Influence Of Posterior Teeth On The Anatomical Location Of Fracture Line In Condylar Fractures – A Cross Sectional Study Using Digital Panaromic ​ Radiographs

Abstract

SUMMARY: Background: Condylar fracture have been probably the most mismanaged fractures throughout history. They were either not treated because of improper diagnosis or were managed minimally using external bandages to immobilise the mandible. If left untreated, condylar fractures lead to temporomandibular disorders like ankylosis, dysfunction, chronic dislocation and chronic pain. Even though many authors classify condylar fractures based on their location, no literature currently exists in determining the exact cause which ascertains the location of the fracture line. In this study we attempted to analyse if the presence or absence of posterior teeth is in any way related to the anatomic level of condylar fractures. Materials and Methods: 200 Orthopantomographic images of patients who presented to the department of oral and maxillofacial surgery with condylar fracture from the year 2017-2021 were collected from the medical records department. Out of these 200 OPGs 170 images where finally selected based on the inclusion criteria. Presence or absence of posterior teeth and the total number of missing posterior teeth were calculated and subjected to statistical analysis. Results: Diacapitular fractures were common in patients with no missing teeth and sub condylar fractures were found in patients with absence of posterior teeth hence validating our hypothesis that the number of missing posterior teeth are indeed associated with the level of condylar fractures and that, missing maxillary posteriors, mandibular posteriors, premolars and molars all statistical significantly independently correlated with the level of condylar fracture. Conclusion: In condylar fractures, the level of fracture line is influenced by the presence or absence of posterior teeth. The teeth are usually neglected as they are considered as an accessory aid and not an integral component of the facial skeleton. Proving that the teeth are involved in a complex mechanism which protects the Temporo- Mandibular joint from traumatic forces on the mandible will further solidify their position as an integral functional component and shift the focus towards preserving rather than removing them whenever possible.