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Teeth in Fracture Line — MFDS Part 1 MCQ

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ModerateOral Surgery PrinciplesTeeth in Fracture LineMFDS Part 1

A 28-year-old patient has a mandibular body fracture undergoing reduction and internal fixation. The fracture line passes through the socket of a permanent tooth. The tooth is intact, not excessively mobile, has no significant caries, periodontal or periapical disease, and does not prevent anatomical reduction. What is the most appropriate management of this tooth?

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Correct answer: B — Retain it during fixation and arrange clinical and radiographic follow-up

The tooth should be retained during fracture fixation and reviewed clinically and radiographically. An intact tooth without severe mobility, infection, significant periodontal or periapical disease, root fracture, or interference with reduction does not require prophylactic extraction. Retention may also help preserve occlusal and alveolar relationships. Extraction is appropriate when the tooth prevents reduction or has an untreatable fracture, infection or poor periodontal prognosis. Routine extraction merely because a tooth lies in the fracture line is therefore unjustified. Leaving it without follow-up is inappropriate because loss of vitality, apical disease or mobility may develop later. Tooth splinting alone does not stabilise the mandibular fracture, and immediate implant placement is inappropriate in an acute fracture site.

Reference: Walker LJ et al. Retention of teeth in the fracture gaps of the mandible: a retrospective analysis. Clinical Oral Investigations. 2023;27:6055–6061. https://pubmed.ncbi.nlm.nih.gov/37610459/