The Role of Impacted Third Molars in Mandibular Angle Fractures: Findings from Trauma-Related Panoramic Radiographs
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Abstract
Introduction: Mandibular angle and condylar fractures are highly prevalent maxillofacial injuries. The presence of impacted third molars may influence fracture patterns by weakening mandibular biomechanics, though the literature remains controversial. Deeper impactions, angulation, and root morphology have been variably associated with fracture risk. This study aims to investigate the effect of the presence of impacted third molars and their characteristics on mandibular fracture. Materials and Methods: Panoramic images of 300 patients with mandibular fractures were examined. The presence of impacted third molars, position, angle, number of roots, and distance from the inferior border of the mandible were considered as independent variables, while the location of the fracture was considered as the dependent variable.Results: The presence of impacted third molars increased mandibular angle fracture odds by 11.15-fold but decreased condylar fracture odds by 0.28-fold. Class B and Class 3 impactions had higher angle fracture odds compared to Class A and Class 1, respectively. Distoangular or horizontal molars increased angle fracture odds 5.09 and 4.22. The odds of angle fracture in mandibular quadrants with a single conical root third molar and in those with a tooth bud without root formation were 2.60 and 3.32 times higher. Conversely, Class C impactions decreased condylar fracture odds. Conclusion: The existence of impacted third molars, along with a deeper impaction within the mandibular bone and a closer proximity to the inferior border of the mandible, heightens the probability of mandibular angle fracture while diminishing the occurrence of mandibular condyle fracture. Furthermore, in cases where third molars possess a single conical root and are positioned distoangularly or horizontally, the risk of mandibular angle fracture is elevated. Keywords: Mandibular fracture; Impacted mandibular third molar; Mandibular angle.
1. Hasegawa T, Sadakane H, Kobayashi M, Tachibana A, Oko T, Ishida Y, et al. A multi-centre retrospective study of mandibular fractures: do occlusal support and the mandibular third molar affect mandibular angle and condylar fractures? Int J Oral Maxillofac Surg. 2016;45(9):1095-9.
2. Giovacchini F, Paradiso D, Bensi C, Belli S, Lomurno G, Tullio A. Association between third molar and mandibular angle fracture: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2018;46(4):558-65.
3. Tevepaugh DB, Dodson TB. Are mandibular third molars a risk factor for angle fractures? J Oral Maxillofac Surg. 1995;53(6):646-9.
4. Naghipur S, Shah A, Elgazzar RF. Does the presence or position of lower third molars alter the risk of mandibular angle or condylar fractures? J Oral Maxillofac Surg. 2014;72(9):1766-72.
5. Yoon WJ, Kim SG, Oh JS, You JS, Lim KS, Shin SM, et al. A Clinical Study of Mandibular Angle Fracture. Maxillofac Plast Reconstr Surg. 2014;36(5):201-6.
6. Javidi B FH, Sadeghi Sh, Mohammadpour M, Dorostan N. Influence of Growing Status of Third Molar on Mandible Angle Fracture. Jundishapur Sci Med J 2014: Suppl: 65-72.
7. Fuselier JC, Ellis EE, III, Dodson TB. Do mandibular third molars alter the risk of angle fracture? J Oral Maxillofac Surg. 2002;60(5):514-8
8. Thangavelu A, Yoganandha R, Vaidhyanathan A. Impact of impacted mandibular third molars in mandibular angle and condylar fractures. Int J Oral Maxillofac Surg. 2010;39(2):136-9.
9. Cho BH. Diagnostic performance of dental students in identifying mandibular condyle fractures by panoramic radiography and the usefulness of reference images. Imaging Sci Dent. 2011;41(2):53-7.
10. Armond ACV, Martins CC, Gloria JCR, Galvao EL, Dos Santos CRR, Falci SGM. Influence of third molars in mandibular fractures. Part 1: mandibular angle-a meta-analysis. Int J Oral Maxillofac Surg. 2017;46(6):716-29.
11. Duarte BG, Assis D, Ribeiro-Junior P, Goncales ES. Does the Relationship between Retained Mandibular Third Molar and Mandibular Angle Fracture Exist? An Assessment of Three Possible Causes. Craniomaxillofac Trauma Reconstr. 2012;5(3):127-36.
12. Inaoka SD, Carneiro SC, Vasconcelos BC, Leal J, Porto GG. Relationship between mandibular fracture and impacted lower third molar. Med Oral Patol Oral Cir Bucal. 2009;14(7):E349-54.
13. Kumar PS, Dhupar V, Akkara F, Kumar GB. Eruption status of third molar and its possible influence on the location of mandibular angle fracture: a retrospective analysis. J Maxillofac Oral Surg. 2015;14(2):243-6.
14. Rozenbilds M, Chung L, Thomas M. Prevalence of angle and condyle fractures according to the presence or absence of the mandibular third molar in patients with surgically treated mandible fractures. Int J Oral Maxillofac Surg. 2025. doi: 10.1016/j.ijom.2025.10.011.
15. Revanth Kumar S, Sinha R, Uppada UK, Ramakrishna Reddy BV, Paul D. Mandibular Third Molar Position Influencing the Condylar and Angular Fracture Patterns. J Maxillofac Oral Surg. 2015;14(4):956-61.
16. Yamada T, Sawaki Y, Tohnai I, Takeuchi M, Ueda M. A study of sports-related mandibular angle fracture: relation to the position of the third molars. Scand J Med Sci Sports. 1998;8(2):116-9.
17. Yadav S, Tyagi S, Puri N, Kumar P, Kumar P. Qualitative and quantitative assessment of relationship between mandibular third molar and angle fracture on North Indian population: A clinico-radiographic study. Eur J Dent. 2013;7(2):212-7.
18. Duan DH, Zhang Y. Does the presence of mandibular third molars increase the risk of angle fracture and simultaneously decrease the risk of condylar fracture? Int J Oral Maxillofac Surg. 2008;37(1):25-8.
19. Samieirad S, Eshghpour M, Dashti R, Tohidi E, Javan AR, Mianbandi V. Correlation Between Lower Third Molar Impaction Types and Mandibular Angle and Condylar Fractures: A Retrospective Study. J Oral Maxillofac Surg. 2019;77(3):556-64.
20. Iida S, Nomura K, Okura M, Kogo M. Influence of the Incompletely Erupted Lower Third Molar on Mandibular Angle and Condylar Fractures. J Trauma Acute Care Surg. 2004;57(3):613-7.
21. Lee JT, Dodson TB. The effect of mandibular third molar presence and position on the risk of an angle fracture. J Oral Maxillofac Surg. 2000;58(4):394-8; discussion 9.
22.Barman A, Tandon S, Wadhwani P, Borse SS, Chakravarty C, Gaffar MA. Risk of Mandibular Angle Fracture and Its Co-relation to Absence/Presence, Type of Mandibular Impacted 3rd molar; A Retrospective and Prospective Study. J Neonatal Surg. 2025;14(7):322-30.
23. Gaddipati R, Ramisetty S, Vura N, Kanduri RR, Gunda VK. Impacted mandibular third molars and their influence on mandibular angle and condyle fractures--a retrospective study. J Craniomaxillofac Surg. 2014;42(7):1102-5.
24. Antic S, Milicic B, Jelovac DB, Djuric M. Impact of the lower third molar and injury mechanism on the risk of mandibular angle and condylar fractures. Dent Traumatol. 2016;32(4):286-95.
25. Deng YF, Dong QQ, Zhao HK, Diarra D, Li Z. Traumatic characteristics and trauma-specific management of the third molars involved in mandibular angle fractures. BMC Oral Health. 2025;25(1):1-9.
26.Ansari MA, Ghavimi MA, Farhadi F, Khorshidi R, Esmaeeli F. The relationship between mandibular chin angle, age, gender, anterior fracture type and condyle fracture. J Craniomaxillofac Res. 2025;14(2):28-34.
2. Giovacchini F, Paradiso D, Bensi C, Belli S, Lomurno G, Tullio A. Association between third molar and mandibular angle fracture: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2018;46(4):558-65.
3. Tevepaugh DB, Dodson TB. Are mandibular third molars a risk factor for angle fractures? J Oral Maxillofac Surg. 1995;53(6):646-9.
4. Naghipur S, Shah A, Elgazzar RF. Does the presence or position of lower third molars alter the risk of mandibular angle or condylar fractures? J Oral Maxillofac Surg. 2014;72(9):1766-72.
5. Yoon WJ, Kim SG, Oh JS, You JS, Lim KS, Shin SM, et al. A Clinical Study of Mandibular Angle Fracture. Maxillofac Plast Reconstr Surg. 2014;36(5):201-6.
6. Javidi B FH, Sadeghi Sh, Mohammadpour M, Dorostan N. Influence of Growing Status of Third Molar on Mandible Angle Fracture. Jundishapur Sci Med J 2014: Suppl: 65-72.
7. Fuselier JC, Ellis EE, III, Dodson TB. Do mandibular third molars alter the risk of angle fracture? J Oral Maxillofac Surg. 2002;60(5):514-8
8. Thangavelu A, Yoganandha R, Vaidhyanathan A. Impact of impacted mandibular third molars in mandibular angle and condylar fractures. Int J Oral Maxillofac Surg. 2010;39(2):136-9.
9. Cho BH. Diagnostic performance of dental students in identifying mandibular condyle fractures by panoramic radiography and the usefulness of reference images. Imaging Sci Dent. 2011;41(2):53-7.
10. Armond ACV, Martins CC, Gloria JCR, Galvao EL, Dos Santos CRR, Falci SGM. Influence of third molars in mandibular fractures. Part 1: mandibular angle-a meta-analysis. Int J Oral Maxillofac Surg. 2017;46(6):716-29.
11. Duarte BG, Assis D, Ribeiro-Junior P, Goncales ES. Does the Relationship between Retained Mandibular Third Molar and Mandibular Angle Fracture Exist? An Assessment of Three Possible Causes. Craniomaxillofac Trauma Reconstr. 2012;5(3):127-36.
12. Inaoka SD, Carneiro SC, Vasconcelos BC, Leal J, Porto GG. Relationship between mandibular fracture and impacted lower third molar. Med Oral Patol Oral Cir Bucal. 2009;14(7):E349-54.
13. Kumar PS, Dhupar V, Akkara F, Kumar GB. Eruption status of third molar and its possible influence on the location of mandibular angle fracture: a retrospective analysis. J Maxillofac Oral Surg. 2015;14(2):243-6.
14. Rozenbilds M, Chung L, Thomas M. Prevalence of angle and condyle fractures according to the presence or absence of the mandibular third molar in patients with surgically treated mandible fractures. Int J Oral Maxillofac Surg. 2025. doi: 10.1016/j.ijom.2025.10.011.
15. Revanth Kumar S, Sinha R, Uppada UK, Ramakrishna Reddy BV, Paul D. Mandibular Third Molar Position Influencing the Condylar and Angular Fracture Patterns. J Maxillofac Oral Surg. 2015;14(4):956-61.
16. Yamada T, Sawaki Y, Tohnai I, Takeuchi M, Ueda M. A study of sports-related mandibular angle fracture: relation to the position of the third molars. Scand J Med Sci Sports. 1998;8(2):116-9.
17. Yadav S, Tyagi S, Puri N, Kumar P, Kumar P. Qualitative and quantitative assessment of relationship between mandibular third molar and angle fracture on North Indian population: A clinico-radiographic study. Eur J Dent. 2013;7(2):212-7.
18. Duan DH, Zhang Y. Does the presence of mandibular third molars increase the risk of angle fracture and simultaneously decrease the risk of condylar fracture? Int J Oral Maxillofac Surg. 2008;37(1):25-8.
19. Samieirad S, Eshghpour M, Dashti R, Tohidi E, Javan AR, Mianbandi V. Correlation Between Lower Third Molar Impaction Types and Mandibular Angle and Condylar Fractures: A Retrospective Study. J Oral Maxillofac Surg. 2019;77(3):556-64.
20. Iida S, Nomura K, Okura M, Kogo M. Influence of the Incompletely Erupted Lower Third Molar on Mandibular Angle and Condylar Fractures. J Trauma Acute Care Surg. 2004;57(3):613-7.
21. Lee JT, Dodson TB. The effect of mandibular third molar presence and position on the risk of an angle fracture. J Oral Maxillofac Surg. 2000;58(4):394-8; discussion 9.
22.Barman A, Tandon S, Wadhwani P, Borse SS, Chakravarty C, Gaffar MA. Risk of Mandibular Angle Fracture and Its Co-relation to Absence/Presence, Type of Mandibular Impacted 3rd molar; A Retrospective and Prospective Study. J Neonatal Surg. 2025;14(7):322-30.
23. Gaddipati R, Ramisetty S, Vura N, Kanduri RR, Gunda VK. Impacted mandibular third molars and their influence on mandibular angle and condyle fractures--a retrospective study. J Craniomaxillofac Surg. 2014;42(7):1102-5.
24. Antic S, Milicic B, Jelovac DB, Djuric M. Impact of the lower third molar and injury mechanism on the risk of mandibular angle and condylar fractures. Dent Traumatol. 2016;32(4):286-95.
25. Deng YF, Dong QQ, Zhao HK, Diarra D, Li Z. Traumatic characteristics and trauma-specific management of the third molars involved in mandibular angle fractures. BMC Oral Health. 2025;25(1):1-9.
26.Ansari MA, Ghavimi MA, Farhadi F, Khorshidi R, Esmaeeli F. The relationship between mandibular chin angle, age, gender, anterior fracture type and condyle fracture. J Craniomaxillofac Res. 2025;14(2):28-34.
| Files | ||
| Issue | Vol 13, No 2 (Spring 2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Mandibular fracture; Impacted mandibular third molar; Mandibular angle. | ||
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How to Cite
1.
Esmaeeli N, Mosavat F, Razmara F, Ahmadi A. The Role of Impacted Third Molars in Mandibular Angle Fractures: Findings from Trauma-Related Panoramic Radiographs. J Craniomaxillofac Res. 2026;2026(2):168-177.
