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

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

PURPOSE

To critically examine reported data to compare patient outcomes between load-sharing and load-bearing plate fixation for edentulous mandibular fractures.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Use of the MatrixWAVE™ system with dentures to establish maxillomandibular fixation in edentulous patients

Various methods have been described to establish maxillomandibular fixation in the treatment of fractures of atrophic, edentulous mandibles. We used the Synthes MatrixWAVE™ system (DePuy Synthes) in combination with dentures in two patients with fractured, edentulous, atrophic mandibles. Fixation was maintained for fractures that were not amenable to, or did not require, open reduction and internal fixation, and the mandibles were both well-healed and had good function at the end of treatment.

[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.