Impact of Mandibular Third Molar Impaction, Extraction History, and Deleterious Oral Habits on Angle Fractures: A Retrospective Study in Western Rajasthan

Objective: This retrospective study evaluates the association between mandibular third molar impaction, extraction history, deleterious oral habits (gutka chewing, smoking, oral submucous fibrosis [OSMF]), and mandibular angle fractures, examining incidence, risk factors, fracture favourability (horizontal and vertical), and clinical implications in 190 patients. Methods: We analysed data from 190 mandibular fracture cases treated at a tertiary care centre’s Dental Department from January 2022 to June 2025. Variables included third molar status (impacted, erupted, absent), Pell and Gregory classification, extraction history, oral habits, fracture patterns (favourable/unfavourable), and treatment outcomes. Angle fractures were classified as horizontally favourable (resisting medial displacement) or unfavourable (prone to medial displacement) and vertically favourable (resisting inferior displacement) or unfavourable (prone to inferior displacement). Statistical analysis used Chi-square tests, Fisher’s exact tests, and multivariable logistic regression, adjusted for age, sex, and injury mechanism (p < 0.05 significant). Results: Angle fractures occurred in 77 of 190 cases (40.5%), with a higher incidence in impacted third molar cases (58/92, 63.0%) compared to erupted (10/60, 16.7%) or absent (9/38, 23.7%) cases (χ² = 25.4, p < 0.001; OR = 8.5, 95% CI: 4.2–17.3). Among impacted cases, Class II/III impactions were predominant (50/58, 86.2%), with unfavourable horizontal (36/58, 62.1%) and vertical (40/58, 69.0%) fractures (p = 0.02 and p = 0.01, respectively). Late fractures (1–3 weeks post-extraction) occurred in 5/15 patients (33.3%), associated with Class III impactions and older age (mean 45.2 years, SD 8.1; OR = 4.2, 95% CI: 1.1–16.0, p = 0.04). Gutka chewing (16.8%) and OSMF (6.3%) increased angle fracture risk (OR = 3.1, 95% CI: 1.4–6.8, p = 0.005; OR = 4.0, 95% CI: 1.2–13.5, p = 0.03). Condylar fractures were more frequent with erupted or absent third molars (p = 0.02). Open reduction and internal fixation (ORIF) achieved good healing in 84.4% of cases; complications (13.0%) were higher in smokers (p = 0.04) and unfavourable fractures (p = 0.03). Conclusion: Impacted third molars (Class II/III, B/C), recent extractions, and deleterious oral habits (gutka, OSMF) significantly elevate mandibular angle fracture risk, with unfavourable fractures predominating. Comprehensive preoperative assessment, cautious extraction techniques, and habit cessation counselling are critical to reducing risk and optimizing outcomes. Clinical Relevance: Prophylactic extraction of high-risk impactions and targeted interventions for deleterious oral habits may lower fracture risk in trauma-prone populations