Atrophic Edentulous Mandible Research Articles

Spontaneous bilateral fracture of the mandible: A case report and review of literature

Several mechanisms have been described in the literature for mandibular fractures. However, it is to be noted that fracture of mandible can occur spontaneously, especially in elderly persons with atrophic edentulous mandible. It is important to rule out local and systemic factors that can be the possible causes for fractures in these cases. We describe a case of spontaneous fracture of the mandible in an elderly lady with a review on possible mechanisms that can result in such fractures.

Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants

Extensive resorption of the mandible increases the interarch space and rehabilitation with traditional dentures is often unsatisfactory due to the superficialization of intraoral muscles. A study of 19 patients who underwent augmentation of an atrophic mandible using a bilateral two-step osteotomy and interpositional bone graft technique is presented. Three horizontal bone cuts (one in the intraforamina and two in the molar region) were made and jointed together by two short vertical bone cuts mesialy to the mental nerve. The cranial fragment was lifted and the iliac bone graft was interposed recreating the correct intermaxillary relationship. A broad vascular pedicle was maintained during surgery, ensuring nutrition from the lingual side, essential to reduce resorption of the bone graft and cranial fragment. 141 Biomet 3i Osseotite((R)) implants were placed. Patients were rehabilitated with a full-arch implant-supported fixed prosthesis or an implant-supported overdenture. This clinical study describes the resorption process over a 4 year follow-up. 3 of 19 suffered from persistent neurosensitive disturbances. In conclusion, bilateral two-step osteotomy in association with interpositional bone graft is a reliable surgical means to recreate the anatomical morphology of the mandible.

The fractured edentulous atrophic mandible — open or closed treatment?

The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were used for searches. The Internet was searched for potentially relevant meta-analyses and non-Cochrane systematic reviews, ongoing clinical trials and published dissertations. Reference lists of identified studies were cross-checked for any potentially relevant clinical trials. There were no language restrictions. Studies were selected if they were randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoid process of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were selected. Screening of eligible studies was conducted in duplicate and independently by two review authors. It was intended to express results as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomised controlled trials were identified. This review illustrates that there is currently inadequate evidence to support the effectiveness of any single approach, either open or closed, in the management of fractured atrophic edentulous mandibles and that, until high-level evidence is available, treatment decisions should continue to be based on clinician's prior experience. This absence of evidence may in part reflect a certain lack of clarity and the apparent diversity and lack of reliability in some of the traditional and normative predictors of successful outcomes.

Miniplate osteosynthesis of fractures of the edentulous mandible

This study was performed to analyze treatment of fractures of the edentulous mandible and to discuss this method in relation to the mandibular height at the fracture site. Fifteen fracture sites in 11 patients with an edentulous mandible were retrospectively examined. These fractures were located: nine fractures in the mandibular body, three in the paramedian region, and three in the mandibular angle. Fractures in a mandible measuring more than 10 mm in the vertical height were treated with one miniplate. Fractures in an extremely atrophic mandible with 10 mm or less were treated using one or two miniplates, also using a modified Champy plate with 1.3 mm in thickness. A mandibular fracture with a height of 5 mm was treated with a combination of a microplate on the buccal side and a miniplate on the inferior border of the mandible with additional direct circumferential wiring. Oblique or splitting fractures were treated with direct circumferential wiring or a Herbert screw, at one fracture site each, respectively. Complications, including infection, fibrous union, nonunion and trismus, were not seen. In one patient, hypesthesia of the lower lip was, however, persistent 1 month after surgery. Miniplate osteosynthesis is the less invasive treatment, and it is suitable for fractures of the atrophic edentulous mandible, except for comminuted or defect fractures. To obtain stable fixation in severely atrophic mandibles, we need to consider the use of two miniplates or a combination with microplates.

Distraction osteogenesis with subperiosteal devices in edentulous mandibles

Nine patients with severely atrophic edentulous mandibles were treated by distraction osteogenesis with subperiosteal distractors for vertical augmentation of the anterior alveolar bone before insertion of implants. All the patients had severe complications and we conclude that the use of subperiosteal devices for vertical augmentation of edentulous mandibles is hazardous and offers no advantage over other surgical methods.

An in vitro evaluation of miniplate fixation techniques for fractures of the atrophic edentulous mandible

This study was undertaken to evaluate the biomechanical stability of various miniplate fixation techniques in varying degrees of atrophy and to determine optimal fixation techniques for fractures of the atrophic edentulous mandible. A total of 78 bovine ribs were randomly divided into 13 groups of six each; one non-atrophic group and twelve atrophic groups. Each one of the 13 sets of six ribs was formed based on the vertical dimension (40, 20, 15 or 10 mm) and osteotomized. The segments so produced were then reduced and fixed using various miniplate fixation techniques. The stability of various miniplate fixations in ribs showing varying degrees of atrophy (10, 15 and 20 mm) was compared with that of one miniplate fixation in non-atrophic ribs (40 mm), used as a standard. Atrophic groups utilizing single miniplate were significantly less stable than the non-atrophic group, whereas atrophic groups fitted with double miniplates, such as two 4-hole or two 6-hole miniplates, were significantly more stable than the non-atrophic group. The two miniplate fixation technique is recommended for the provision of adequate fracture site stability when open reduction is indicated in cases of atrophic edentulous mandibular fractures.

Image processing and analysis program for measurement of bone density changes in reference and follow-up standardized extraoral oblique lateral cephalometric radiographs of the mandible.

The aim of this study was to develop an image processing and analysis program for peri-implant bone density measurements of the mandible using extraoral radiographs, which includes a correction for the variable projection of the soft tissues of the face. The measurement procedure is based on pairs of reference and follow-up extraoral oblique lateral cephalometric radiographs (OLCRs) of patients with endosseous implants in the anterior part of the atrophic edentulous mandible. The procedure consists of image acquisition, correction for radiographic variation using an aluminium wedge (i.e. film exposure and development) and transformation of the grey values into aluminium-equivalent values. After correction for variation in the projection of the soft tissues of the face using internal calibration fields, the actual peri-implant bone density measurements are performed. The soft tissue projection correction significantly reduces the variation between radiographs owing to the position of the soft tissues. It is concluded that the described image processing and analysis program, in combination with extraorally made OLCRs, is a valuable technique for measurement of peri-implant bone density changes of the mandible. With minor adaptations, the program can be used for other semi-edentulous patients.

Use of upper-lid blepharoplasty full-thickness skin for peri-implant keratinized tissue grafting: A report of 2 cases

Patients with an edentulous atrophic mandible restored with endosseous dental implants frequently have an inadequate zone of keratinized tissue in the peri-implant region. Soft tissue reconstructive procedures are commonly required to establish a zone of keratinized tissue adjacent to the supracrestal implant structure that will resist abrasion and adhere tightly to underlying bone and provide a tight marginal seal. A variety of procedures have been described to accomplish this goal, such as free gingival grafts, allografts, pedicle grafts, and split-thickness skin grafts (STSG).

Part I: Conservative management of the fractured atrophic edentulous mandible

Part I: Conservative management of the fractured atrophic edentulous mandible

Part II: Invasive management of the fractured atrophic edentulous mandible

Part II: Invasive management of the fractured atrophic edentulous mandible

Long-term follow-up of severely atrophic edentulous mandibles reconstructed with short Brånemark implants.

Oral implant treatment (Brånemark System) of edentulous mandibles has been presented in numerous studies. However, with regard to the severely atrophic lower jaw, no long-term follow-up studies with solely short implants are available. The purpose of the present investigation was to retrospectively follow the long-term treatment outcome of patients with severely resorbed edentulous mandibles being subjected to oral implant placement with short (6-7 mm) Brånemark implants. A total of 247 standard (7 mm long, Ø 3.75 mm) and 13 wide (6 mm long, Ø 5 mm) implants were inserted in 49 patients, all of whom exhibited severe resorption of edentate mandibles. Fixed implant-supported prostheses were manufactured for 45 patients, whereas 4 patients received overdentures. The patients were followed for a mean period of 8 years (range, 1-14 yr). Seventeen implants failed during the study period (cumulative implant survival rate 95.5% at 5-yr and 92.3% at 10-yr follow-up). Implant-supported constructions were worn continuously throughout the investigation by all study subjects. Marginal bone loss, measured after 1, 5, and 10 years of function, concurred with studies of Brånemark implants placed in more voluminous mandibles. No major clinical or construction complications occurred in the followed patients. The outcome of the present study showed that placement of short Brånemark implants without the use of bone grafting procedures for reconstruction of severely atrophic edentulous mandibles is a highly predictable treatment procedure.

Distraction implants – a new possibility for augmentative treatment of the edentulous atrophic mandible: case report

Distraction implants – a new possibility for augmentative treatment of the edentulous atrophic mandible: case report

Osteosynthesis of fractured atrophic edentulous mandibles—Miniplate versus stable plate

Osteosynthesis of fractured atrophic edentulous mandibles—Miniplate versus stable plate

The role of autogenous primary rib grafts in treating fractures of the atrophic edentulous mandible: Newman L. Br J Oral and Maxillofacial Surg 33:6, 381–387, 1995

The role of autogenous primary rib grafts in treating fractures of the atrophic edentulous mandible: Newman L. Br J Oral and Maxillofacial Surg 33:6, 381–387, 1995

The role of autogenous primary rib grafts in treating fractures of the atrophic edentulous mandible: Newman L. Br J Oral Maxillofac Surg 33:381, 1995

The role of autogenous primary rib grafts in treating fractures of the atrophic edentulous mandible: Newman L. Br J Oral Maxillofac Surg 33:381, 1995

Results of treatment of fractures of the atrophic edentulous mandible by compression plating: A retrospective evaluation of 84 consecutive cases

Results of treatment of fractures of the atrophic edentulous mandible by compression plating: A retrospective evaluation of 84 consecutive cases

Results of treatment of fractures of the atrophic edentulous mandible by compression plating: A retrospective evaluation of 84 consecutive cases

Purpose: This article introduces a simple and reproducable classification of the degree of atrophy in fractures of the atrophic edentulous mandible, and evaluates the results of treatment in 84 consecutive fractures based on this classification. Material and Methods: Eighty-four fractures of the edentulous mandible, with a height at the fracture site of ≤20 mm, were included. Using the ratio of actual plate width to plate width on the postoperative radiograph, the actual height of the mandible at the fracture site was calculated. Twenty-five fractures (30%) were in the Class I atrophy group (height at the fracture site 16 to 20 mm), 33 fractures (39%) occurred in Class II atrophi mandibles (height 11 to 15 mm), and 26 fractures (31 %) were seen in extremely atrophic Class III mandibles (height ≤10 mm). The treatment was performed by compression plating without any postoperative MMF. Primary bone grafting was used in six cases (7%) because a partial bony defect was present at the fracture site. Results: In 81 (96.5%) of the 84 fractures an uncomplicated, solid, bony union was achieved. Three major complications occurred: one osteomyelitis and two nonunions. The two nonunions occurred in bilateral fracture of an extremely atrophied mandible (Class III atrophy). Minor soft tissue infections, without interference with fracture healing, were observed in six cases (7%). Conclusions: Because there is an obvious relation between the height of the mandible and the incidence of complications in fracture healing, a special classification of the degree of atrophy is needed. In fractures of the extremely atrophic mandible (Class III atrophy) periosteal degloving should be avoided and supraperiosteal placement of plates is recommended. Compression osteosynthesis has proved to be a successful method, with minimal impairment of the patient and a low frequency of serious complications.

The role of autogenous primary rib grafts in treating fractures of the atrophic enedtulous mandible

Fractures of the atrophic edentulous mandible are relatively uncommon representing less than 1% of all facial bone fractures seen at The Queen Victoria HOspital, East Grinstead. Only 35 patients have been treated for fractures of the atrophic edentulous mandible at this unit from a total of over 4000 facial bone fractures seen here between 1975 and 1994. All traditional treatment modalities have been utilised with varying degrees of success. A technique is presented whereby all displaced fractures of the atrophic edentulous mandible with a measured bony vertical dimension of less than 10 mm at the fractures site are managed with primary autogenous rib grafting. This reduces the risk for formation of pseudarthosis and facilitates subsequent prosthetic rehabilitation.

Reconstruction of the severely atrophic edentulous mandible with the transmandibular implant system

Reconstruction of the severely atrophic edentulous mandible with the transmandibular implant system

Reconstruction of the severely atrophic edentulous mandible with endosseous implants: A 10-year longitudinal study

Reconstruction of the severely atrophic edentulous mandible with endosseous implants: A 10-year longitudinal study