Vikas S Kotha, Brandon J de Ruiter, M Grace Knudsen, Marvin Nicoleau, Edward H Davidson
{"title":"Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review.","authors":"Vikas S Kotha, Brandon J de Ruiter, M Grace Knudsen, Marvin Nicoleau, Edward H Davidson","doi":"10.1177/19433875211059330","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation.</p><p><strong>Methods: </strong>PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II).</p><p><strong>Results: </strong>Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (<i>P</i> = .043).</p><p><strong>Conclusions: </strong>For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.8000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647372/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Craniomaxillofacial Trauma & Reconstruction","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19433875211059330","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/12/9 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Study design: Systematic review.
Objective: There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation.
Methods: PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II).
Results: Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (P = .043).
Conclusions: For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.
研究设计:系统评价。目的:下颌角骨折(maff)骨折线上第三磨牙的循证治疗日益发展。本研究的目的是根据第三磨牙的萌出程度和拔牙策略来区分Champy固定患者的MAF固定并发症。方法:到2020年5月,在PubMed、EMBASE、OVID、SCOPUS、Cochrane图书馆和clinicaltrials.gov上查询涉及第三磨牙的MAFs的英文出版物。使用作者定义的标准评估偏倚。计算拔出未萌和保留部分萌的第三磨牙(第一组)术后并发症的相对风险(RR),对照保留未萌和拔出部分萌的第三磨牙(第二组)。结果:10项研究报告了拔出或拔出的并发症;然而,只有一项研究将出疹和拔牙并发症分层以满足纳入标准。偏倚风险为中等,因为只有符合规定随访的病例被纳入。纳入73例(N):ⅰ组34例,ⅱ组39例。个体病例数据的定量综合显示,I组的并发症发生率明显高于II组(23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1)。感染并发症、机械并发症、骨不连或骨裂在两组间无显著差异。第1组需要再次手术的次数明显增加(P = 0.043)。结论:对于涉及第三磨牙的maf,同时拔除未萌出的第三磨牙和保留部分萌出的第三磨牙会增加Champy固定技术并发症的风险。对于这些患者,应考虑其他固定策略。