Pathological (late) fractures of the mandibular angle after lower third molar removal. A case series.

Introduction. Pathological (late) fracture of the mandibular angle after third molar (M3) surgery is very rare (0.005% of the M3 removed). The cases reported in literature are 111 and does not include those associated with osseous pathologies such as osteomyelitis or any local and systemic diseases that may compromise the mandibular bone strength. Cases Presentation. We describe three new cases. The first patient was a 27-old-year Caucasian man who was undergone to surgical removal of 3.8, mesioangular variety, class II - C, 20 days before the admission to our clinic. The fracture of the left mandibular angle, complete and composed, occurred during chewing. The second patient was a 32-old-year Caucasian man. He was undergone to surgical remove of 3.8, mesioangular variety, class II – B 22 days before the admission. The fracture, occurred during the mastication, was studied also by CT that showed a reparative tissue in the fracture site. The third patient was a 36-old-year Caucasian man who was undergone to surgical removal of 3.8 vertical variety, class II – C 25 days before the observation. Also in this case the fracture of the mandibular angle was oblique (unfavourable), complete and composed, occurred during chewing. We studied the fracture by OPT and CT. All the surgical removal of 3.8, performed by their own dentists with more than ten years of experience, were hard and difficult. We treated the fractures with open surgical reduction, internal fixation (IF) by miniplates and IMF (intermaxillary elastic fixation) removed after 6 weeks. Conclusions. The literature indicates that the risk of pathological (late) fracture of the mandibular angle after surgery of M3 is double for total inclusions (Class II-III, type C) due to necessity of ostectomies more generous than in the partial inclusions. Important factor is also the anatomy of the teeth and the features of the teeth roots. The predominance of these fractures occurs in subjects with more than 25 years. The highest incidence (67.8% of cases) is found in the second and third week post-surgery. We emphasize that before the M3 surgery it is extremely important to always provide adequate instructions to the patient in order to avoid early masticatory loads and prevent this event that, although rare, acn occurs.