The Role of Impacted Third Molars in Mandibular Angle Fractures: Findings from Trauma-Related Panoramic Radiographs

Abstract

Introduction: Mandibular angle and condylar fractures are highly prevalent maxillofacial in­juries. The presence of impacted third molars may influence fracture patterns by weakening man­dibular biomechanics, though the literature remains controversial. Deeper impactions, angulation, and root morphology have been variably associated with fracture risk. This study aims to inves­tigate the effect of the presence of impacted third molars and their characteristics on mandibular fracture.

Materials and Methods: Panoramic images of 300 patients with mandibular fractures were examined. The presence of impacted third molars, position, angle, number of roots, and distance from the inferior border of the mandible were considered as independent variables, while the loca­tion of the fracture was considered as the dependent variable.

Results: The presence of impacted third molars increased mandibular angle fracture odds by 11.15-fold but decreased condylar fracture odds by 0.28-fold. Class B and Class 3 impactions had higher angle fracture odds compared to Class A and Class 1, respectively. Distoangular or hori­zontal molars increased angle fracture odds 5.09 and 4.22. The odds of angle fracture in mandib­ular quadrants with a single conical root third molar and in those with a tooth bud without root formation were 2.60 and 3.32 times higher. Conversely, Class C impactions decreased condylar fracture odds.

Conclusion: The existence of impacted third molars, along with a deeper impaction within the mandibular bone and a closer proximity to the inferior border of the mandible, heightens the probability of mandibular angle fracture while diminishing the occurrence of mandibular condyle fracture. Furthermore, in cases where third molars possess a single conical root and are positioned distoangularly or horizontally, the risk of mandibular angle fracture is elevated.