Management of atrophic mandible fractures: are bone grafts necessary?

r t 2 t t a d h C 1 l g U c t t t a w t p anagement of patients with atrophic mandible fracures has been a challenge for maxillofacial surgeons or years. Techniques that have been used are plints, external pins, split ribs wire osteosynthesis, nd rigid fixation. Results with each of these techiques have had variable success depending on the mount of atrophy that the patient underwent before njury. There has been an evolution of treatment over he years in which closed techniques have been gradally replaced by open techniques. In 1976, ruce and Strachan suggested that closed reductions hould be tried first and that if an open reduction was equired, wire mesh was preferable to a bone plate. n 1979, Marciani and Hill, after reviewing 33 wellocumented cases, recommended that a closed reuction of fractures of the atrophic mandibular body e done. In the second Chalmers J. Lyons Academy tudy, published in 1993, Bruce and Ellis noted that 1.5% of the 104 patents had an open reduction and nternal fixation with a bone plate. In 1996, Luhr et al resented their results in 84 patients with atrophic dentulous mandible fractures treated with compresion bone plates. In 2006, Wittwer et al reviewed heir outcomes of the treatment of 30 patients treated ith different plating systems. They concluded that he more atrophic a fractured mandible is, the more igid the fixation of the fracture needed to be. Tiwana t al, in 2009, suggested that for ideal healing of dentulous, atrophic mandible fractures, bone graftng is needed in addition to a large reconstruction late and a bone graft. The patient population with atrophic mandible ractures is different in several ways from the average