Unveiling the link between impacted third molars and bad split risk in sagittal split ramus osteotomy: A 12-year retrospective study

Bad splits are a known complication of Bilateral Sagittal Split Osteotomy (BSSO), yet their occurrence remains unpredictable. This retrospective study investigated whether the presence, impaction status, and anatomical position of mandibular third molars affect the incidence and pattern of bad splits. A total of 819 patients who underwent BSSO between 2012 and 2023 were analyzed, encompassing 1638 osteotomy sites. Patients were grouped based on third molar status at the time of surgery. Bad splits were observed in 2.38 % of all osteotomy sites. There was no statistically significant difference between patients with retained third molars (2.65 %) and those whose third molars were removed at least six months earlier (2.33 %, p = 0.77). Similarly, no significant associations were found between bad split occurrence and impaction status (p = 0.74) or anatomical position (p = 0.33). However, patients with retained third molars who experienced bad splits were significantly older (p = 0.004). These findings suggest that the configuration of third molars alone does not increase bad split risk, but age may play a contributory role.