Title: The effects of mandibular wisdom teeth on angle and condyle fractures
Abstract:
Objectives:
The aim of our study was to evaluate the relationship between mandibular third molars, their positioning within the mandible and the risk of angle or condyle fracture.
Materials and methods:
This retrospective study included all patients admitted to the Department of Maxillofacial/Head & Neck Surgery of the Royal Darwin Hospital for open reduction internal fixation of the mandible from January 2020 to March 2024. Patient records and imaging were evaluated. Predictor variables included the mechanism of injury, fracture pattern, presence or absence of mandibular third molars, their impaction status (Gregory & Pell classification) and angulation (Winter classification). The outcome variable was the type of fracture.
Results:
475 patients were admitted for repair of a total of 792 fractures. 281 patients suffered a total of 289 angle fractures (mean age 30.6 ± 1.2, 80.1% male); 110 patients suffered a total of 127 condyle fractures (mean age 33.5 ± 1.2 years, 67.3% male). 23% of the mandible fractures occurred as a single fracture, 68% as a double fracture, 9% as a triple and 1% as a quadruple fracture. The most common site for single fractures was the angle (56%), then body (16%) and condyle (15%). The most common pattern for double fractures was angle/body (32%), angle/parasymphysis (21%) and condyle/body (8%). 39 patients were noted to have mandibular metalwork present from previous fracture repairs (8.2%)
88.6% of all angle fractures had mandibular wisdom teeth present (odds ratio (OR) 3.32, 95% Cl (2.23 – 4.94), p<0.001), whereas only 69.2% of all condylar fractures had mandibular wisdom teeth present (OR 1.46, 95% (0.97 - 2.19), p=0.072). Mandibular wisdom teeth associated with both angle and condyle fractures were most commonly found to have a vertical angulation (45% and 51%) and A1 level of impaction (59% and 61%, respectively). The most common mechanism of injury was assault (82% and 65%, respectively).
Conclusion:
Patients with mandibular wisdom teeth present were greater than 3 times more likely to suffer an angle fracture as compared to patients with no mandibular wisdom teeth. There was no statistically significant relationship found between condyle fractures and the presence or absence of mandibular wisdom teeth. Consideration should be given to recommendations for prophylactic extraction of mandibular wisdom teeth in a population more at risk of trauma, as removal may predispose to condylar fractures which are technically more challenging to repair and carry a greater risk of complications.
Audience Take Away:
- Discussion points to consider when talking with high-risk trauma patients (eg contact sports, boxing etc) about prophylactic wisdom teeth extraction.
- Clinicians will be aware of the most common fracture patterns to assess for after a patient has suffered from facial trauma.
- Supplies further evidence in a controversial field that could be used to expand future research
