The management of complex mandibular fractures can be a humbling experience, even to experienced CMF trauma surgeons. Widely known are the advances brought on with acceptance and use of the concepts and techniques of rigid internal fixation in atrophic, comminuted and defect fractures. Simplification of the fractures if necessary, application of load bearing osteosynthesis and primary bone grafting have allowed both convalescent function and improved outcomes. Likewise, the same load bearing osteosynthesis, debridement and primary bone grafting have dramatically both simplified and shortened the course of treatment for infected and other complex fractures. The problem is not the complexity of the fracture, but in determining proper occlusion. Difficulties arise when the surgeon, because of the patient's abnormal occlusal relationship, cannot determine what the correct occlusion and/or jaw relationship is. Situations occur when the patient may have a naturally occurring malocclusion or due to the patient being in active orthodontic treatment. In other instances, due to the traumatic episode, the proper shape of the mandible cannot be determined because critical landmarks are lost. Comminuted mandibular symphysis fractures with loss of anterior teeth in conjunction with palatal fractures and maxillary incisor tooth loss is the most classic example. Bilateral mandibular condylar fractures in conjunction with a splayed symphysis, particularly if anterior teeth are lost or posterior maxillary teeth are missing is another. Concominent alveolar process fractures of the maxilla or mandible also complicate recognition of the proper occlusal relationship as well as reduction of the underlying bony segments. Obtaining the correct occlusion is a major factor in order to effect a correct reduction and allow stable osteosynthesis. Our experience with several of these complex fractures will be reported, describing both old and new techniques and strategies for determining and maintaining correct occlusion and reduction allowing correct ORIF. Pitfalls and suboptimal outcomes will be shown with analyses as to how it might have been done better. The management of complex mandibular fractures can be a humbling experience, even to experienced CMF trauma surgeons. Widely known are the advances brought on with acceptance and use of the concepts and techniques of rigid internal fixation in atrophic, comminuted and defect fractures. Simplification of the fractures if necessary, application of load bearing osteosynthesis and primary bone grafting have allowed both convalescent function and improved outcomes. Likewise, the same load bearing osteosynthesis, debridement and primary bone grafting have dramatically both simplified and shortened the course of treatment for infected and other complex fractures. The problem is not the complexity of the fracture, but in determining proper occlusion. Difficulties arise when the surgeon, because of the patient's abnormal occlusal relationship, cannot determine what the correct occlusion and/or jaw relationship is. Situations occur when the patient may have a naturally occurring malocclusion or due to the patient being in active orthodontic treatment. In other instances, due to the traumatic episode, the proper shape of the mandible cannot be determined because critical landmarks are lost. Comminuted mandibular symphysis fractures with loss of anterior teeth in conjunction with palatal fractures and maxillary incisor tooth loss is the most classic example. Bilateral mandibular condylar fractures in conjunction with a splayed symphysis, particularly if anterior teeth are lost or posterior maxillary teeth are missing is another. Concominent alveolar process fractures of the maxilla or mandible also complicate recognition of the proper occlusal relationship as well as reduction of the underlying bony segments. Obtaining the correct occlusion is a major factor in order to effect a correct reduction and allow stable osteosynthesis. Our experience with several of these complex fractures will be reported, describing both old and new techniques and strategies for determining and maintaining correct occlusion and reduction allowing correct ORIF. Pitfalls and suboptimal outcomes will be shown with analyses as to how it might have been done better.