The presence of a tooth in the fracture line constitutes a specific problem in mandibular fractures. Therefore, our objective was to characterize the approach to teeth in the fracture line used in the Department of Maxillofacial Surgery, Plovdiv, by retrospectively investigating the association between various preoperative factors and the decision to extract or preserve the tooth.
Material and methods: The following variables were studied based on data from available hospital records: 1) gender and age of patients; 2) local preoperative infections; 3) time from trauma to treatment; 4) degree of fracture displacement; 5) relationship between tooth and fracture line; 6) periapical pathology; 7) periodontal diseases; 8) type of tooth in the fracture line; 9) degree of eruption; 10) method of treatment.
Results: 593 fractures with a tooth in the fracture line were included in the study. The tooth was preserved in 69.90 +/- 0.14% of the cases, it was extracted in 29.30 +/- 1.91% and exarticulated in 0.80 +/- 0.38% of all fracture lines. The results demonstrated the existing association between the studied variables and the decision to extract or preserve the tooth. Extraction was generally preferred in the following cases: if a local preoperative infection was present; the time from trauma to treatment was more than 72 hours; there was a significant displacement of the fracture; the dental root was fractured; periapical pathology or periodontal disease was present; the tooth was multi-rooted; or treatment consisted of open reduction and internal fixation.
Conclusions: Making a decision to extract or preserve the tooth in the fracture line is a complex process. Each case, therefore, should be approached individually.