Evaluating The Role Of Buccolingual Tooth Angulation In Predicting Lingual Plate Fracture In Horizontally Impacted Mandibular Third Molars " A Prospective Observational CBCT Analysis
DOI:
https://doi.org/10.64252/63ps8g88Keywords:
Buccolingual angulation, Mandibular third molar, Horizontally impacted tooth, CBCT, Lingual plate fracture, Odontectomy.Abstract
Background: Extraction of horizontally impacted mandibular third molars is a common oral surgical procedure, yet it carries potential complications. Lingual plate fracture, although rare, can lead to nerve injury, postoperative hemorrhage, and delayed recovery. Tooth orientation, specifically buccolingual angulation, may influence the risk of cortical thinning and fracture.
Aim: To evaluate the role of buccolingual angulation in predicting lingual plate thinning and fracture, and to examine its relationship with odontectomy patterns using CBCT imaging.
Methods: Preoperative CBCT assessment was performed on 58 patients (mean age 28.3 years; 32 females, 26 males) with horizontally impacted mandibular third molars in this prospective observational study. Buccolingual angulation was measured relative to the pulp axis of adjacent molars. Odontectomy patterns were recorded intraoperatively, and lingual plate integrity was assessed. Postoperative outcomes, including pain, mouth opening, and nerve function, were evaluated.
Results: Mean buccolingual angulation was 3.28°. A significant inverse correlation was found between angulation and lingual plate thickness at both mid-root and apical levels. Only one lingual plate fracture occurred (longitudinal odontectomy group), highlighting the multifactorial nature of fracture risk. Angulation values varied across odontectomy patterns (longitudinal: 1.32°, transverse: 6.53°, full: 13.66°, p = 0.001), but the pattern was randomly assigned. Postoperative recovery was favorable, with improved mouth opening and complete pain resolution by day 30.
Conclusion: Buccolingual angulation is a significant predictor of lingual plate thinning and potential fracture. Preoperative CBCT assessment is critical for surgical planning, while careful flap handling and periosteum preservation contribute to optimal postoperative outcomes.
