Maxillary Tuberosity Fractures: A Structured Narrative Review and Clinical Decision-Making Considerations

Background: Maxillary tuberosity fracture is an uncommon but clinically significant complication of maxillary molar extraction. It may compromise immediate surgical outcomes, reduce posterior maxillary bone volume, and complicate subsequent prosthetic or implant rehabilitation. Despite its clinical relevance, the available literature remains limited and heterogeneous, and no universally accepted recommendations for diagnosis or management have been established. Methods: This structured narrative review was undertaken to synthesize clinically relevant evidence on anatomical risk factors, biomechanical mechanisms, diagnostic considerations, and management strategies associated with maxillary tuberosity fractures, with particular emphasis on biomechanical interpretation and intraoperative surgical decision-making. A targeted search of PubMed/MEDLINE and Scopus identified English-language publications relevant to the topic. After assessment for clinical relevance, 37 publications covering the period from 1967 to March 2026 were included in the final narrative synthesis. Results: The reviewed literature indicates that maxillary tuberosity fractures result from the interaction of anatomical and biomechanical factors, including maxillary sinus pneumatization, reduced posterior maxillary bone support, complex root morphology, and excessive or inappropriate force application during extraction. Early recognition of increased intraoperative resistance and timely modification of the surgical approach emerged as key factors in reducing structural complications. The available evidence also demonstrates substantial heterogeneity in reported management strategies and the absence of standardized clinical recommendations. Based on the narrative synthesis, a clinically oriented classification and decision-making framework are presented to support intraoperative assessment and surgical reasoning. Conclusions: Although the available evidence is derived predominantly from case reports, case series, retrospective studies, narrative reviews, anatomical studies, and selected surgical textbooks, the structured synthesis of this evidence provides a practical foundation for clinical decision-making. Improved recognition of biomechanical risk factors and structured intraoperative assessment may contribute to safer surgical management, preservation of posterior maxillary bone support, and maintenance of future prosthetic and implant rehabilitation options.