Partially Edentulous Arches and Bilateral Mandibular Fracture: Application of Condensation-Silicone Bite Block-Splint, Mandibulo-Maxillary Fixation Screws, and Elastics for Intraoral Immobilization

Abstract

Each mandibular fracture is unique. It requires individual treatment solutions due to different number of fracture sites, fracture terms, level of dislocation, presence/absence of the infection, number, location, and condition of teeth, etc. Management of jaw fractures in partially edentulous arches are even more complicated and typically can involve assistance of a dental technician. Published English language literature lacks information about application of condensation silicone (C-silicone) bite block-splint with mandibulo-maxillary fixation (MMF) screws and elastics for management of bilateral mandibular fracture. This is why we present this novel technique developed by our team based on fracture treatment in a 38-year-old male partially edentulous patient. Also, we introduce a Kyiv’s Modification of the Kennedy Classification System of the partially edentulous arches useful for mandible fracture cases. The Kennedy–Kyiv Classification System considers the non-treated teeth roots as supporting locking points (temporary additional retention points) that increase the stability of the bite block-splint and decrease probability of micromovements. Moreover, it contraindicates extracting such teeth roots immediately before the block-splint fixation as extraction of such roots can provoke the alveolar osteitis upon the fracture site(s) healing and immobilization period what will increase the risk of the block removal for the treatment of osteitis. A review of published MMF techniques and appliances designed for mandible fracture treatment is performed. Multiple appliances for partially and totally edentulous mandibles are considered as well as for the dentulous jaws. The Gunning-type splints and its modifications were considered. An in-chair fabrication of C-silicone bite block-splint and its combined application with MMF screws and elastics is a novel alternative for the Gunning splint. This appliance allows to decrease the time typically required for the Gunning splints fabrication, decreases number of the involved specialists, decreases cost of treatment, and easy for performance.