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Journal of Medical Case Reports

, 7:121

First Online: 30 April 2013Received: 11 November 2012Accepted: 08 March 2013DOI: 10.1186-1752-1947-7-121

Cite this article as: Cutilli, T., Bourelaki, T., Scarsella, S. et al. J Med Case Reports 2013 7: 121. doi:10.1186-1752-1947-7-121

Abstract

IntroductionPathological late fracture of the mandibular angle after third molar surgery is very rare 0.005% of third molar removals. There are 94 cases reported in the literature; cases associated with osseous pathologies such as osteomyelitis or any local and systemic diseases that may compromise mandibular bone strength have not been included. We describe three new cases of pathological late fracture of the mandibular angle after third molar surgery.

Case presentationsThe first patient was a 27-year-old Caucasian man who had undergone surgical removal of a 3.8, mesioangular variety, class II-C third molar 20 days before admission to our clinic. The fracture of his left mandibular angle, complete and composed, occurred during chewing. The second patient was a 32-year-old Caucasian man. He had undergone surgical removal of a 3.8, mesioangular variety, class II-B third molar 22 days before his admission. The fracture, which occurred during mastication, was studied by computed tomography that showed reparative tissue in the fracture site. The third patient was a 36-year-old Caucasian man who had undergone surgical removal of a 3.8, vertical variety, class II-C third molar 25 days before the observation. In this case the fracture of his mandibular angle was oblique unfavorable, complete and composed. The fracture had occurred during chewing. We studied the fracture by optical projection tomography and computed tomography.

All of the surgical removals of the 3.8 third molars, performed by the patients’ dentists who had more than 10 years of experience, were difficult. We treated the fractures with open surgical reduction, internal fixation by titanium miniplates and intermaxillary elastic fixation removed after 6 weeks.

ConclusionsThe literature indicates that the risk of pathological late fracture of the mandibular angle after third molar surgery for total inclusions class II-III, type C is twice that of partial inclusions due to the necessity of ostectomies more generous than those for partial inclusions. Other important factors are the anatomy of the teeth and the features of the teeth roots. These fractures predominantly occur in patients who are older than 25 years. The highest incidence 67.8% of cases is found in the second and third week postsurgery. We emphasize that before the third molar surgery it is extremely important to always provide adequate instructions to the patient in order to avoid early masticatory loads and prevent this rare event.

KeywordsLate mandibular angle fractures Lower third molar removal Early masticatory loading Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-7-121 contains supplementary material, which is available to authorized users.

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Autor: Tommaso Cutilli - Theodora Bourelaki - Secondo Scarsella - Desiderio Di Fabio - Emanuele Pontecorvi - Pasqualino Cargini -

Fuente: https://link.springer.com/







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