Maxillo Mandibular Fixation in Edentulous Scenarios: Combined MMF Screws and Gunning Splints

Management of Bilateral Condylar Fractures in an Edentulous Patient with Atrophic Mandible Using CADCAM Technology

Purpose

The objective of this article is to report the case of an edentulous patient with a diagnosis of bilateral condylar fracture, who was treated using virtual planning.

Methods

CAD/CAM technology was used for the design and manufacture of a Gunning splint, which was employed for open reduction of the right fracture and closed management of the left side.

Results

The reduction of the right condylar fracture projected in the planning was achieved, as well as the return of the vertical dimension and the restoration of function, after 28 months of observation.

Conclusion

In the case of total edentulism, the lack of occlusal guidance and bone atrophy are important variables to consider; however, tools such as CAD/CAM technology can be used to take more predictable treatment decisions and facilitate the execution of the procedures.

Use of a Monoblock Gunning Splint in a Bilateral Condylar Fracture in an Edentulous Patient

This paper presents the outcomes of a conservative approach to a bilateral condylar fracture in an edentulous patient. Serial changes of the inclination angle were measured in an edentulous mandibular fracture treated with a monoblock Gunning splint.After being hit by a motor vehicle, a 67-year-old man fell onto his face. He had been edentulous for 7 years and did not use dentures. His mouth-opening was 28 mm between the edentulous maxilla and the mandible. X-rays and computed tomography revealed a comminuted mandibular angle fracture and bilateral condylar fractures. Stone casts were made from maxillary and mandibular alginate impressions. Maxillary and mandibular labiolingual splints were constructed using an autopolymerizing acrylic resin. In the most comfortable jaw position, the wax-bite was inter-positioned between the upper and lower splints and the vertical dimension was measured. Using a calibration resin, the inter-positional segment containing the eyelet wire was fixed between the splints with glue. A monoblock Gunning splint was applied and intermaxillary fixation (IMF) was performed with circummandibular and circumzygomatic wiring. The inclination of the fractured condyle was compared with the contralateral side. The difference in inclination between the fractured and contralateral sides was plotted over time.On post-IMF day 34, the inclination angle had decreased to 22.9°, only 3.2° greater than the contralateral side. The difference in inclination was fitted to an exponential regression model (y = 11.378e, R = 0.766, P = 0.022).This case shows that a condylar fracture in an edentulous patient can be treated by vertical lengthening using a monoblock Gunning splint and IMF.

Management of Bilateral Edentulous Mandible Fractures Through an Intraoral Approach Using CAD/CAM Technology: A Case Report

The surgical management of edentulous mandible fractures presents unique challenges secondary to poor bone stock and the absence of dentition to assist with fracture reduction. In complex injury patterns, such as bilateral edentulous mandible fractures, an external approach is often necessary to achieve adequate reduction and adaptation of a load-bearing reconstruction plate. We report a case in which computer-assisted design/computer-assisted manufacturing (CAD/CAM) was applied as an adjunct for the acute management of bilateral edentulous mandible fractures in a 58-year-old man. CAD/CAM technology was used to fabricate a patient-specific reconstruction plate and a maxillomandibular splint, which facilitated the successful treatment of this complex injury through an intraoral approach. This case highlights the potential of CAD/CAM technology to improve operative efficiency and clinical outcomes in the acute management of complex edentulous mandible fractures.

[Current therapy of atrophic edentulous mandibular fractures among elderly people]

The cases of mandible fractures among elderly people, especially those with atrophic mandibles, are increasing. Atrophic mandibular fractures among elderly people require specific treatment because of the differences between the anatomicophysiologies of elderly people and those of normal adults. This paper serves as a literature review on the characteristics, selection of the treatment method, and complication of atrophic edentulous mandibular fractures among elderly people.