Dr Rahul VC Tiwari - Oral & Maxillofacial Surgery - SIBAR Institute of Dental Sciences, Gunutr, Andhra Pradesh. Relationship between fracture of mandibular condyle and absence of unerupted mandibular third molar—a retrospective study

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Presented By
Dr. Rahul Tiwari
Final Yr. MDS
OMFS, SIDS

2. TITLE
•
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Relationship between fracture of mandibular condyle and absence of unerupted
mandibular third molar—a retrospective study
Ritesh Rajan, Dinesh Kumar Verma, R. M. Borle & Abhilasha Yadav

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5. TERMINOLOGY
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1. CONVENTIONAL RADIOGARPHY
1. OPG
2. REVERSE TOWNE’S
3. TRANSCRANIAL VIEWS FOR TMJ
2. CT SCAN
3. MRI
4. ARTHROGRAPHY
Any third molar partially or completely
covered by bone was regarded as unerupted.
INVESTIGATIONS

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REVIEW OF LITERATURE
Total – 319
Deciduous and Mixed - 29
Dentulous- 113
Quadrants Missing- 46
Edentulous - 30
Individual Missing Teeth- 101
Frequency of edentulous mandibular fractures was found to be 7.3% more.
20% more reported by Halazonetis
9% more recorded by Huelke et al.
34 Patients
1961
1988

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REVIEW OF LITERATURE
40% less chance of # of mandible in fully erupted 3rd molars
Pt. with 3M present have higher risk of mandibular angle fracture however depends on position
437 patients

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REVIEW OF LITERATURE
Unerupted third molar teeth weaken the mandibular angle both quantitatively and qualitatively.
200 X rays
Patients with fractured mandibles and mandibular third molars are 3.8 times more
likely to have an angle fracture
73 Patients
1995
1995

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REVIEW OF LITERATURE
Dental screening and early removal of impacted teeth can reduce the risk of mandibular
fractures in young adults participating in contact sports.
Factures at the condylar region showed a significantly higher incidence in patients
without unerupted third molars. Removal of unerupted mandibular third molars
predisposes the mandible to condyle fractures.
439 Patients

10. Abstract:
Keywords:
• Condylar fracture .Angle fracture .Impacted third molar . Unerupted third molar
PURPOSE:
• The purpose of the present study was to find, if there exists, a co-relation
between presence of unerupted mandibular third molar and fracture of
mandibular condyle.
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11. METHODS
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• A retrospective, multicenter study was done collecting the data of all mandibular
condyle fractures treated from November 2006 till August 2015.
• Data was collected from the patient’s records and radiographs for the following
information: age, sex, etiology of fracture, presence and state of lower third molars,
and associated fracture.
• The results were subjected to statistical analysis

12. CRITERIA
• A fracture line extending from the sigmoid notch and involving condylar process
was categorized as a condylar fracture.
• Patients were divided into two groups based on the presence or absence of
unerupted mandibular third molar. Any third molar partially or completely
covered by bone was regarded as unerupted.
• The data was analyzed by calculating the means and standard deviation, and
cohort comparisons were made by the chi square test and the Student’s T test. P
value of <0.05 was considered significant.
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PATIENT CHARACTERSTICS
180- 35/145

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RESULTS

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RESULTS

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RESULTS

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RESULTS
Frequency of multiple fractures for patient with and without the unerupted
third molars

18. TREATEMENT REASONS
• Treatment of condyle fracture is more fraught with the difficulty in repositioning the
condylar fragments, placement of fixation hardware, and danger of injuring facial
nerve.
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Angle fractures are more amenable to excellent reduction and stable fixation

19. conclusion
• This study suggests that the fractures of mandibular condylar region have a
significantly higher incidence in patients without an unerupted mandibular third
molar.
• But further studies with larger sample size and comparison with angle of
mandible fracture incidence are necessary before drawing any definitive
conclusion.
•
•
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OTHERREFERENCES
1102 mandibular fractures in 600 patients. 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.
398 patients, older than 18 years, with 464 mandibular fractures. Unerupted mandibular third molars
significantly reduced the occurrence of condylar fractures.
110 fractures of the mandibular condyle and 80 of the angle. An incompletely erupted third molar reduces the risk
of condylar fractures and increases the risk of fractures of the mandibular angle.

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OTHERREFERENCES
2015
2014
2014
147 mandibular fracture. Condylar fracture was two times greater in those with missing or completely erupted
mandibular third molars as compared to those with unerupted ones.
118 mandibular angle and condyle fractures in 110 patients. presence of impacted third molar predisposes
the angle to fracture and reduces the risk of a concomitant condylar fracture
100 Patients. Practice of prophylactic removal of mandibular third molar and resultant strengthening of angle
region should be reconsidered, as it increases the risk of fracture at condylar region which is difficult to treat
and associated with more morbidity.

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OTHERREFERENCES
2014
CT Scan on mandible models were made.
A force of 2000 N was applied to three different regions of the models:
the symphysis, ipsilateral body, and contralateral body.
When the force was applied to the mandibular body, the results revealed
increased angle fragility in cases with unerupted M3.
When the force was applied to the symphysis, the condyle region showed
higher fragility, irrespective of the presence of an unerupted M3.
In summary, fragility of the angle and condyle regions depends on the
presence of an unerupted M3 and on the direction and point of impact of the
force.

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