Treatment of Atrophic Mandibular Fractures Based on the Degree of Atrophy—Experience With Different Plating Systems: A Retrospective Study
Clinic for Cranio and Maxillofacial Surgery, University of Vienna Medical School, General Hospital, Vienna, Austria. Journal of Oral and Maxillofacial Surgery
(Impact Factor: 1.43).
03/2006; 64(2):230-4. DOI: 10.1016/j.joms.2005.10.025
The aim of this retrospective study was to evaluate the clinical outcome of fractures of the atrophic mandible based on the degree of atrophy and treatment by different plating systems.
Thirty patients with 40 fractures of atrophic mandibles were treated by open reduction and internal fixation at our department between 1994 and 2001. Twelve fractures occurred in Class I (between 15- and 20-mm bone height), 10 fractures in Class II (between 10 and 15 mm), and 18 fractures in Class III atrophy (<10 mm). The profile heights of plating systems used for stabilization varied from 0.5 to 2.2 mm and were applied with an intraoral (n = 37) and extraoral (n = 3) approach.
In 36 fractures, bone healing was uneventful. Major complications (loose hardware or nonunion) occurred in 4 fractures: 2 in Class II and 2 in Class III atrophy. Major complications were observed with 1.4-mm (n = 3) and 2.2-mm (n = 1) plates. Minor complications (infections or dehiscence) were observed in 6 fractures: 3 in Class II and 3 in Class III atrophy. Hypesthesia of the inferior alveolar nerve was present 1 week and 1 year postoperatively in 39 and 16 fractures, respectively.
Treatment of atrophic mandible fractures should be based on the degree of atrophy. More rigid fixation may be necessary in mandibles with less than 15 mm bone height.
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- "Usualmente estas fracturas ocurren en pacientes adultos mayores, con capacidad osteogénica reducida por una disminución de sus células osteoprogenitoras y morfológicamente por la presencia mayoritaria de hueso cortical, acompañado de insuficiente irrigación sanguínea, características asociadas a la atrofia ósea mandibular (Aziz & Najjar, 2009). Luhr desarrolló una clasificación basada en el grado de atrofia ósea, el cual es de utilidad para el tratamiento de este tipo de mandíbulas, determinando: Grado I (altura ósea de 16 – 20 mm), Grado II (altura ósea de 11 – 15 mm) y Grado III (altura ósea menor de 10 mm) (Wittwer et al., 2006). "
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ABSTRACT: This paper sets out to present a case of retreatment of a complex fracture in atrophic mandible bone with the insertion of endosseous dental implants. The management chosen is discussed in relation to the main potential causes of such fractures, surgical treatments available, bone grafting, as well as to the possibility of immediate recovery of the masticatory function through dental implants. In addition, a report of the seven-year clinical follow-up showing the patient's complete prosthetic rehabilitation is also included. Descriptors: Mandibular Fractures; Fracture Fixation, Internal; Bone Transplantation; Dental Implantation.
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