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

Purpose: The management of atrophic mandibular fractures presents challenges due to the absence of stable occlusion and the insufficient bone volume. In this case series, we present a technique based on virtual surgical planning and in-house computer-aided design and manufacturing (CAD/CAM) for the surgical treatment of severe atrophic mandibular fractures. Methods: etween 1 January 2022 and 31 December 2024, eight patients with edentulous mandibular fractures were treated. Data collected 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, length of hospital stay, adequacy of reduction according to Ramanathan, and clinical outcomes. Results: Seven female and one male patient (mean age 82.6 ± 3.99 years; range 80-92) were included. Six patients were classified as having class III atrophy, and two as class II. Mild, moderate, and severe displacement were observed in three (37.5%), two (25%) and three (37.5%) patients respectively. Postoperative panoramic radiography demonstrated good and very good reduction in three (37.5%) and five (62.5%) patients respectively. Virtual surgical planning and plate pre-bending required an average of 90.5± 10.5 minutes. The mean operative time was 135.3 ± 6.63 minutes. Conclusion: Virtual fracture reduction and plate pre-bending on stereolithographic models represent a valuable tool for managing severe atrophic mandibular fractures. The authors believe this approach has potential to improve operative accuracy and reduce surgical time in these complex cases, offering good cost-effectiveness and time efficiency.