Impact of impacted mandibular third molars in mandibular angle and condylar fractures

Previous retrospective analyses prove that impacted mandibular third molars (M3s) increase the risk of angle fractures and decrease the risk of concomitant fractures to the condyle. The authors have attempted to verify these relationships and identify the underlying mechanism of injury. A retrospective cohort was designed for patients attending the Division of Oral and Maxillofacial Surgery from January 2001 till October 2008. The primary predictor variable was M3. The secondary predictor variables were: M3 position, classified using the Pell and Gregory system; angulation, classified using Shiller's method; and the number of visible dental roots. The outcome variables were angle and condyle fractures. Hospital charts and radiographs were used to determine and classify these variables. The study sample comprised 1102 mandibular fractures in 600 patients. For patients injured by moderate traumatic force resulting in two fractures of the mandible, the presence/absence of impacted M3s played an important role in angle/condylar fractures. Patients with impacted M3s were three times more likely to develop angle fractures and less likely to develop condylar fractures than those without impacted M3s. This study provides clinical evidence to suggest that the removal of unerupted mandibular third molars predisposes the mandible to condyle fractures.