{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T08:26:16Z","timestamp":1787041576081,"version":"build-2736575974"},"reference-count":81,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral Health"],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Previous meta-analyses (MAs) and systematic reviews (SRs) reported that presence of third molars increases the risk of angle and decreases the risk of condylar fractures, but the data is dispersed across these studies. The aim of this umbrella review is to pool quantifiable data from the previous MAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This umbrella review searched the PubMed, Embase and Web of Science databases through June 2026 in accordance with PRISMA recommendations. The MAs that looked at the relationships between third molars and mandibular fractures were included. The odds ratios (OR) and risk ratios (RR) for angle and condylar fractures were the main extraction data. The Newcastle-Ottawa Scale (NOS) criteria were applied for quality assessment and the GRADE tool was utilized to evaluate evidence certainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 8 MAs with \u223c40 thousand participants were included. Due to the high overlap across these MAs, only 32 unique primary studies were selected from these reviews. Further, an additional 10 studies were included from an independent literature search. In total, 42 studies encompassing \u223c16 thousand participants were included for an updated meta-analysis. Third molars were associated with a significantly higher observed risk of mandibular angle fractures (RR 2.18, 95% CI 1.66\u20132.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001) but they were associated with a significantly lower observed risk of condylar fractures (OR 0.28, 95% CI 0.19\u20130.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Most of the subgroup and sensitivity analyses showed the consistency of the results. However, both outcomes received \u201cvery low\u201d rate of evidence certainty, mostly due to the observational nature of the included studies, significant heterogeneity and publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Third molars are associated with a higher observed risk of mandibular angle fractures, but they were associated with a lower observed risk of condylar fractures. Clinical decision on the prophylactic removal of the third molar should balance the risks of angle vs. condylar fractures. Definitive preventive strategies require well-designed prospective research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>The protocol of this review is registered in PROSPERO database with the registration number of CRD420251121903.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/froh.2026.1865229","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T07:56:02Z","timestamp":1787039762000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Role of third molars in mandibular fractures: a systematic umbrella review with updated meta-analysis"],"prefix":"10.3389","volume":"7","author":[{"given":"Shahen Hiwa","family":"Omer","sequence":"first","affiliation":[{"name":"Department of Dentistry, Komar University of Science and Technology","place":["Sulaymaniyah, Iraq"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Khalid","family":"Mahmood","sequence":"additional","affiliation":[{"name":"French National Center of Scientific Research (CNRS), French Blood Establishment (EFS), Bio-Cultural Anthropology, Law, Ethics and Health Laboratory (ADES), Faculty of Medical and Paramedical Sciences, Aix-Marseille University","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Aso","family":"Abdulghafor","sequence":"additional","affiliation":[{"name":"College of Dentistry, Sulaymaniyah University","place":["Sulaymaniyah, Iraq"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yad Mariwan Mohammed","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Dentistry, Tishk International University","place":["Sulaymaniyah, Iraq"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Falguiere","sequence":"additional","affiliation":[{"name":"Oral Surgery Department, Timone University Hospital","place":["Marseille, Provence-Alpes-C\u00f4te d'Azur, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Lan","sequence":"additional","affiliation":[{"name":"French National Center of Scientific Research (CNRS), French Blood Establishment (EFS), Bio-Cultural Anthropology, Law, Ethics and Health Laboratory (ADES), Faculty of Medical and Paramedical Sciences, Aix-Marseille University","place":["Marseille, France"]},{"name":"Oral Surgery Department, Timone University Hospital","place":["Marseille, Provence-Alpes-C\u00f4te d'Azur, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1002\/9781119842958.ch6.3","article-title":"Mandibular trauma","volume-title":"Oral and Maxillofacial Surgery","author":"Farzad","year":"2025"},{"key":"B2","doi-asserted-by":"publisher","first-page":"915","DOI":"10.3390\/medicina61050915","article-title":"The global burden of maxillofacial trauma in critical care: a narrative review of epidemiology, prevention, economics, and outcomes","volume":"61","author":"Maniaci","year":"2025","journal-title":"Medicina (Mex)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1177\/19433875221095984","article-title":"Nine years of retrospective study of mandibular fractures in semi-urban teaching hospital, shimla, himachal pradesh, India","volume":"16","author":"Ghezta","year":"2023","journal-title":"Craniomaxillofacial Trauma Reconstr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1111\/edt.12857","article-title":"Trends in mandibular fractures in the USA: a 20-year retrospective analysis","volume":"39","author":"Adik","year":"2023","journal-title":"Dent Traumatol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1476.e1","DOI":"10.1016\/j.joms.2017.03.021","article-title":"How is third molar status associated with the occurrence of mandibular angle and condyle fractures?","volume":"75","author":"Xu","year":"2017","journal-title":"J Oral Maxillofac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1016\/j.ijom.2017.02.1264","article-title":"Influence of third molars in mandibular fractures. 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