Crucial decisions on the management of the atrophic mandibular fractures: a ten-year prospective study of 48 injuries.

Abstract Purpose: The purpose of this study was to a) record and evaluate the epidemiological data relevant to the fractures of the atrophic mandible in the Greek population b) present our experience in the management of these difficult injuries and c) compare our results to the outcomes of other similar studies and discuss the postoperative complications. Methods: A prospective analysis of all the edentulous patients with fractures of the atrophic mandible treated at the Oral and Maxillofacial Surgery Department of K.A.T General Hospital of Athens in Greece was performed from November 2012 to December 2022. Age, gender and medical history of the patient, etiology and site of the fracture, classification of atrophy, type of surgical approach, type of osteosynthesis and postoperative complication. Results: 34 patients were included in the present study and 48 fractures of the atrophic edentulous mandible were managed surgically. 22 fractures were classified as class II of atrophy, 21 fractures as class III and 5 injuries as class I. In 32 patients we used an extraoral approach and only 2 patients were treated with an intraoral access. 44 fractures were treated with a 2.0mm locking reconstruction plate and only 4 injuries of class I atrophy were treated with mini plates. Conclusions Clinical practice has confirmed that for these cases an extraoral approach followed by stable fixation with a 2.0mm reconstruction locking plate can deliver excellent results. Our findings show that the routine use of primary bone grafts is not necessary and can be reserved for more complex cases.