Impacted tooth at the mandibular angle fracture line: Retained or remove?

Background: Management of mandibular fractures is usually associated with teeth at the fracture line. The involvement of impacted teeth in mandibular angle fractures is a consideration for the surgeon to retain or extract them. 

Purpose: This case report aims to discuss the necessity to retain or remove an impacted tooth in the mandibular angle fracture line.

Case: A 23-year-old woman came to the emergency installation with complaints of lumpy bite and pain due to falling from the motorbike with his chin hitting the asphalt. Discontinuity was found in the mandibular border of the right angle and left parasymphysis regions. Tooth 48 is impacted and is in the fracture line of the mandibular angle region. The diagnosis of mandibular segmental fractures in the right mandibular angulus region and left mandibular parasymphysis and total impaction of 48 class II position B (Pell & Gregory) were established.

Case management: Open reduction internal fixation (ORIF) plating on right mandibular angulus and left mandibular parasymphysis was performed with the use of inter maxillary fixation with rubber ligature. Odontectomy of the impacted tooth involved in the fracture line was also done.

Conclusion: The impacted tooth at the fracture line was removed in order to facilitate repositioning and fixation of the mandibular angle and with the consideration of delayed healing which may increase the chance of infection.