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

Abstract

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.

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

“…Our models and results elucidate how the removal of M3s can increase the short-term risk of angle fractures, aligning with clinical observations. The findings of this study indicate that the presence of lower M3 may increase the likelihood of mandibular angle fractures, while the extraction of incompletely erupted mandibular M3 can decrease the probability of mandibular angle fractures, consistent with previous research [28,30,37]. Fractures in the mandibular angle region are influenced by many factors such as the retromolar space, perimeter of the cross-section just proximal to the second molar, breadth of the ramal cross-section, thickness of the oblique ridge, transgonial angle, location of the ipsilateral mental foramen, and occlusal support [38][39][40][41][42].…”

“…In the past decade, clinical articles have predominantly been retrospective studies involving large samples comprising hundreds of patients with mandibular angle and/ or condylar fractures [5,8,[28][29][30][31][32][33]. The results and conclusions drawn from these studies are robust and compelling.…”

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

“…Our models and results elucidate how the removal of M3s can increase the short-term risk of angle fractures, aligning with clinical observations. The findings of this study indicate that the presence of lower M3 may increase the likelihood of mandibular angle fractures, while the extraction of incompletely erupted mandibular M3 can decrease the probability of mandibular angle fractures, consistent with previous research [28,30,37]. Fractures in the mandibular angle region are influenced by many factors such as the retromolar space, perimeter of the cross-section just proximal to the second molar, breadth of the ramal cross-section, thickness of the oblique ridge, transgonial angle, location of the ipsilateral mental foramen, and occlusal support [38][39][40][41][42].…”

“…In the past decade, clinical articles have predominantly been retrospective studies involving large samples comprising hundreds of patients with mandibular angle and/ or condylar fractures [5,8,[28][29][30][31][32][33]. The results and conclusions drawn from these studies are robust and compelling.…”

Role of third molars in mandibular fractures: a systematic umbrella review with updated meta-analysis

“…Thirty-two studies were qualified to be included in the updated meta-analysis ( 8 , 21 , 27 – 56 ). Moreover, a literature search was conducted independent of the included MAs and this revealed another 10 primary studies published after the last MA on the topic ( 57 – 66 ). Finally, 42 unique studies were included.…”

The interaction between third molars and surrounding periapical tissues in mandibular stress distribution during high-impact trauma: a finite element study

“…Contrarily, observational studies report a higher risk of angular fractures with 3Ms present and condylar fractures when absent ( 11 , 15 - 17 ). Although conflicting evidence exists regarding dental impaction's role in fracture occurrence, some studies suggest fully erupted 3Ms may correlate with increased condylar fractures ( 18 , 19 ). Notably, Mohammed Al-Sharani et al .…”

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

“…Our models and results elucidate how the removal of M3s can increase the short-term risk of angle fractures, aligning with clinical observations. The findings of this study indicate that the presence of lower M3 may increase the likelihood of mandibular angle fractures, while the extraction of incompletely erupted mandibular M3 can decrease the probability of mandibular angle fractures, consistent with previous research [28,30,37]. Fractures in the mandibular angle region are influenced by many factors such as the retromolar space, perimeter of the cross-section just proximal to the second molar, breadth of the ramal cross-section, thickness of the oblique ridge, transgonial angle, location of the ipsilateral mental foramen, and occlusal support [38][39][40][41][42].…”

“…In the past decade, clinical articles have predominantly been retrospective studies involving large samples comprising hundreds of patients with mandibular angle and/ or condylar fractures [5,8,[28][29][30][31][32][33]. The results and conclusions drawn from these studies are robust and compelling.…”

Role of third molars in mandibular fractures: a systematic umbrella review with updated meta-analysis

“…Thirty-two studies were qualified to be included in the updated meta-analysis ( 8 , 21 , 27 – 56 ). Moreover, a literature search was conducted independent of the included MAs and this revealed another 10 primary studies published after the last MA on the topic ( 57 – 66 ). Finally, 42 unique studies were included.…”

The interaction between third molars and surrounding periapical tissues in mandibular stress distribution during high-impact trauma: a finite element study

“…Contrarily, observational studies report a higher risk of angular fractures with 3Ms present and condylar fractures when absent ( 11 , 15 - 17 ). Although conflicting evidence exists regarding dental impaction's role in fracture occurrence, some studies suggest fully erupted 3Ms may correlate with increased condylar fractures ( 18 , 19 ). Notably, Mohammed Al-Sharani et al .…”

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

“…Our models and results elucidate how the removal of M3s can increase the short-term risk of angle fractures, aligning with clinical observations. The findings of this study indicate that the presence of lower M3 may increase the likelihood of mandibular angle fractures, while the extraction of incompletely erupted mandibular M3 can decrease the probability of mandibular angle fractures, consistent with previous research [28,30,37]. Fractures in the mandibular angle region are influenced by many factors such as the retromolar space, perimeter of the cross-section just proximal to the second molar, breadth of the ramal cross-section, thickness of the oblique ridge, transgonial angle, location of the ipsilateral mental foramen, and occlusal support [38][39][40][41][42].…”

“…In the past decade, clinical articles have predominantly been retrospective studies involving large samples comprising hundreds of patients with mandibular angle and/ or condylar fractures [5,8,[28][29][30][31][32][33]. The results and conclusions drawn from these studies are robust and compelling.…”

Role of third molars in mandibular fractures: a systematic umbrella review with updated meta-analysis

“…Thirty-two studies were qualified to be included in the updated meta-analysis ( 8 , 21 , 27 – 56 ). Moreover, a literature search was conducted independent of the included MAs and this revealed another 10 primary studies published after the last MA on the topic ( 57 – 66 ). Finally, 42 unique studies were included.…”

The interaction between third molars and surrounding periapical tissues in mandibular stress distribution during high-impact trauma: a finite element study

“…Contrarily, observational studies report a higher risk of angular fractures with 3Ms present and condylar fractures when absent ( 11 , 15 - 17 ). Although conflicting evidence exists regarding dental impaction's role in fracture occurrence, some studies suggest fully erupted 3Ms may correlate with increased condylar fractures ( 18 , 19 ). Notably, Mohammed Al-Sharani et al .…”