Is there association between the presence of lower third molar and mandibular angle fractures: a meta-analysis?

Publication date: Available online 13 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Wagner de Sousa Ruela, Vinícius Lima de Almeida, Luciana Monti Lima-Rivera, Pâmela Letícia dos Santos, André Luís Porporatti, Paulo Henrique Luiz de Freitas, Luiz Renato Paranhos
PurposeThe current literature suggests that the presence of lower third molars predisposes to a higher risk of mandibular angle fracture. Thus, this review aims to answer the following question: "Is there an association between the presence of lower third molar and mandibular angle fractures in adults?", as well as to assess the influence of third molar position according to Pell and Gregory.Material and methodsthe present study is a systematic review and meta-analysis on analytical observational studies. The study population was composed of all publication on the relationship between mandibular angle fracture and the lower third molar. There was no restriction of year, language, and publication status. The review protocol was registered at the PROSPERO database (CRD42016047057). Electronic searches unrestricted for publication period and language were performed in the PubMed, Scopus, SciELO, LILACS databases. Google Scholar and Open Grey databases were used to search the "grey literature", avoiding selection and publication biases. The entire search was performed by two eligibility reviewers. Association and proportion meta-analyses were planned for the studies with sufficient data. The primary predictor variable was the relationship between the presence of lower third molar and the development of mandibular angle fractures. The secondary outcome variables were the vertical and horizontal positions of the lower third molar, according to the classification by Pell and Gregory and their relation to the susceptibility to developing mandibular angle fracture.Resultsthe search strategies resulted in a set of 411 studies, from which 16 were selected for qualitative and quantitative review. Association meta-analysis included all the selected studies and showed that patients with lower third molars are 3.16 times more likely to develop mandibular angle fractures. Proportion meta-analysis included five studies and showed that the overall rate of mandibular angle fractures was 51.58% and that positions III and C are more likely to cause fracture, with rate of 59.84 and 63.67%, respectively.Conclusionsthis study showed that the presence of impacted third molars increases by 3.16 times the risk of mandibular angle fractures in adults, with the highest risk present when third molars are classified as IIIC according to Pell and Gregory. The available evidence is not sufficiently robust to determine third molar presence or level of impaction as the main causative factors for mandibular angle fractures.



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