Executive Editor: Marcelo Figari, Gregorio Sánchez Aniceto General Editor: Daniel Buchbinder

Authors: Ricardo Cienfuegos, Carl-Peter Cornelius, Edward Ellis III, George Kushner

Mandible - Special considerations

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1 Diagnosis top

Involvement of the alveolar area enlarge

Routine diagnosis of alveolar fractures should include an OPG. Periapical and occlusal dental x-rays can be beneficial.

OPG showing a right body mandibular fracture with an associated alveolar component.

Involvement of the alveolar area enlarge

CT or digital volume tomography (DVT) imaging may be useful to delineate the fracture exactly.

The fragment of the alveolar process reaching from the canine to the first molar is clearly visible.

Involvement of the alveolar area enlarge

The oblique course of the fracture line across the inferior border is revealed.

Involvement of the alveolar area enlarge

In this representative slice from the sagittal series the fractured alveolar fragment is displayed.

2 Treatment options top

Involvement of the alveolar area enlarge

Alveolar process fractures can usually be treated by reduction and fixation with an arch bar that must be maintained for approximately 6 weeks to provide time for the fracture to heal.

As an alternative, open reduction and internal fixation may be used in selected isolated alveolar fractures and mostly in those associated with more severe mandibular fractures. Sufficient size of the teeth-bearing bone fragments is required in order to position the miniplates and screws without damaging the dental roots.

Tooth luxations and fractures are commonly associated. The teeth in the fracture lines should be carefully assessed clinically and radiographically to determine the need of extraction. Click here for further information on treating teeth in the line of fracture.

3 Case example top

Involvement of the alveolar area enlarge

In this case, it was possible to include the alveolar fragment using a miniplate plate fixed with monocortically inserted screws located adjacent to the tooth apices. The mandibular fracture was treated with a large profile locking plate 2.0 to give enough stability along the inferior mandibular border.

v1.0 2008-12-01