Impact of Mandibular Third Molar Impaction, Extraction History, and Deleterious Oral Habits on Angle Fractures: A Retrospective Study in Western Rajasthan

This retrospective study evaluates the association between mandibular thirdmolar impaction, extraction history, deleterious oral habits (gutka chewing, smoking,oral submucous fibrosis [OSMF]), and mandibular angle fractures, examiningincidence, risk factors, fracture favourability (horizontal and vertical), and clinicalimplications in 190 patients.

We analysed data from 190 mandibular fracture cases treated at a tertiarycare centre’s Dental Department from January 2022 to June 2025. Variables includedthird molar status (impacted, erupted, absent), Pell and Gregory classification,extraction history, oral habits, fracture patterns (favourable/unfavourable), andtreatment outcomes. Angle fractures were classified as horizontally favourable(resisting medial displacement) or unfavourable (prone to medial displacement) andvertically favourable (resisting inferior displacement) or unfavourable (prone to inferiordisplacement). Statistical analysis used Chi-square tests, Fisher’s exact tests, andmultivariable logistic regression, adjusted for age, sex, and injury mechanism (p < 0.05significant).

Angle fractures occurred in 77 of 190 cases (40.5%), with a higher incidencein impacted third molar cases (58/92, 63.0%) compared to erupted (10/60, 16.7%) orabsent (9/38, 23.7%) cases (χ² = 25.4, p < 0.001; OR = 8.5, 95% CI: 4.2–17.3). Amongimpacted cases, Class II/III impactions were predominant (50/58, 86.2%), withunfavourable horizontal (36/58, 62.1%) and vertical (40/58, 69.0%) fractures (p = 0.02and p = 0.01, respectively). Late fractures (1–3 weeks post-extraction) occurred in 5/15patients (33.3%), associated with Class III impactions and older age (mean 45.2 years,SD 8.1; OR = 4.2, 95% CI: 1.1–16.0, p = 0.04). Gutka chewing (16.8%) and OSMF(6.3%) increased angle fracture risk (OR = 3.1, 95% CI: 1.4–6.8, p = 0.005; OR = 4.0, 95% CI: 1.2–13.5, p = 0.03). Condylar fractures were more frequent with erupted orabsent third molars (p = 0.02). Open reduction and internal fixation (ORIF) achievedgood healing in 84.4% of cases; complications (13.0%) were higher in smokers (p =0.04) and unfavourable fractures (p = 0.03).

Impacted third molars (Class II/III, B/C), recent extractions, and deleteriousoral habits (gutka, OSMF) significantly elevate mandibular angle fracture risk, withunfavourable fractures predominating. Comprehensive preoperative assessment,cautious extraction techniques, and habit cessation counselling are critical to reducingrisk and optimizing outcomes.

Prophylactic extraction of high-risk impactions and targetedinterventions for deleterious oral habits may lower fracture risk in trauma-pronepopulations.