The literature has been inundated with research evidence associating the incidence of mandibular angle and condyle fractures to the presence or absence of an impacted third molar respectively. However, no consensus has been reached regarding the level of risk associated with the status of the third molar and its predisposition to mandibular angle or condyle fracture. This systematic review seeks to articulate the existing evidence. After a rigorous search of medical databases, relevant articles were selected and critically appraised using a mixed model analysis. The findings confirmed an inverse relationship between mandibular angle and condyle fractures; angle fractures increase with the presence of impacted third molar, while condyle fractures reduce with the presence of impacted third molar. In a simple meta-analysis, this relationship tested statistically significant (P = 0.04) with a strong correlation coefficient of 0.732. This evidence lies between Level III(Limited) and Level II (Limited) on the hierarchy of evidence. A simple guideline is proposed to guide clinical decisions on third molar surgery in trauma-prone individuals.
Clinical relevanceScientific rationale for the study To determine mandibular angle/condyle fractures risk in the presence/absence of an impacted M3, and the most important predictor variables.
Principal findingsRisk of angle fracture increases with the presence of impacted M3; however, removal of the tooth also predisposes to angle fracture within the first 1-4 weeks when undertaken within the 4th-5th decade of life. Combined angulation, depth and distal room score is a good predictor. Conversely, absence of M3 predisposes to condyle fractures.
Practical implicationProphylactic removal of the third molar is discouraged to avoid the more complicated condyle fracture.If removal is undertaken for therapeutic reason, preemptive measures should be recommended.Oral Surgery 10 (2017) e7--e16.
