Prevention of Iatrogenic Mandibular Fracture Associated with Deeply Impacted Tooth Removal–Report of Two Borderline Cases

Case Report

J Dent & Oral Disord. 2016; 2(9): 1048.

Prevention of Iatrogenic Mandibular Fracture Associated with Deeply Impacted Tooth Removal–Report of Two Borderline Cases

Yuce Mo¹*, Adali E¹, Sener E¹, Gunbay T¹, Akay Mc¹ and Koyuncu Bo¹

¹Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ege, Turkey

²Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Ege, Turkey

*Corresponding author: Yuce Mo, Department of Oral and Maxillofacial Surgery Ege University, Faculty of Dentistry, Bornova, Izmir, Turkey

Received: November 07, 2016; Accepted: December 05, 2016; Published: December 09, 2016

Abstract

Iatrogenic fracture of the mandible occurring either immediately or after the removal of impacted teeth is a rare condition but it can occur as a severe complication of oral surgery. Most reports regarding these fractures connect it to the removal of third molars; however mandibular fracture can occur in association with any impacted tooth. The clinician should be aware of the predisposing factors and should take preventive measures to reduce the risk for this serious complication.

This case report presents the prevention of mandibular fracture in two cases of deeply impacted tooth removal and their follow up after the surgery. The first case presents the removal of deeply impacted infected third molar and the second case presents the removal of complex odontoma in the right mandibular angle region involving the impacted second molar. In both cases miniplates were used to prevent mandibular fracture.

Keywords: Iatrogenic fracture; Tooth removal; Prevention

Introduction

Removal of impacted tooth is the most common procedure in oral surgery and this procedure can be accompanied by variety of complications [1]. Immediate or late fracture of mandible are among the severe and also the major complication associated with difficult surgical extractions in the lower arch with a reported incidence ranging from 0.0034% to 0.0075%. Mandibular fracture after the removal of deeply impacted tooth is reported to be highly associated with the removal of third molar [1-6]. In many cases it was advocated that surgeon’s role and surgical approach is primarily important. Before surgery, clinician has to inform the patient about the possible risks of the procedure. Moreover, potential complications of surgical removal must be weighed against the potential benefits before surgery therefore, it was recommended for surgeons to consider all preventive measures carefully [2,7].

The presented cases report the importance of prophylactic plating to avoid iatrogenic mandibular fracture in patients with deeply impacted tooth.

Case Presentation

Case I

A 43 year old female was referred to the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry. She complained of a recurrent “toothache” of the right lower molar area. She was healthy with no history of any systemic disorders. Presence of deeply impacted third molar that was surrounded by a well-circumscribed radiolucency was observed during radiographic examination (Figure 1).