The Internet Journal of Geriatrics and Gerontology. Fractures of edentulous mandible are common in elderly persons. The advancing age, residual ridge resorption and decreased vascularity impairs the mandibular bone strength, predisposing it to fracture during traumatic event and even to spontaneous fracture. Gunning splint is a prosthetic aid designed to stabilize the reduced fractured mandibular segments.
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Treating edentulous mandibular fracture is difficult in elderly patients due to compromised medical condition of the patient and various contraindications for the surgical approach. The complication rate of infection or malunion is higher compared to fractures in younger, dentulous patients.
For edentulous patients, treatment planning poses greater difficulties during reduction and fixation of fractured atrophic mandible. Due to edentulism, guidelines provided by occluding teeth for reduction and fixation of fracture, are absent.
Also, open reduction of fracture site is not helpful due to compromised medical condition of the patient at older age.
The denture bearing area of the edentulous mandible is not only more easily fractured, but also has less possibility of rapid and uneventful healing [ 2 ]. For such condition, closed reduction and fixation of fractured segment with Gunning type splint is preferred over open reduction technique.
It holds together fractured segments of mandibular bone and immobilizes the jaws in occlusion. A Gunning splint for the edentulous mandible consists of a type of monoblock resembling two bite blocks joined together. These splints take form of modified dentures with bite block placed in posterior region and a space in incisal area to facilitate feeding.
Immobilization is carried out by attaching the upper splint to maxilla by per-alveolar wiring and the lower splint to the mandibular body by circumferential wires. Intermaxillary splinting can be done by connecting two splints with wire loops or elastic bands [ 3 , 4 ]. In this clinical report, step by step method for fabrication of Gunning splint and its intraoral fixation in an edentulous patient is discussed.
A year old male patient was referred to Department of Prosthodontics, from Department of oral and maxillofacial surgery for the fabrication of Gunning splint. Orthopantomograph showed displaced mandibular fracture in right mandibular anterior region.
Fracture line was extending till the base of the mandible in vertically favourable manner. Hence, it was decided to perform closed reduction of the fractured mandible with Gunning splint instead of open reduction.
Impression of fractured mandibular arch was made with irreversible hydrocolloid impression material Tropicalgin, Zhermack, Italy , while for maxillary arch, medium fusing impression compound was used. Impressions were immediately poured in dental stone to obtain casts.
These parts were then repositioned to resemble normal mandibular contours. On this altered cast, the record bases were fabricated and occlusal rims were made. Approximate jaw relation was made by clinical judgement and it was mounted on an articulator. Then the occlusal rims were altered. One anterior opening was made in rims for feeding purpose and posteriorly interlocking mechanism was provided to avoid any movement between two splints Fig.
The arch bar was incorporated on buccal side of each splint with help of self cured acrylic resin Fig. These arch bars were used for intermaxillary fixation of the splints. Then finishing and polishing of splints was carried out and they were disinfected in glutaraldehyde solution,.
During surgical procedure, first the maxillary splint was fixed with per-alveolar wiring. The tissue side of mandibular splint was relined with low fusing impression compound. This was done to compensate for any discrepancy between the splint and the mandible and also to provide firm immobilization of mandibular segments [ 5 ]. Mandibular splint was fixed by circum-mandibular wiring Fig. After securing the splints to the underlying bone, intermaxillary fixation was done with arch wires to provide firm immobilisation Fig.
Orthopantogram showed complete reduction of fractured segments Fig. Normal aging process is associated with significant changes in the functional vascular supply of mandible [ 5 ]. The endosteal supply from inferior alveolar artery begins to disappear and bone becomes increasingly dependent on periosteal network of vessels for its blood supply. Atrophic edentulous mandible has a reduced cross-sectional area as compared to dentate mandible. Due to decreased vascularity and dense sclerotic nature of bone, open reduction of mandible will lead to slow and complicated healing process of the fracture site [ 6 ].
If mandible is atrophic, then the fractured fragments will be more easily displaced. Due to decrease in bone height, it is not suitable for screwing and plating the fracture site. Close reduction with Gunning splint is advantageous because, not only it preserves the periosteal blood supply, but also provides firm mandibular fixation and immobilisation [ 7 ].
In almost all the selected and planned cases of fractured atrophic edentulous mandible, a satisfactory union of the fractured segments can be obtained with Gunning type of splint.
The splints are easy to fabricate, are cost effective and minimally invasive for the treatment of fractured jaw segments. Gunning type splints, when properly designed and planned for a particular case; prove to be a very good treatment option for fractured atrophic edentulous mandible.
Shrinivas Dharaskar, Email: moc. Smita Athavale, Email: moc. National Center for Biotechnology Information , U. J Indian Prosthodont Soc. Published online Jun Shrinivas Dharaskar Department of Prosthodontics, Dr. Smita Athavale Department of Prosthodontics, Dr. Dilip Kakade Department of Prosthodontics, Dr. Author information Article notes Copyright and License information Disclaimer. Department of Prosthodontics, Dr. Corresponding author. Received Mar 25; Accepted Jun 4.
This article has been cited by other articles in PMC. Abstract Treating edentulous mandibular fracture is difficult in elderly patients due to compromised medical condition of the patient and various contraindications for the surgical approach. Keywords: Gunning splint, Edentulous patient, Mandibular fracture, Intermaxillary fixation.
Case Report A year old male patient was referred to Department of Prosthodontics, from Department of oral and maxillofacial surgery for the fabrication of Gunning splint. Open in a separate window. Orthopantomograph of patient showing displaced fractured segments. Procedure Used for the Fabrication of Gunning Splint Impression of fractured mandibular arch was made with irreversible hydrocolloid impression material Tropicalgin, Zhermack, Italy , while for maxillary arch, medium fusing impression compound was used.
Discussion Normal aging process is associated with significant changes in the functional vascular supply of mandible [ 5 ]. Advantages 1. It does not require surgical exposure of fracture site 2. Can be used in both dentulous and edentulous patients 3. In edentulous cases, even the previous dentures can also be used as splints to stabilize the fractured segments, if the fracture line is present in the denture bearing area 4.
It is a minimally invasive technique. Disadvantages 1. Inadequately secured splints—if circummandibular wires placed too close to the fracture site 2. Contraindicated in unfavourably displaced fractures 3. The splints may become foul, if proper oral hygiene is not maintained. Conclusion In almost all the selected and planned cases of fractured atrophic edentulous mandible, a satisfactory union of the fractured segments can be obtained with Gunning type of splint. Contributor Information Shrinivas Dharaskar, Email: moc.
References 1. Moodie F Mr. Gunning and his splints. Compound splint for comminuted mandibular fracture. J Prosthet Dent. Alastair N. Goss, R. Ormand B An improved Gunning splint.
Use of Gunning Splint for the Treatment of Edentulous Mandibular Fracture: A Case Report
ABSTRACT Treating edentulous mandibular fracture is difficult in elderly patients due to compromised medical condition of the patient and various contraindications for the surgical approach. The complication rate of infection or malunion is higher compared to fractures in younger, dentulous patients. Edentulous patient. Mandibular fracture. Intermaxillary fixation.
Establishing anatomic reduction of an edentulous mandible fracture is a frequently acknowledged challenge in craniomaxillofacial trauma surgery in elderly patients due to compromised medical condition, lack of occlusive dental surfaces to capitalize on maxillomandibular fixation and various contraindications for the surgical approach. The solution is to overcome such problems in an edentulous mandible is to create occlusal guidance by either making dentures or by fabricating intraoral splints to guide in the reduction of jaws in correct alignment. A case report is presented here where close collaboration between an oral surgeon and a prosthodontist comes into role. The oral surgeon, after assessing the exact nature and extent of fracture, must communicate with the prosthodontist regarding the type of splint and management of fracture for the improvement of the patient's prognosis. Advanced Search. An improved gunning splint. J Prosthet Dent ;
New Method for Fabrication of Gunning Splint in Orthognathic Surgery for Edentulous Patients
Treatment planning poses difficulties in edentulous patients for orthognathic surgery prediction and fixation. Treatment of severe class III malocclusion frequently requires orthognathic surgical procedures. For such patients, orthognathic surgery would be the only option before prosthetic rehabilitation. This clinical report describes step-by-step fabrication of a surgical splint for an edentulous year-old patient with a severe class III malocclusion. Using splints for planning and guiding the surgery in edentulous patients facilitates accurate positioning of the jaws and saves time in the operating room.