Edentulous Mandibular Fractures Research Articles

Comparing Load-Sharing Miniplate and Load-Bearing Plate Fixation in Atrophic Edentulous Mandibular Fractures: A Systematic Review and Meta-Analysis.

To critically examine reported data to compare patient outcomes between load-sharing and load-bearing plate fixation for edentulous mandibular fractures. A systematic review and meta-analysis were designed to test the null hypothesis of no difference in postoperative outcomes between load-sharing and load-bearing plate fixation in atrophic, edentulous mandibular fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried up until July 2016. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation method. A total of 1212 studies were screened for inclusion of which we included 1 high-quality Cochrane review, 6 narrative reviews, and 21 publications of case reports and case series. Overall, the quality of evidence was low. No difference was found between load-bearing and load-sharing fixation in functional recovery, nonunion, or infection. An uncontrolled case series portrayed complete functional and morphological restoration in 96.9% of patients (83.2-99.5; 95% confidence interval) in load-bearing osteosynthesis while another demonstrated the same outcome in only 40.0% of patients (17.5-65.0; 95% confidence interval). The authors did not find a statistically significant difference between load-bearing and load-sharing plate fixation in edentulous atrophic mandibular fracture patients; although this finding may be influenced by type 2 statistical error. Surgeons should continue to use their best clinical judgment in deciding on treatment approach for these challenging fractures. Future studies with higher level evidence are necessary to guide optimal fracture management.

A comparative evaluation of parasymphyseal fracture fixation in edentulous patients performed using dynamic navigation systems and Herbert screws with the conventional two-plate method: A study on models

PurposeThe investigators performed this study to compare the rigidity outcomes for minimally invasive fixation of edentulous mandibular parasymphyseal fractures without flap creation using Herbert screws with a dynamic navigation system and the conventional two-plate method. MethodsThe investigators implemented an in-vitro study design, and 20 polyurethane edentulous mandibular models covered with flexible plastic to simulate the gingiva were used. Parasymphyseal fractures were created in all models using a reciprocal saw. In the study group, the fracture segments in each model were planned to be fixed using two 30-mm Herbert screws. The Herbert screws were placed using a screwdriver with the dynamic navigation system guiding the process. In the control group, to simulate open reduction, the fracture fragments were fixed using two 4-hole straight titanium plates and 6-mm titanium screws. All mandibular models on the prepared platform were attached to the biomechanical testing machine. They were subjected to a continuous linear compression until plastic deformation occurred. Displacement resistance was measured once for every model when the displacement reached 1, 3, 5, 10, and 15 mm. Furthermore, the maximum breaking forces that the models could withstand before deformation were measured. Data were analyzed using independent samples t-test. A value of p < .05 was considered statistically significant. ResultsManual examination of the models did not reveal any mobility between the fragments. In all evaluated displacement steps, the models fixed using Herbert screws showed significantly higher resistance to mechanical loading compared to the models fixed using parallel miniplates. ConclusionIn present study, parasymphyseal fracture of edentulous mandible models were fixed successfully using Herbert screws with the dynamic navigation system. The results of this study may encourage future clinical studies.

The management of a high-risk patient with edentulous mandibular fractures

The management of a high-risk patient with edentulous mandibular fractures

A Treatment Protocol for Fractures of the Edentulous Mandible

The incidence of fractures of edentulous mandibles is relatively low. Knowledge about the management of these fractured edentulous mandibles relies heavily on case reports and observational studies. On the basis of the current literature, we compiled a treatment protocol for fractures of the edentulous mandible and hypothesized that this protocol would result in fewer complications. We conducted a retrospective cohort study of edentulous patients with mandibular fractures. The predictor variable was the fulfillment of the treatment protocol (yes or no). The outcome variables were postoperative complications and reoperations. Patient demographic characteristics were collected from patient records. The χ2 test was used for statistical analysis between predictor and outcome variables. Of 61 edentulous mandibular fractures (36 patients), 53 were treated according to the protocol and 8 were not. We observed 4 complications in the first group (complication rate, 7.5% [4 of 53]) and 4 in the second group (complication rate, 50% [4 of 8]). The fracture treatments that followed the protocol had a significantly lower postoperative complication rate (P=.001; odds ratio, 0.082) and needed fewer reoperations (P=.0001; odds ratio, 0.019) compared with the treatments that did not follow the protocol. The results of this study show that following the compiled treatment protocol for fractures of edentulous mandibles significantly reduces postoperative complications and reoperations.

Current therapy of atrophic edentulous mandibular fractures among elderly people

The cases of mandiblefracturesamong elderlypeople, especially those with atrophic mandibles, are increasing. Atrophic mandibularfractures among elderly people require specific treatment because of the differences between the anatomicophysiologies of elderly people and those of normal adults. Thispaper serves asaliteraturereviewon the characteristics, selection of the treatment method, and complication of atrophic edentulous mandibular fractures among elderly people.

Interrami intraoral fixation technique utilized as a conservative approach to edentulous/atrophic mandibular fractures.

Interrami intraoral Kirschner wire fixation (IRIF) technique is presented as new conservative successful indirect rigid fixation utilized for the reduction and fixation of edentulous/atrophic mandible fractures. This technique is carried out under local anesthesia without the need for open reduction internal fixation, which can lead to a compromise in the blood supply of fracture region. It is also quicker, easier, requires fewer postoperative visits, and cheaper than small or large bone plate fixations.Five edentulous mandibular fractures, 2 of them atrophic, 2 non-atrophic, and 1 partial edentulous, were successfully treated. In all cases, the IRIF technique was utilized to establish an indirect rigid fixation using horseshoe-shaped Kirschner wire with a 2-mm diameter. No complication was reported during these cases. This technique prevails over the Gunning splint and external edentulous fracture fixation techniques as it provides adequate fracture site stability, is more comfortable, and is better tolerated for a longer period of time by the patient. In addition, there are fewer complications caused by malunions from direct intraoral or extraoral small and large plate fixation techniques. Other advantages of the IRIF technique are that it enables the mandible to function as a single unit and preserves its function and anatomical position immediately after surgery. In contrast, the Gunning splint acts only to preserve the balance of a single segment's position.

Treatment of Edentulous Mandibular Fractures with Rigid Internal Fixation: Case Series and Literature Review

The aim of the study is to analyze the effectiveness of rigid internal fixation (RIF) for treating edentulous mandibular fractures. Because of the low incidence of fractures in edentulous mandible, there is no consensus of the optimal treatment for it. This study included all edentulous patients with mandibular fracture diagnosis, who were treated with internal fixation at the Hospital Italiano de Buenos Aires from November 1991 to July 2011. Data such as age, gender, etiology and location of fracture, surgical approach, type of osteosynthesis used, and postoperative complications were analyzed. A total of 18 patients, 76.2 years mean age, 12 females (66.6%), presented a total of 35 mandibular fractures. The mandibular body was the most common localization of the fractures. Twenty-five fractures received surgical treatment with RIF, mainly approached extraorally. Reconstruction plates were the most common type of fixation used. Fracture reduction was considered satisfactory in 96.5%, with 22.2% of complications and 11.1% of reoperations needed. Open reduction and RIF demonstrated to be a reliable method for treating edentulous mandibular fractures. Nevertheless, there is lack of high-level recommendation publication to support this.

Our experience in management of atrophic mandibular fractures: 2.0 mm locking plate system versus 2.4 mm locking plate system

Background and objectives: Incidence of atrophic edentulous mandibular fractures is less than 1% of facial fractures. The fixation system may be the only way to enhance the outcome of treatment. The purpose of this study was to compare the outcomes of different plating system used for stabilization.

Transmucosal fixation of the fractured edentulous mandible

Transmucosal fixation is a new strategy for the treatment of edentulous mandibular fractures using external fixation principles within the oral cavity. The component parts of this technique are not new. External fixation, locking plates and transmucosal implants represent the foundations of this technique; the authors' development has been to bring these established methods together as a transmucosal intra oral locking plate fixation technique. The first eight patients treated with this technique have achieved bony union, they have no long-term sensory deficit and all patients were able to eat a soft diet with minimal discomfort the day after surgery. The first five of eight patients on long-term review showed bony union confirmed radiographically. For the remainder and subsequent patients, radiographs have not been scheduled at review, in the absence of symptoms.

Open reduction with internal fixation for mandibular fracture of 98-year-old female with severe atrophic mandible: Report of a case

Atrophic edentulous mandibular fractures occur primarily in elderly population. Elderly patients who are more than 80 years old have risks for general anesthesia because of degradation of biological function. Recently, drugs and medical instruments have been developed and appliance for general anesthesia has also improved. We had the experience of a case where we had to carry out open reduction with internal fixation (ORIF) under general anesthesia for a 98-year-old female with severe atrophic mandible to improve her functional disability and acquire a faster recovery. Osteosynthesis was carried out using 2.8 mm Mandibular Recon Plate (Stryker Osteosynthesis, Friburg, Germany). She made a good recovery and there were no complications. There was no relapse or complications during 17 months of follow-up so that she could reach the age of 100 years.

Lower incisor intrusion with intraoral transosseous stainless steel wire anchorage in rabbits

The purpose of this research was to investigate the potential use of intraoral transosseous stainless steel wires as anchorage for intrusion of the lower incisors using a rabbit model. Placement of intraoral transosseous stainless steel wires around incisors is similar to that of intraoral transosseous wiring of edentulous mandibular fractures. Ten male New Zealand rabbits, 9 +/- 1.5 months of age, average weight 1.8 +/- 0.3 kg, were used in this study. One lower incisor was intruded with a 50 g bilateral force using a coil spring for 10 weeks, while the other incisor served as the control. Clinical measurements of the distances between the occlusal edges of the incisors (EE) were performed weekly with a calliper. In addition to standard descriptive statistical calculations, a paired Student's t-test was used for comparison of the two groups. All surgical sites healed uneventfully after insertion of the wires. Significant differences were found in the change of EE between the experimental and control sides from 4 weeks onwards. Intrusion of the incisor, 4 +/- 0.58 mm, was seen on the test side, while EE on the control side remained unchanged. Within the limits of this animal study, it is concluded that the intraoral transosseous stainless steel wire anchorage system is a cost-effective method for intrusion of lower incisors when the use of other anchorage system is not possible.

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.

Miniplate osteosynthesis for fractures of the edentulous mandible: A clinical study 1989–96

Our 8 years experience of treating fractures of the edentulous mandible by miniplate osteosynthesis, is discussed. Forty patients (31 men and 9 women) aged 37 to 86 years (mean: 64.6 years, SD: +/- 14.07) with 67 fracture sites were treated. The surgical approach was mainly intraoral (37 out of 40 patients) without the use of intermaxillary fixation. The postoperative clinical and radiological findings are reported and discussed. The advantages of the method are of great importance since immediate postoperative opening of the mouth is permitted, as the fractured bones are anatomically stabilized by means of titanium miniplates and screws. Our results were felt to be satisfactory, with a reoperation rate of only 3.9% (two out of 51 operated fracture sites, 16 condylar fractures were treated conservatively). This allows us to propose intraoral miniplate osteosynthesis as a routine method of treatment in cases of edentulous mandibular fractures which are mainly seen in elderly people.

Healing of dentate or edentulous mandibular fractures treated with rigid or semirigid plate fixation — an experimental study in dogs

The right mandibles of 40 dogs were fractured with a bending clamp, at a site being either dentate or edentulous, and treated with compression-plates or miniplates. After 1, 2, 4, 6, 8, 12 and 24 weeks the mandibles were examined by microradiography and histology. Some variation in the healing mode within the groups was observed, interindividual as well as intra-individual in different layers of the same mandible. Generally, healing displayed slightly more time-related progression with compression plates compared with miniplates and similarly in dentate fracture sites when compared with edentulous ones. The so-called indirect healing mode through cartilaginous callus was found to take place in the group with miniplates and edentulous fracture sites, whereas in the three other groups a type of direct bone healing through woven bone in the presence of more or less callus could be observed. The conclusions drawn from these findings are: that compression plates as well as miniplates are suitable for treatment of mandibular fractures in dogs, and the presence of teeth appears to exert a stabilizing effect on the fracture.

Fractures of the edentulous mandible: a retrospective review.

Treatment of edentulous mandibular fractures has remained somewhat controversial. A recent review of the literature showed that a number of techniques have been proposed with varying degrees of success. It was my clinical impression that I encountered an extremely high proportion of complications when caring for these injuries. For this reason, I performed a retrospective chart review of all patients with a diagnosis of mandibular fractures admitted to the University of California, Davis, Medical Center during the period July 1, 1989 to June 30, 1991. A total of 11 patients of 349 admissions were found to have edentulous mandibular fractures (3%). They were treated with a variety of techniques, including splints or dentures, intraosseous wire fixation, or rigid internal fixation with miniplates and screws. Successful results were obtained with each technique; however, the overall complication rate was 18% (2 patients), which was consistent with my overall results for the treatment of mandibular fractures. I recommend that no one technique is applicable to each fracture and that treatment must be individualized.

The treatment of long standing bilateral fracture non- and mal-union in atrophic edentulous mandibles

Long standing non-unions and mal-unions of atrophic edentulous mandibular fractures present a serious problem in oral surgical management. This paper describes a method of surgical treatment which involves an open reduction, freshening of the host bone margins, and the placement of an autogenous particulate bone graft of cancellous bone and marrow placed within a mesh implant of titanium. No intermaxillary fixation need be employed in this technique. A series of 12 cases of long standing intractable non- and mal-union of atrophic edentulous mandibles are presented and three cases are described in detail. The authors believe that this procedure is an optimal one for the management of patients presenting with these types of deformities and with this form of functional loss.