Speakers - 2027

Title: Mandibular fracture in impacted third molar extraction surgery

Abstract

Mandibular fracture is one of the complications associated with the surgical removal of impacted mandibular third molars , with an incidence ranging from 0.0034% to 0.075%. Despite their low incidence, these fractures represent a major clinical complication requiring surgical intervention and carrying significant morbidity. Additionally, the etiology of mandibular fractures following third molar surgery is widely acknowledged to encompass patient-related, tooth-related, and surgical technique-related factors. The literature identified various risk factors across different categories: patient age, sex, jaw bone-related systemic conditions, and oral habits could affect the severity of complications. In tooth-related type of risk factors, deep bony impaction (Pell and Gregory Class II/III, depth B/C), mesioangular or distoangular tooth angulation, reduced residual bone volume (B/A ratio <0.4), and local pathological conditions should be mentioned. Moreover, excessive osteotomy, uncontrolled or excessive force during extraction, failure to perform tooth sectioning have been considered as some of the surgeon-related factors. Of note, given the multifactorial etiology of mandibular fractures following third molar surgery, a comprehensive preoperative assessment is crucial. The aforementioned assessment should include CBCT evaluation of impaction depth, angulation, residual bone volume, and IAN proximity. Minimally invasive surgical techniques, appropriate tooth sectioning, and the use of controlled force are critical intraoperative measures. In addition, novel approaches such as customized 3D-printed titanium plates have been proposed to provide structural reinforcement during surgery. Postoperatively, patients should be advised to maintain a soft diet for at least four weeks and to avoid activities that may subject the mandible to excessive loading.