Management of Edentulous and Atrophic Mandibular Fractures: A Systematic Review of Treatment Modalities and Outcomes

Fracture of the edentulous mandible presents a significant clinical challenge due to anatomical alterations, reduced bone density, and lack of natural occlusal support, particularly in elderly patients with comorbidities. This systematic review aimed to evaluate and synthesize the available evidence on the treatment of edentulous and atrophic mandibular fractures, focusing on clinical outcomes, treatment success, and associated complications. A comprehensive search of four electronic databases was conducted to identify studies published between 1995 and 2024. Studies were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included adult patients with edentulous mandibles who sustained mandibular fractures and were managed conservatively or surgically. Eight studies, involving 382 patients and at least 366 fracture sites, were included in the final analysis. Most studies have focused on atrophic mandibular fractures, with a few evaluating isolated body or condylar fractures. The most commonly used treatment approach was open reduction and internal fixation using locking reconstruction plates. Other modalities included compression plating, miniplate osteosynthesis with intermaxillary fixation, and conservative management in selected cases. Surgical access varied between intraoral and extraoral routes, with the latter providing improved outcomes in severely atrophic cases. Across studies, treatment outcomes were favorable, with bone union rates ranging from 74% to 100%. Complications, including soft tissue infections and transient nerve weakness, were infrequent and primarily minor. Non-union and reoperation rates were low. Despite the generally positive outcomes, the quality of evidence was limited. The risk of bias was rated as serious in seven out of eight studies due to confounding, missing data, and concerns regarding outcome measurement. These findings suggested that locking reconstruction plates offer reliable fixation and high success rates in managing edentulous and atrophic mandibular fractures. However, the overall evidence was constrained by the methodological limitations. Future research should focus on prospective studies with standardized protocols and long-term functional outcome assessments to enhance clinical decision-making in this complex patient population.