Three-dimensional fracture mapping of the mandible: a retrospective CBCT-based analysis

BACKGROUND: The evaluation of three-dimensional fracture mapping may offer significant benefits for clinicians, as well as for engineers involved in the design of advanced implants. The specific objectives of this study were to perform three-dimensional mapping of mandibular fractures based on the unique fracture morphologies of a defined cohort and to assess fracture distribution according to demographic variables, etiological factors, mandibular third molar impaction status, and fracture characteristics. METHODS: This retrospective single-center cohort study included patients with mandibular fractures who were admitted to the Department of Oral and Maxillofacial Surgery at a tertiary healthcare center between January 2018 and February 2025. The primary outcome was the three-dimensional mapping of mandibular fracture distribution, visualized as fracture line density using color-coded heat maps. Covariates included demographic, etiological, mandibular third molar-related, and fracture-related variables. Fracture mapping was performed at the fracture level, whereas statistical analyses evaluating the association between impacted third molars and fracture location were conducted at the patient level. RESULTS: One hundred fifty eight patients with mandibular fractures were analyzed, including 103 males (65.2%) and 55 females (34.8%) patients. The mean age of the patients was 36.8 ± 13.7 years. A total of 239 fractures were identified, and 267 fracture lines were delineated. In three-dimensional mapping, mandibular fractures most frequently clustered in the retromolar area, condylar neck, canine socket, and mental foramen regions. Mandibular fractures were most frequently observed in young male patients. The angle/ramus region was the most commonly fractured anatomical site, and assault was the predominant etiological factor. Impacted mandibular third molars were associated with a higher frequency of angle/ramus fractures, whereas condylar process fractures were more common in patients without impacted third molars. (OR = 2.04, 95% CI = 1.08-3.85, p = .027; and OR = 0.40, 95% CI = 0.20-0.80, p = .015, respectively). CONCLUSIONS: Three-dimensional fracture mapping revealed clustering of mandibular fractures in the retromolar area, condylar neck, canine socket, and mental foramen regions, indicating areas of higher observed fracture-line density in this cohort.