Iatrogenic Fracture of the Lower Jaw: A Rare Complication of Lower Molar Extraction

Abstract

Iatrogenic mandible fracture is a rare complication of a tooth extraction with an incidence between 0.0033–0.0034%. This study retrospectively analyzes a total of 8 patients who underwent lower molar extraction associated with mandible fracture during tooth removal in the period from April 2006 to March 2019. The assessed parameters were age and sex of patients, method of tooth extraction, side distribution of fracture, type of extracted tooth, the position of a lower third molar, presence of bone pathological lesion formed in connection with a tooth, displacement of bone fragments, and sensory impairment in the innervation area of the mental nerve. The position and impaction of the lower third molars were evaluated according to Pell and Gregory’s classification and Winter’s classification. One fracture was left-sided, and 7 fractures were right-sided. In 6 cases, Winter’s extraction elevator was used. In 7 patients, the mandible fracture was treated surgically by performing stable osteosynthesis with the plates and screws. One patient was treated conservatively. This work analyzes the causes of iatrogenic mandible fractures and provides recommendations to reduce the risk of their occurrence.

Evaluation of residual bone mass of the mandibular third molar and the risk of mandibular fracture

“…This case also suggests reconsidering the definition of the B value as the shortest distance from the mandibular M3 to the mandible's edge, potentially offering a more accurate metric for fracture risk assessment. Meanwhile, Case H ( 22 ), involving a fracture following the extraction of the left mandibular second molar, indicates that areas with less bone surrounding the second molar might require simultaneous preoperative risk assessment and B/A ratio evaluation with extraction. These findings suggest that the B value should be adapTable based on the specific conditions of the mandible.…”

Accidental Intraoperative Mandibular Fracture in a Third Molar Surgery: When Surgical Skills Are Mandatory in the Face of Empiricism

“…Of note, even when no intraoperative fracture results from an exaggerated osteotomy—a characteristic of lacking manual dexterity—the bone unnecessarily lost may aggravate the mandible weakening and lead to a postoperative fracture. Despite rare occurrences (~26% of cases), intraoperative fractures of the mandible associated with lower third molar extraction are a potential complication that may impact patients' quality of life, provoke a traumatic experience and tissue injury, such as swelling, pain, facial asymmetry, and nerve damage [ 6 , 7 , 16 ]. Thus, it is mandatory for oral surgeons to ponder the multiple variables involved among different patients to minimize the risks of any complication.…”

“…Despite the low incidence of complications, a third molar surgery may also lead to a rare, but the most severe of the complications: the mandible fracture [6]. Associated with third molar surgeries, the incidence of mandible fractures is below 0.005% [6,7]. Different from postoperative fractures, which occur within the first postoperative month, intraoperative fractures-also known as immediate fractures-occur specifically in the transoperatory [7][8][9].…”

“…Associated with third molar surgeries, the incidence of mandible fractures is below 0.005% [6,7]. Different from postoperative fractures, which occur within the first postoperative month, intraoperative fractures-also known as immediate fractures-occur specifically in the transoperatory [7][8][9].…”