classification and angulation was determined by measuring the angle between the long axis of the M3 and the mandibular occlusal plane. Outcome variables were the presence of angle and condylar fractures. Other study variables included age, gender, and fracture etiology. Data were analyzed using the χ(2) test and Student t test.

RESULTS

The study sample consisted of 446 patients with 731 mandibular fractures. Results showed that the risk of mandibular angle fracture was significantly higher in patients and mandible sides with impacted M3s (P < .001), whereas the risk of condylar fracture was significantly higher in patients and mandible sides lacking impacted M3s (P < .001). A relation between the position of M3s to angle or condylar fractures could not be found (P > .05).

CONCLUSION

The presence of impacted M3s increased the risk of angle fracture and simultaneously decreased the risk of condylar fracture. However, no relation appeared to exist between M3 position and fracture pattern.

Does the Relationship between Retained Mandibular Third Molar and Mandibular Angle Fracture Exist? An Assessment of Three Possible Causes

The objective of this study is to discuss problems associated with dental retention through three clinical cases of mandible fractures related to the presence of retained lower third molars, emphasizing the possibility of mandible fractures resulting from this or from the extraction procedure. The three evaluated patients had a fracture in the mandible angle. The third molars were present in all the cases, as was the relationship of the fracture with the teeth. After evaluating the three cases and reviewing literature, it is believed that the presence of the retained lower third molars and the surgical procedures for their extraction increase the risk of mandible angle fractures.

Incidence and pattern of maxillofacial fractures in children and adolescents: a 10 years retrospective cohort study

OBJECTIVE

The purpose of this study was to evaluate and compare the demographic characteristics of maxillofacial fractures between children and adolescents.

METHODS

The sample was composed of all children (less than 12 years) and adolescents (between 13 and 18 years old) who presented with maxillofacial fractures during a 10-year period (2000-2009). The age, gender, time of injury, mechanism of trauma, location and pattern of fracture, associated injuries, and treatment methods were recorded and analyzed. Data analysis included Chi-Square test, Fisher exact test. p less than 0.05 was considered significant.

RESULTS

Seventy-nine children (male-to-female ratio, 1.63:1) and 113 adolescents (male-to-female ratio, 3.52:1) sustained 389 maxillofacial fractures. Children were more involved in falls compared to adolescents (44.3% versus 23.9%, p=0.003), while adolescents sustained more assault-related injuries (13.3% versus 2.5%, p=0.010) and motorcycle accidents (22.1% versus 8.9%, p=0.015) compared to children. Children suffered mandibular fractures proportionally higher than adolescents (93.1% versus 64.5%, p<0.001). Adolescents sustained mid-facial fractures more frequently than children (35.5% versus 6.9%, p<0.001). Severe facial fractures occurred more in adolescents compared to children (35.4% versus 14.1%, p=0.001). Open reduction was done more in adolescents than in children (92.3% versus 74.6%, p<0.001).

CONCLUSIONS

The incidence and pattern of maxillofacial fractures in children were remarkably different from that in adolescents. Preventive measures and treatment plan should be designed with differences between the two groups in mind.

Effect of lower third molars on the incidence of mandibular angle and condylar fractures

PURPOSE

Numerous previous studies already have proven that mandibles with a third molar are significantly more susceptible to angle fracture by external force. Similarly, other data suggest that the absence of a third molar increases the risk of condylar fracture, while concurrently decreasing the risk of angular fracture. We attempt to characterize the effect of a third molar on the incidence of mandibular angle and condylar fractures.

METHODS

This retrospective study reviews data from 385 patients, all of whom were seen in our clinics between February 2006 and November 2009. All data were collected from clinical examination notes and panoramic radiographs, with third-molar state evaluated by the Pell and Gregory classification system.

RESULTS

Our results mirror those of previous studies. The incidence of mandibular angle fracture was significantly greater on sides with a third molar, whereas the condylar fracture rate significantly increased in mandibles lacking a third molar or without a fully erupted third molar. The rate of symphysis and mandibular angle fracture was also high in cases of multiple comorbid fractures.

CONCLUSIONS

Both the presence and the state of the lower third molar affect the risk of future mandibular angle and condylar fracture.

Considerations of mandibular angle fractures during and after surgery for removal of third molars: a review of the literature

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.

CONCLUSIONS

The danger of an immediate jaw fracture can be avoided by means of proper instrumentation and by refraining from excessive force on the bone. The tooth should be sectioned in such a way as to minimize the extent of bone removal and force caused by instrumentation. The danger of a late jaw fracture can be avoided by precise diagnosis in cases of patients over 25 years of age, particularly men, whose tooth roots are superimposed on or adjacent to the inferior alveolar canal on a panoramic image, any local pathology and systemic disease or medications which may impair bone strength, and patients who present bruxism and are active athletes.

Extraction versus nonextraction management of third molars

Surgical removal of impacted third molars is the most commonly performed procedure by oral and maxillofacial surgeons. The removal of diseased or symptomatic third molars has not been an issue of controversy. The risk of surgery and associated complications are justified and uniformly accepted by most surgeons when the teeth are associated with chronic or acute pathologic processes, including caries, nonrestorable teeth, fractured roots, resorption, associated pathologic conditions (cysts, tumors), periapical abscesses, odontogenic infections, osteomyelitis, removal before reconstructive or ablative surgery, and radiation therapy.

Does the presence of mandibular third molars increase the risk of angle fracture and simultaneously decrease the risk of condylar fracture?

Previous studies have shown that impacted mandibular third molars (M3s) increase the risk of mandibular angle fractures and decrease the risk of mandibular condylar fractures. This study attempted to verify these relationships and identify the influence of mechanism and cause of injury. The incidence of fractures was compared in 700 patients with and without impacted M3s. The results showed that patients with impacted M3s had a lower risk of condylar fracture and a higher risk of angle fracture than those without impacted M3s when injured by moderate trauma force. Such relationships could not have been identified when patients were injured by high trauma force. Patients with impacted M3s had a higher risk of angle fracture than those without impacted M3s no matter how they were injured (assault, fall, motor vehicle accident, other). When patients were injured by assault or in a motor vehicle accident, those with impacted M3s were less likely to have a condylar fracture. M3s were a dominant factor for developing a mandibular angle fracture and preventing condylar fracture. The risk of angle fracture was much more affected by impacted M3s than that of condylar fracture, when injury mechanism and cause were taken into consideration.

Do pathologies associated with impacted lower third molars justify prophylactic removal? A critical review of the literature

Surgical removal of impacted lower third molars is widely carried out in general dental practice and in many institutional clinics. Despite the fact that there are well established indications for the removal of impacted lower third molars, prophylactic removal of these teeth is still being universally practiced. Some reports have estimated that the proportion of impacted third molars that are removed when no clinically sound justification for surgery is present is between 18% and 50.7%. Justifications for prophylactic surgery include the need to minimize the risk of disease (cysts and tumors) development, reduction of the risk of mandibular angle fracture, increased difficulty of surgery with age, and that third molars have no definite role in the mouth. This article critically examines the literature regarding the relationship between impacted lower wisdom teeth, cysts and tumor development, and mandibular fractures.

Relationship between the risk of mandibular angle fractures and the status of incompletely erupted mandibular third molars

BACKGROUND

Several studies have shown the increased risk of mandibular angle fractures associated with incompletely erupted mandibular third molars. But only a few reports analysed in detail the relationship of the status of eruption of this tooth and this type of fracture.

OBJECTIVES

The purpose of this study was to clarify the influence of the eruption status of incompletely erupted mandibular third molars on the incidence of mandibular angle fractures.

METHODS

Four hundred and thirty-six mandibular halves in 218 patients with mandibular fractures, aged between 15 and 40 years old, were analysed using panoramic radiographs.

RESULTS

The incidence of angle fractures in the mandibular halves with incompletely erupted mandibular third molars was 30.8% and this was statistically significantly higher than that in another group (p<0.0001). Deeply located mandibular third molars clearly showed a higher incidence of this fracture when compared with the adjacent second molar (p<0.0001).

CONCLUSION

The results of this investigation showed that incompletely erupted mandibular third molars close to the inferior border of the mandible have a high risk of angle fractures.