Evaluation of Teeth in Line of Mandibular Fractures Treated with Stable Internal Fixation

Abstract

Purpose: To determine whether retention or removal of teeth in line of mandibular fractures affects the incidence of postoperative complications. To evaluate the fate of teeth retained in mandibular fractures based on location of fracture line in relation to apical foramen and lateral periodontium of retained tooth. Method: 51 mandibular fracture sites in 39 patients were treated by open reduction and internal fixation using miniplates. Teeth in line of fracture were removed if showed extensive caries, excessive mobility of tooth, or root fracture. Accordingly patients were divided into two groups, group I tooth removed (15 sites) and group II tooth retained (36 sites). Teeth retained in fracture line were classified based on position of the fracture in relation to apical foramen and the lateral periodontium of involved tooth estimated from preoperative panoramic radiograph into four types. Postoperative periodic follow up done for 1 year and seen for incidence of postoperative complications and fate of tooth in line of fracture. Results: Out of 36 fracture sites in which teeth were retained 5 (13.89%) showed postoperative complications, and out of 15 fracture sites in which teeth were removed 3 (20%) showed postoperative complications. Out of 36 fracture sites in which tooth was retained we found in 3 cases fracture line passed through 2 adjacent teeth. Thus we had in total 39 teeth in fracture line out of them 26 required no treatment 9 required endodontic treatment and 4 teeth required extraction. Need for extraction and endodontic treatment was found more in type I and type III relation. Conclusion: There is an increased risk for postoperative complications when a tooth is removed, although it is not statistically significant. Evaluation of fate of retained teeth showed better prognosis of teeth in type II cases than type III and type I cases. Results of this study leads to conclusions that teeth associated with mandibular fractures need not be removed on prophylactic basis.