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1General considerations

Tooth in the line of fracture

A common problem in managing mandibular fractures involves dealing with teeth in the line of fracture (frequent source of complications). Commonly, there are impacted wisdom teeth associated with mandibular angle fractures. However, any fracture involving the dentate areas of the jaw has the potential to involve erupted teeth in the fracture line.

The surgeon can either remove the offending tooth or leave it in place if it is thought not to compromise the result of fracture treatment.

Any fracture that involves the periodontal ligament space of an erupted tooth should be considered an open (contaminated) fracture, requiring administration of systemic antibiotics, at least until the fracture has been reduced and stabilized.

Because many fractures through the angle communicate with either the erupted third or second molars, most angle fractures are open. If the fracture extends only into the area of an unerupted third molar, and there is no break in the surface mucosa, such fractures are considered closed.

Closed fractures may not require the use of antibiotics prior to surgery but may be treated with prophylactic antibiotics in the perioperative period.