Late mandibular fracture after third molar extraction: a malpractice case or not?

Fractures of the mandibular angle following surgical extraction of the third molar occur at an incidence ranging from 0.0034% to 0.0075%. The low incidence and the data present in the literature reveal how legal claims based on late mandibular fractures from third molar extractions are unlikely, being an uncommon clinical condition. The present case investigates the causal relationship between the fracture of the mandibular angle and the intervention of extraction of a dental element 3.8 in conditions of semi-inclusion and the possible hypothesis of dental malpractice. About two weeks after the extraction, the patient felt a noise like that produced by shattering glass, followed by severe and sudden pain along the area of the left mandibular joint and numbness. The following day, the patient underwent an orthopantomogram performed by the same medical team that carried out the operation in question, with an incorrect diagnosis of dislocation of the condyle, which is to be treated with muscle relaxants and anti-inflammatories. Upon further radiological investigations performed by different operators, it is concluded that the patient is suffering from a "fracture of the left mandibular angle". The patient, therefore, reported and sued the dentists for the crime of negligent personal injury who had extracted element 3.8. From medical history, clinical examination, and documentation produced by the patient, it can be said that the extraction of element 3.8 was necessary as the pericoronary sac had caused an untreatable periodontal lesion at the distal root of the 3.7. From a medico-legal point of view, it was established that the extraction maneuvers may have caused the fracture of the mandibular angle, but it can be excluded professional responsibility in the criminal field of the medical team that carried out the res judicata intervention, since the fact in itself represents a known complication of the extraction of mandibular third molars.