Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up

Abstract

Background: The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. Methods: Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. Results: Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. Conclusions: A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review

“…After meticulous evaluation, 8 papers were excluded because full texts were not available, and 15 other papers were not included in this scoping review because they concerned the use of non-orthodontic approaches. Thus, at the end of the selection process, 17 articles were considered for this scoping review [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ].…”

“…The sizes of the analyzed samples ranged from 1 to 40 subjects, and the follow-up periods (when specified) ranged from 2 months to 10 years. Twelve studies [ 56 , 57 , 58 , 59 , 61 , 63 , 64 , 65 , 68 , 70 , 71 , 72 ] included growing subjects (age range: 3–16 years), while five articles [ 60 , 62 , 66 , 67 , 69 ] included adults (age range: 16–55 years).…”

“…Other articles were designed with prospective approaches (comparative [ 67 , 69 ] or non-comparative [ 58 ]) but with a lack of a systematic randomized (controlled and non-controlled) enrolment design. Finally, four studies featured retrospective designs [ 62 , 64 , 70 , 72 ].…”

“…In contrast to the intermaxillary fixation (IMF) approaches, which are usually managed by a maxillofacial surgeon, such as conventional or mini-screw-retained arch bars and occlusal splints fixed with circummandibular wiring, from the results of the present review, among the conservative IMF methods that are manageable by orthodontists and pediatric dentists, the following approaches emerged: (1) mini-screws and elastics [ 62 , 66 , 70 ]; (2) bonded orthodontic brackets and elastics [ 60 , 62 , 66 , 69 , 71 ]; (3) cemented [ 56 , 61 , 63 , 65 , 67 ] or (4) removable [ 59 , 68 , 72 ] occlusal splints; and (5) functional removable appliances [ 64 ], which may be associated with functional exercises ( Figure 2 ). From the results of this review, these approaches have mainly been adopted for children and adolescents [ 56 , 57 , 58 , 59 , 61 , 63 , 64 , 65 , 68 , 70 , 71 , 72 ]. In some articles, these conservative approaches were presented and compared to the effects of acrylic splints fixed with circummandibular wires or arch bars [ 56 , 62 , 69 ] and the competence of the maxillofacial surgeons.…”

“…Many authors presented the use of acrylic splints that were removable [ 59 , 68 , 72 ] or cemented with glass ionomer cement [ 56 , 61 , 65 ] for the management of mandibular fractures. Sabbagh HT et al [ 64 ] described the use of a functional appliance for the management of condylar fractures in growing subjects.…”