Abstract
BACKGROUND: There is a close relationship between the third molars and mandibular angle fractures. Previous studies focused more on the influence of third molars on the healing of mandibular angle fractures than on the damage condition of the third molars themselves. The aim of this study was to investigate and classify the traumatic characteristics of third molars involved in mandibular angle fractures, and to evaluate the prognostic impact of a stratified trauma-specific management strategy on postoperative outcomes. METHODS: A retrospective analysis was conducted on the patients presenting to the authors’ department for treatment of mandibular angle fractures with third molar involved in the fractures between Jan 2014 and Dec 2023. A stratified trauma-specific management was performed. The third molars with Type I (complete dislocation) or Type II (crown/root fracture) injuries were extracted. In contrast, Type III injuries, where the tooth was exposed to the fracture line but remained stable without displacement or disruption, were retained. The comprehensive clinical parameters and postoperative complications were documented and analyzed. RESULTS: 110 patients with 113 third molars were included in this study. Severe dental injuries (Types I and II) were infrequently observed (n = 14; 12.39%), while the majority of third molars presented Type III injuries (n = 99; 87.61%). Among these, mesially impacted teeth were more prone to severe periodontal ligament avulsion. Eventually, 5.31% of the fractures suffered wound infection, and 10.62% of the fractures had inferior alveolar nerve (IAN) injury, whereas the other complications were rare. There were no statistically significant differences in complication rates among the types and patterns of third molars injuries, but removal of third molars was associated with a higher rate of IAN injury (p = 0.04). CONCLUSION: The third molars exhibited varying degrees of injuries in mandibular angle fracture. The stratified trauma-specific management of the third molars may optimize the prognosis of mandibular angle fractures and is a viable clinical strategy.