The fractured edentulous atrophic mandible--open or closed treatment?

The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were used for searches. The Internet was searched for potentially relevant meta-analyses and non-Cochrane systematic reviews, ongoing clinical trials and published dissertations. Reference lists of identified studies were cross-checked for any potentially relevant clinical trials. There were no language restrictions.

Studies were selected if they were randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoid process of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were selected.

Screening of eligible studies was conducted in duplicate and independently by two review authors. It was intended to express results as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.

No eligible randomised controlled trials were identified.

This review illustrates that there is currently inadequate evidence to support the effectiveness of any single approach, either open or closed, in the management of fractured atrophic edentulous mandibles and that, until high-level evidence is available, treatment decisions should continue to be based on clinician's prior experience. This absence of evidence may in part reflect a certain lack of clarity and the apparent diversity and lack of reliability in some of the traditional and normative predictors of successful outcomes.