Skip to main content

Advertisement

SpringerLink
Log in

The influence of third molars in the line of mandibular angle fractures on wound and bone healing

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The objective of this study was to evaluate postoperative complications after removal or retention of the third molar in the line of mandibular angle fractures.

Materials and methods

This retrospective study included the data of 98 patients with a molar in the line of a mandibular angle fracture treated with internal reduction and mini-plate fixation at our department over 9 years. Patients were classified into two groups: tooth removal during osteosynthesis (n = 45) and tooth retention (n = 55). The primary target criterion was the incidence of minor (outpatient treatment, local measures) and major (surgical revision, rehospitalisation) complications. Time between trauma and surgery was 1.4 days (range 0 to 12), and the average follow-up 291 days (range 66 to 863).

Results

Regarding the eruption status, 26 of 52 (50.0 %) impacted third molars, 11 of 19 (57.9 %) incompletely erupted and 8 of 27 (29.6 %) completely erupted molars had been removed during open reduction. Overall, 17 (17.3 %) patients had postoperative minor (n = 7) or major (n = 10) complications, in detail 10/45 (22.0 %) patients after tooth removal and 7/55 (13 %) patients after tooth retention (p = 0.286). Complication rates between impacted and incompletely erupted third molars (impacted molars 15.0 %, incompletely erupted molars 10.0 %) did not differ significantly, but completely erupted molars had a complication rate of 26.0 %.

Conclusions

Mandibular angle fractures with a completely erupted third molar show the highest complication rate after open reduction and osteosynthesis. Retention of a non-infectious third molar facilitates open reduction and does not increase the complication risk.

Clinical relevance

The study helps with the decision of removing or retention of a third molar during surgical treatment of a mandibular angle fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Perez R, Oeltjen JC, Thaller SR (2011) A review of mandibular angle fractures. Cranio-Maxillofac Trauma Reconstr 4(2):69–72

    Article  Google Scholar 

  2. van den Bergh B, van Es C, Forouzanfar T (2011) Analysis of mandibular fractures. J Craniofac Surg 22(5):1631–1634

    Article  PubMed  Google Scholar 

  3. Neal DC, Wagner WF, Alpert B (1978) Morbidity associated with teeth in the line of mandibular fractures. J Oral Surg 36(11):859–862

    PubMed  Google Scholar 

  4. Rink B, Stoehr K (1978) Wisdom teeth in the fracture line. Stomatol DDR 28(5):307–310

    PubMed  Google Scholar 

  5. Ellis E 3rd (2002) Outcomes of patients with teeth in the line of mandibular angle fractures treated with stable internal fixation. J Oral Maxillofac Surg 60(8):863–865, discussion 866

    Article  PubMed  Google Scholar 

  6. Bui P, Demian N, Beetar P (2009) Infection rate in mandibular angle fractures treated with a 2.0-mm 8-hole curved strut plate. J Oral Maxillofac Surg 67(4):804–808

    Article  PubMed  Google Scholar 

  7. Zweig BE (2009) Complications of mandibular fractures. Atlas Oral Maxillofac Surg Clin N Am 17(1):93–101

    Article  Google Scholar 

  8. Merten HA, Halling F (1993) Perioperative antibiotic prophylaxis in maxillofacial surgery. Infection 21(Suppl 1):S45–S48

    Article  PubMed  Google Scholar 

  9. Lopez-Cedrun JL, Pijoan JI, Fernandez S, Santamaria J, Hernandez G (2011) Efficacy of amoxicillin treatment in preventing postoperative complications in patients undergoing third molar surgery: a prospective, randomized, double-blind controlled study. J Oral Maxillofac Surg 69(6):e5–e14

    Article  PubMed  Google Scholar 

  10. Shetty V, Freymiller E (1989) Teeth in the line of fracture: a review. J Oral Maxillofac Surg 47(12):1303–1306

    Article  PubMed  Google Scholar 

  11. Bell RB, Wilson DM (2008) Is the use of arch bars or interdental wire fixation necessary for successful outcomes in the open reduction and internal fixation of mandibular angle fractures? J Oral Maxillofac Surg 66(10):2116–2122

    Article  PubMed  Google Scholar 

  12. Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D (1978) Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg 6(1):14–21

    Article  PubMed  Google Scholar 

  13. Braasch DC, Abubaker AO (2013) Management of mandibular angle fracture. Oral Maxillofac Surg Clinics N Am 25(4):591–600

    Article  Google Scholar 

  14. Ellis E 3rd (1999) Treatment methods for fractures of the mandibular angle. Int J Oral Maxillofac Surg 28(4):243–252

    Article  PubMed  Google Scholar 

  15. Bradley RL (1965) Treatment of fractured mandible. Am Surg 31:289–290

    PubMed  Google Scholar 

  16. Maloney PL, Welch TB, Doku HC (1991) Early immobilization of mandibular fractures: a retrospective study. J Oral Maxillofac Surg 49:698–702

    Article  PubMed  Google Scholar 

  17. Spinnato G, Alberto PL (2009) Teeth in the line of mandibular fractures. Atlas Oral Maxillofac Surg Clin N Am 17(1):15–18

    Article  Google Scholar 

  18. Rai S, Pradhan R (2011) Tooth in the line of fracture: its prognosis and its effects on healing. Indian J Dent Res 22(3):495–496

    Article  PubMed  Google Scholar 

  19. Soriano E, Kankou V, Morand B, Sadek H, Raphael B, Bettega G (2005) Fractures of the mandibular angle: factors predictive of infectious complications. Rev Stomatol Chir Maxillofac 106(3):146–148

    Article  PubMed  Google Scholar 

  20. Ramakrishnan J, Shingleton A, Reeves D, Key JM, Vural E (2009) The effects of molar tooth involvement in mandibular angle fractures treated with rigid fixation. Otolaryngol Head Neck Surg 140(6):845–848

    Article  PubMed  Google Scholar 

  21. Bobrowski AN, Sonego CL, Chagas Junior OL (2013) Postoperative infection associated with mandibula angle fracture treatment in the presence of teeth on the fracture line: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 42:1041–1048

    Article  PubMed  Google Scholar 

  22. Spiessl B (1988) Osteosynthese des Unterkiefers. Manual der AO-Prinzipien. Springer Verlag, New York

    Book  Google Scholar 

  23. Schierle HP, Schmelzeisen R, Rahn B, Pytlik C (1997) One- or two-plate fixation of mandibular angle fractures? J Craniomaxillofac Surg 25(3):162–168

    Article  PubMed  Google Scholar 

  24. Senel FC, Jessen GS, Melo MD, Obeid G (2007) Infection following treatment of mandible fractures: the role of immunosuppression and polysubstance abuse. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(1):38–42

    Article  PubMed  Google Scholar 

  25. Serena-Gomez E, Passeri LA (2008) Complications of mandible fractures related to substance abuse. J Oral Maxillofac Surg 66(10):2028–2034

    Article  PubMed  Google Scholar 

  26. Ellis E 3rd (2013) Open reduction and internal fixation of combined angle and body/symphysis fractures of the mandible: how much fixation is enough? J Oral Maxillofac Surg 71(4):726–733

    Article  PubMed  Google Scholar 

  27. Coulthard P, Bailey E, Esposito M, Furness S, Renton TF, Worthington HV (2014) Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev 7, CD004345

    PubMed  Google Scholar 

  28. Ellis E 3rd (2009) Management of fractures through the angle of the mandible. Oral Maxillofac Surg Clin N Am 21(2):163–174

    Article  Google Scholar 

  29. James RB, Fredrickson C, Kent JN (1981) Prospective study of mandibular fractures. J Oral Surg 39(4):275–281

    PubMed  Google Scholar 

  30. Rowe NL (1985) Maxillofacial injuries. In. Churchill Livingstone, Edinburg, p 52

  31. Kunkel M (2012) Leitlinie: operative Entfernung von Weisheitszähnen.

Download references

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Regensburg University Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    N. Ulbrich, T. Ettl, W. Waiss, A. Moralis, T. E. Reichert & S. Mueller

  2. Department of Oral and Maxillofacial Surgery, Nuremberg Hospital, Breslauer Straße 201, 90471, Nürnberg, Germany

    M. Gosau

Authors
  1. N. Ulbrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Ettl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Waiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Gosau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Moralis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. E. Reichert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Ettl.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ulbrich, N., Ettl, T., Waiss, W. et al. The influence of third molars in the line of mandibular angle fractures on wound and bone healing. Clin Oral Invest 20, 1297–1302 (2016). https://doi.org/10.1007/s00784-015-1612-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-015-1612-3

Keywords

Search

Navigation