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9Aftercare following treatment of an edentulous atrophic fracture with a reconstruction plate

Edentulous atrophic fractures

If MMF screws are used intraoperatively in conjunction with the patient’s prostheses, they are usually removed at the conclusion of surgery if proper anatomic fracture reduction and fixation have been achieved.

Postoperative x-rays are taken within the first days after surgery. In an uneventful course, follow-up x-rays are taken after 4–6 weeks.

The patient is examined approximately 1 week postoperatively and periodically thereafter to assess the stability of the fracture and to check for infection of the surgical wound. During each visit, the surgeon must evaluate the patients ability to perform adequate oral hygiene and wound care, and provide additional instructions if necessary.

Follow-up appointments are at the discretion of the surgeon, and depend on the stability of the mandible on the first visit. Weekly appointments are recommended for the first 4 postoperative weeks.

Postoperatively, patients will have to follow three basic instructions:

1. Diet
Depending upon the stability of the internal fixation, the diet can vary between liquid and semi-liquid to “as tolerated”, at the discretion of the surgeon.

2. Oral hygiene
Patients having only extraoral approaches are not compromised in their routine oral hygiene measures and should continue with their daily schedule.
Patients with intraoral wounds must be instructed in appropriate oral hygiene procedures. A soft toothbrush (dipping in warm water makes it softer) should be used to clean the oral cavity. Chlorhexidine oral rinses should be prescribed and used at least three times each day to help sanitize the mouth. For larger debris, a 1:1 mixture of hydrogen peroxide/chlorhexidine can be used. The bubbling action of the hydrogen peroxide helps remove debris.

3. Physiotherapy
Physiotherapy can be prescribed at the first visit and opening and excursive exercises begun as soon as possible. Goals should be set, and, typically, 40 mm of maximum interincisal jaw opening should be attained by 4 weeks postoperatively. If the patient cannot fully open his mouth, additional passive physical therapy may be required such as Therabite or tongue-blade training.

Long-term dental rehabilitation
An existing dental prosthesis (denture) must often be remade. Dental implants may be placed in the anterior mandible after symphyseal screws have been removed. Implant reconstruction is undertaken when bony union of the mandible has been achieved.