A Clinical Study of Mandibular Angle Fracture

Characteristics and management of teeth in the line of mandibular fractures treated with internal fixation

BACKGROUND/AIMS

The ideal management of teeth in the line of mandibular fractures is unclear and controversial. The aim of this study was to analyze the characteristics and management of teeth in the line of mandibular fractures treated with open reduction and internal fixation.

MATERIAL AND METHODS

Medical records of patients with mandibular fractures in the symphysis, body and angle regions seen between July 2019 and January 2021 were evaluated. Personal data, etiology, location of fractures, characteristics of the teeth involved in the fracture lines and management were collected. The relationship between the fracture lines and the periodontium was classified according to Kamboozia & Punnia-Moorthy. Fractures were divided into two groups according to the management of the tooth in the fracture line: removal and retention. The likelihood ratio test was used (p < .050).

RESULTS

During the study period, 52 patients with mandibular fractures were seen, of which 42 patients (83.3% men) with a mean age of 29.6 years and 54 fractures were included. The most frequent location was the angle of the mandible (41.3%) (p < .001). The removal group represented 35.2% of the fractures, and the retention group represented 64.8%. The most frequently removed tooth was the third molar (p < .001), and the most frequent classification of dental involvement in the fracture line was type II (p = .047). There was no correlation between age, gender, or etiology and the management of the teeth involved.

CONCLUSION

The retention of teeth in the fracture line predominated, and the third molar in angle fractures was the most often removed tooth when the fracture line followed the root surface but did not cross the apical region, probably due to the greater frequency of this type of relationship between the fractures and the periodontium.

Correlation of radiomorphometric indices of the mandible and mandibular angle fractures

This study assessed the correlation of radiomorphometric indices of the mandible and mandibular angle fractures (MAFs) in an Iranian population. This retrospective study was conducted on 3D computed tomography (CT) scans of 118 patients between 18 to 60 years. The images were divided into two groups with MAFs and other types of mandibular fractures (non-MAF). The gonial angle, ramus height, condylar neck width, minimum ramus width, and mandibular length were all measured using MARCO PACS software. Age, gender, and presence and eruption status of third molar at the fracture side were all recorded. The correlation between these parameters and MAF was analyzed using R software (alpha = 0.05). Of all patients, 41 samples had MAF. The two groups were not significantly different regarding the mean age and gender (P > 0.05). The mean size of gonial angle and ramus height in the MAF group were significantly larger, and smaller than the corresponding values in the non-MAF group, respectively (P < 0.001). The median minimum ramus width in the MAF group was significantly smaller than that in the non-MAF group (P = 0.001). Patients with a large gonial angle had 6.6 times higher odds of MAF compared with other fracture types (P = 0.046). Condylar neck width, mandibular length, and erupted third molars had no significant correlation with type of fracture. Presence of impacted third molar increased the odds of MAF by 5.55 times.

Patients with a large gonial angle, short ramus height, minimum ramus width, and impacted third molar are more susceptible to MAF. Surgeons can use these indices to predict the risk of MAF in trauma patients with such facial characteristics, and make a diagnosis by radiographic modalities.

Morbidity of Teeth in Mandibular Fracture Lines - A Retrospective Study

BACKGROUND/AIM

Teeth in mandibular fracture lines is common in maxillofacial trauma, but their retention or extraction is a matter of controversy. The aim of this study was to determine the factors related to retaining or extracting teeth situated in mandibular fracture lines and to decide the best treatment option.

METHODS

The study included 115 patients with a single mandibular fracture that had a tooth in the line of fracture. All patients were evaluated for complications and pulp status. Patient distribution was analyzed according to the complications that occurred. Statistical analysis was performed using SPSS 13.0 software.

RESULTS

There were significant effects of tooth type and tooth location on the occurrence of complications. There were no significant differences in the occurrence of complications between the retained teeth group and the extracted teeth group irrespective of age and gender in adult patients. There were significant differences in treatment procedures between the retained teeth group and the extracted teeth group.

CONCLUSION

Mandibular anterior teeth involved in the fracture line should be retained, while in the mandibular angle area, they should be extracted because retaining teeth in this region increases the prediction of complications. There is no role of pulp testing in the assessment of pulp status, but root canal treatment of retained teeth helps to reduce the occurrence of complications. This article is protected by copyright. All rights reserved.