Virtual reduction and 3D printing in the management of edentulous atrophic mandibular fractures: case series and literature review

Purpose . The management of atrophic mandible fractures poses challenges due to the lack of stable occlusion and the inadequate bone volume. In this case series, we introduce a technique based on virtual surgical planning and in-house computer-aided design and manufacturing for surgical treatment of severe atrophic mandibular fractures. Methods . Between January 1sts 2022 and December 31st, 2024, eight patients with edentulous mandibular fractures were treated. Collected data included age, gender, cause of mandibular fracture, degree of atrophy according to Luhr's classification, site and type of fracture according to Ellis and Price, mean virtual planning and operative time, number of osteosynthesis plates, hospital stay length, adequacy of reduction according to Ramanathan and clinical outcomes. Results . Seven females and one male (mean age 82.6 years; range 80–92) were included. Six patients were classified as having class III atrophy, two as class II. The most frequent site of fracture was the body of the mandible. Mild, moderate, and severe displacement were observed respectively in three, two and three patients. Postoperative panoramic radiography showed good and very good reduction respectively in three and five patients. Virtual surgical planning and plate pre-bending took on average 90.5 minutes. Mean operative time was 135.3 minutes. Conclusion . Virtual fracture reduction and plate pre-bending on stereolithographic models stands out as a valuable tool for managing severe atrophic mandibular fractures. The authors believe this approach has potential to improve surgical time and accuracy in such complex cases with good cost-effectiveness and time efficiency.