Mandibular Angle Fractures and Third Molar Management: A 10-Year Retrospective Study on Clinical Outcomes and Complication Patterns

Mandibular angle fractures represent one of the most frequent facial injuries and are often associated with the presence of a third molar within the fracture line. Whether to extract or retain the third molar during surgical treatment remains a topic of ongoing debate. This retrospective study reviewed 218 patients treated for mandibular angle fractures between 2015 and 2025 at the “Department of Maxillofacial Surgery, Umberto I General Hospital, Sapienza University of Rome,” to describe clinical outcomes and complication patterns associated with third molar management. All patients had radiologically confirmed fractures and at least 6 months of follow-up. Demographic data, trauma etiology, fracture type, treatment modality, third molar status, and postoperative complications were recorded. A third molar was present within the fracture line in 123 patients (56.4%), and 121 of these teeth were surgically removed during fixation. Postoperative complications occurred in 29 patients (13.3%), most commonly inferior alveolar nerve hypoesthesia, followed by infection, plate exposure, and malocclusion. No relevant difference in complication rates was observed between patients with or without a third molar in the fracture line. These findings suggest that neither the presence nor the extraction of a third molar significantly influences postoperative outcomes in mandibular angle fractures. A tailored, patient-specific approach to third molar management is therefore recommended, considering factors such as fracture configuration, tooth position, and surgical accessibility rather than adopting routine extraction as standard practice.