Mandibular fractures associated with third molar extraction: A systematic review and meta-analysis

Objective: This study aims to analyze the association between third molar surgery and mandibular fractures, with the goal of providing information to help surgeons prevent such fractures and guide appropriate treatment when they occur. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. A comprehensive search strategy was applied in PubMed and ScienceDirect using relevant MeSH terms. Inclusion criteria were based on the PICO framework. Data extraction and risk of bias assessments were performed for all included studies. Results: The combined proportion of mandibular fractures was 4.2 %, with a confidence interval ranging from 2.7 % to 5.7 %. An extremely high heterogeneity was observed (I² = 99.1 %, Q = 766.05, p < 0.001), indicating true variation among the studies. Meta-regression showed no significant relationship between the fracture proportion and variables such as mean age or percentage of male participants. Subgroup analysis revealed that studies reporting postoperative fractures had higher combined proportions, suggesting a potentially important clinical pattern worthy of further investigation. Conclusions: The present study analyzed the association between third molar surgery and mandibular fractures, aiming to provide useful information for their prevention. It was observed that these fractures occur more frequently in the postoperative period, highlighting the importance of implementing preventive measures before, during and the procedure.