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Should Degree of Third Molar Eruption and Extraction Strategy Affect Fixation Technique of Mandibular Angle Fractures? A Systematic Review
Vikas S. Kotha MD; Brandon J. de Ruiter MD; Marvin Nicoleau B.A.; Edward. H. Davidson M.D.
Case Western Reserve University
2021-02-15
Presenter: Vikas S. Kotha MD
Affidavit:
100% of this project represents the original work of the resident
Director Name: Edward Davidson
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND: This study aimed to differentiate mandibular angle fracture (MAF) fixation complications by degree of third molar eruption and by extraction strategy. We hypothesize concomitant extraction of impacted third molars and retention of partially erupted third molars confer significantly higher risk with Champy fixation.
METHODS: Studies stratifying MAF complications by third molar eruption and extraction were included. Bias was assessed using author-defined criteria. Individual count data was for quantitative synthesis. Relative risk (RR) associated with extracted impacted and retained partially erupted third molars (Group I) were calculated against controls of retained impacted and extracted partially erupted third molars (Group II).
RESULTS: Ten studies reported complications by eruption or extraction, however only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included- 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data produced an overall complication rate of 13.7%. No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (p=0.04). Significantly higher complication rate was observed in Group I than Group II (23.5% vs. 5.1%) (RR4.6, 95% CI 1.04-20.1).
CONCLUSIONS: Concomitant extraction of impacted third molars and retention of partially erupted third molars increases risk of complications with Champy technique fixation of mandibular angle fractures. In these groups alternative strategies for fixation should be considered.
