Assessment of relationships between condylar fracture pattern and mandibular third molar position by panoramic radiography and computed tomography: A retrospective comparative study

Abstract

Background/AimAlthough previous studies have revealed the influence of the mandibular third molar (M3) on mandibular condylar fracture risk and that the presence of M3 could result in different incidences of condylar and angle fractures, there have been no analyses of the influence of M3 on fracture patterns. Moreover, evaluations of M3 position using panoramic radiography have shown insufficient accuracy. This study investigated the relationship between condylar fracture patterns and M3 position using panoramic radiography and computed tomography.Materials and MethodsThis retrospective study included 280 patients with unilateral mandibular condylar fractures and ipsilateral M3 admitted to West China Hospital of Stomatology between January 2016 and June 2022. Patient medical records, panoramic radiographs, and computed tomography images were collected. The vertical and horizontal positions of M3 were classified using the Pell and Gregory system. M3 angulation was defined as the angle between the long axis of M3 and the mandibular occlusal plane. Condylar fracture patterns were classified as intracapsular (Types A–C) or extracapsular (neck and base). Data were analyzed using McNemar–Bowker test, Pearson chi‐squared test, and Fisher's exact test.ResultsClassification of M3 position differed significantly between panoramic radiography and computed tomography images (p < .05). There was a significant association between the mandibular condylar fracture pattern and M3 horizontal position on computed tomography (p < .05). Class I M3 position on computed tomography was associated with a higher incidence of intracapsular than extracapsular fractures, along with a higher incidence of Type B than base fractures; the opposite relationships were observed for Class II. No such association was identified on panoramic radiography.ConclusionsMandibular condylar fracture patterns were presumably influenced by M3 horizontal position on computed tomography. The imaging modality affected the classification of M3 position and subsequent analyses. Computed tomography is recommended for future studies to improve accuracy and reliability.

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“…Furthermore, an assessment of the agreement between panoramic radiographs and CT in terms of mandibular third molar positioning is provided. 37 Understanding the relationship between mandibular third molar position and condylar fracture pattern may have a significant impact on treatment decisions in trauma cases.…”

Enhancing treatment outcomes in dental traumatology—dental trauma first aid and the implementation of mouthguards

“…Roughly half of all maxillofacial injuries primarily impact the lower third of the face, with a notable emphasis on the condyle region 37 . The primary causes of mandibular condylar fractures are falls, road traffic accidents, and assaults 38–40 . In terms of epidemiological distribution, males constitute a larger proportion of mandibular condylar fractures, while the incidence among the pediatric population is relatively lower compared to adults 39,41 .…”