Pathological mandibular fractures following third molar removal

Wagner, Kai Wolfgang; Otten, Jörg-Elard; Schoen, Rudolf; Schmelzeisen, Rainer

doi:10.1016/j.ijom.2005.03.003

Cited by 66 publications

(95 citation statements)

References 9 publications

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“…Our female patient was 28 years old were at low risk for mandibular fracture. Wagner [10] noted that more (70%) iatrogenic mandibular fractures occur on the left side, perhaps due to the reduced visualization of an operation site on this side provided by the surgeon's normal position. Bodner, et al [9] found no difference in the occurrence of fractures on the right and left sides.…”

Section: Discussionmentioning

confidence: 99%

Unfavorable Mandibular Body Fracture Associated with First Molar Removal: Report of a New Case

H¹

2017

Austin J Dent

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First molar extraction is one of the most common procedures performed in dentistry units. It is sometimes accompanied by complications such as alveolar osteitis, infection, hemorrhage, dysesthesia and also iatrogenic fracture. This article describes a rare case of mandibular body fracture that occurred in patient during the extraction of one erupted first molar, including a brief review of the literature. Keywords: First molar extraction; Complication; Mandibular fracture Case PresentationA 28-year-old female was referred to our department by a general dental practitioner (GDP) after the dentist attempted to extract the patient's lower first molar tooth with forceps. She was a healthy young woman with no history of significant medical problems. In intraoral examination there was a mandibular body fracture in socket place with mobile parts, the patient was unable to open her mouth ( Figure 1,2). Based on details indication of extraction was carries and pain of first molar. The radiographic examination revealed a mandibular unfavorable body fracture including buccal and lingual table and also a remained root ( Figure 3,4 and 5). The patient also stated that while the dentist was extracting the tooth, he had used the forceps without supporting the alveolar bone segment. After general anesthesia with nasal intubation, by intaoral vestibular incision the fracture line was exposed and the remained root was surgically extracted, then upper and lower IMF screws was placed and the patient fixed in occlusion with wire, then the fracture line was reduced anatomically and fixed with miniplates and screws, then IMF wires opened and mouth opening was controlled and incision sutured. The patient had IMF for 2 weeks (Figure 6,7), an uneventful recovery and normal occlusion. DiscussionDentists encounter a wide range of hard-tissue injuries in practice. Dental extractions are one of the most common procedures in dentistry and may lead to several complications, including sinus complications, osteitis, infection, dysesthesia, pain, and bleeding [1,2]. Frequently seen injuries include those associated with concomitant dentoalveolar trauma and those inadvertently caused by the dentist in practice. Factors affecting the incidence and etiology of iatrogenic mandibular fractures include the magnitude of tooth impaction, type of tooth angulation, length of roots, patient age, age and experience of the surgeon, presence of a cyst or tumor around teeth, systemic disease or medications that may impair bone strength, preoperative infections in the site, and inadequate preoperative examination [3][4][5]. A fracture occurs when the strength of the bone is overcome by the forces acting on it. The mandible is fractured 2-3 times more frequently than other facial bones because it has less bony support [6,7]. The body of the mandible is naturally strengthened by a system of buttresses extending onto the ramus. We believe that the fracture Case Report

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Section: Discussionmentioning

confidence: 99%

Unfavorable Mandibular Body Fracture Associated with First Molar Removal: Report of a New Case

H¹

2017

Austin J Dent

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“…After a reading of the articles had been performed for verification of the inclusion criteria, 11 articles were selected for the present review (Table 1). No literature reviews (14), mechanical assays with computer simulation (15), or metaanalyses (11) presenting a type of study or approach different from that evaluated in the present study (2,(16)(17)(18)(19)(20) and that did not define angle fracture (21) were selected. Among the articles selected, those presenting some type of sample limitation, for example, including a specific group of individuals (22,23), those not differentiating between erupted and absent third molars (24), and those including samples previously used in other studies (9,10,25) were excluded, with only studies remaining that clearly reported the data of the sample (8).…”

Section: Methodsmentioning

confidence: 99%

Do third molars weaken the mandibular angle?

Tp¹,

Ec²,

Ic³

et al. 2011

Med Oral

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Objective: The purpose of this study is to estimate how is the magnitude of the impact of a mandibular third molar on the mandibular angle stiffness. Study Design: It was performed a literature search on whole MEDLINE and LILACS data base to find articles that match the following inclusion criteria: cohort studies presenting data on patients with mandibular fractures and third molars; that had a similar angle fracture definition; and that present data available to be cross-classified in a statistic analysis. Results: The sample was composed by 4 studies, involving 2533 patients from USA, Nigeria, Germany and Jordan, evaluated between 1976 and 2001. The analysis of the sample shows a relative risk for a mandibula to fracture, comparing patients with and without third molars, ranging from 1,18 to 2,25. The data of the sample was grouped because of the homogeneity of the articles methods. The estimated relative risk across the 4 studies was 1,94 (95% CI 1,6 -2,35). Conclusions: The presence of a third molar may double the risk of an angle fracture of the mandible to occur. Even with this data, the present study cannot support conditions related to the third molar that may affect this impact. Further studies are necessary to discuss the true indication of removal of these teeth as a prophylactic measure in population groups more predisposed to fracture.

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“…Tal procedimento consiste na remoção de osso ao redor da coroa dentária, com o auxílio de instrumentos rotatórios e brocas cirúrgicas, com a finalidade de exposição da mesma. A posterior odontossecção é realizada para facilitar a trajetória de saída do dente de seu alvéolo e evitar osteotomias extensas que levam a fragilidade mandibular 19 . Após a remoção de dentes que necessitaram de grandes osteotomias ou inclusões profundas, a mandibula se apresentará atrófica no pós-operatório e cuidados devem ser tomados para evitar a fratura espontânea 20 .…”

Section: Fratura Mandibular Associada à Remoção Dos Terceiros Molaresunclassified

Fratura mandibular associado à remoção de terceiro molar inferior: revisão de literatura

Lima¹,

Figueiredo²,

Momesso³

et al. 2017

Arch Health Invest

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ResumoA remoção dos terceiros molares inferiores é um procedimento frequente nas clínicas e consultórios odontológicos. Para remoção destes elementos o profissional deve conhecer os possíveis acidentes ou complicações. A fratura mandibular durante ou após este procedimento é uma complicação que pode ser evitada com o auxílio de exames de imagens adequados e técnica cirúrgica bem executada. Os procedimentos cirúrgicos realizados para remoção destes dentes muitas vezes requerem osteotomias e odontosecção com brocas cirúrgicas e o uso de alavancas, sendo que o mal uso de ambas, associado ao padrão de inclusão geram fragilidade do osso mandibular aumentando a possibilidade de fratura no trans ou pós-operatório. O objetivo deste trabalho foi revisar a literatura sobre os aspectos clínicos e tratamentos realizados para restauração das fraturas mandibulares durante ou após a remoção dos terceiros molares inferiores. Concluímos que a fratura mandibular durante ou após a extração dos terceiros molares inferiores, embora rara, é uma complicação complexa que pode ocorrer durante a aplicação de forças excessivas para remoção do elemento dental ou no pós-operatório durante a mastigação, principalmente nas três primeiras semanas. Descritores: Cirurgia Bucal; Fraturas Mandibulares; Terapêutica. AbstractThe removal of third molars is a common procedure in clinics and dental offices. For removal of these elements the surgeon must know the possible accidents or complications. The mandibular fracture during or after this procedure is a complication which should be avoided with the aid of appropriate imaging and surgical technique performed well. The surgical procedures performed to remove these teeth often require osteotomies and odontosection with surgical drills and the use of levers. However, the misuse of both, associated with the inclusion pattern, generate fragility of the mandibular bone increasing the possibility of fracture in the trans or post -operation. The aim of this study was to review the literature on the clinical aspects and treatment provided for restoration of mandibular fractures during or after removal of third molars. We conclude that the mandibular fracture during or after extraction of lower third molars, although rare, is a complex complication that can occur during the application of excessive force to remove the dental element or postoperatively during mastication, especially the first three weeks. Descriptors: Surgery, Oral; Mandibular Fractures; Therapeutics. ResumenLa extracción de los terceros molares es un procedimiento común en las clínicas y consultorios dentales. Para la eliminación de estos elementos técnicos deben conocer los posibles accidentes o complicaciones. La fractura mandibular durante o después de este procedimiento es una complicación que debe evitarse con la ayuda de formación de imágenes adecuadas y técnica quirúrgica realizada también. Los procedimientos quirúrgicos para la eliminación de estos dientes a menudo requieren osteotomías y odontosección con fresas quirúrgicas y el uso ...

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Pathological mandibular fractures following third molar removal

Cited by 66 publications

References 9 publications

Unfavorable Mandibular Body Fracture Associated with First Molar Removal: Report of a New Case

Unfavorable Mandibular Body Fracture Associated with First Molar Removal: Report of a New Case

Do third molars weaken the mandibular angle?

Fratura mandibular associado à remoção de terceiro molar inferior: revisão de literatura

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