Functional Orthodontic Therapy for Mandibular Condyle Fracture: A Systematic Review

Christoph-Ludwig Hennig; Franziska Krause; Ann Nitzsche; Konrad Tolksdorf; Markus Reise; Stefan Kranz; Marco Dederichs; Stefan Schultze-Mosgau; Collin Jacobs

doi:10.3390/medicina60081336

Functional Orthodontic Therapy for Mandibular Condyle Fracture: A Systematic Review

Medicina (Kaunas). 2024 Aug 16;60(8):1336. doi: 10.3390/medicina60081336.

Authors

Christoph-Ludwig Hennig¹, Franziska Krause¹, Ann Nitzsche¹, Konrad Tolksdorf², Markus Reise³, Stefan Kranz³, Marco Dederichs⁴, Stefan Schultze-Mosgau², Collin Jacobs¹

Affiliations

¹ Department of Orthodontics, Center of Dental Medicine, University Hospital Jena, An der alten Post 4, 07743 Jena, Germany.
² Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany.
³ Department of Conservative Dentistry and Periodontics, Center of Dental Medicine, University Hospital Jena, An der alten Post 4, 07743 Jena, Germany.
⁴ Department of Prosthodontics, Center of Dental Medicine, University Hospital Jena, An der alten Post 4, 07743 Jena, Germany.

Abstract

The objective of this study was to compile the currently available evidence regarding the functional and morphologic outcomes of functional orthodontic therapy for mandibular condyle fracture. We performed searches in PubMed and Google Scholar as well as manually (IOK issues 2008-2019) using the keywords "trauma", "TMJ", "activator", "condylar fracture", "fracture", "mandibular condylar fracture", "occlusal splint" and "functional appliance". Screening and analysis of study eligibility were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search strategy identified 198 studies published between 1971 and 2018, with 93 studies remaining after removing duplicate hits. Of the 93 studies, 19 were included in this study, considering the inclusion criteria. There were 12 follow-up, 4 prospective, and 3 purely retrospective studies. Some of the studies showed good functional results of mandibular condyle fracture treatment, in addition to subjective patient satisfaction. The incisal edge difference could be increased to physiological ranges of >35 mm by means of activator therapy. Partial mandibular deviations to the fractured side remained post-therapy, especially after unilateral fractures. Fractures without significant dislocation and luxation showed radiographic changes in shape, described as hypoplastic and ellipsoid, in addition to good morphologic results. One study found that collum length shortened twofold after a luxated fracture compared with fractures without significant dislocation, despite activator therapy. Straightening of the fragment occurred only in the low-dislocated fragments. Overall, children showed a higher remodeling potential than adult patients. Several studies observed an improved clinical outcome for functional therapy after mandibular condyle fracture. The outcome is essentially determined by fracture type, fracture height, and age. Further studies, especially prospective studies, are necessary to improve the evidence of functional orthodontic therapy for mandibular condyle fractures.

Keywords: activator; conservative fracture therapy; functional orthopedic therapy; mandibular condyle fracture.

Publication types

Systematic Review
Review

MeSH terms

Humans
Mandibular Condyle* / injuries
Mandibular Fractures* / therapy
Orthodontic Appliances, Functional
Treatment Outcome

Grants and funding

This study was supported by the Department of Orthodontics, Center of Dental Medicine, University Hospital Jena, An der alten Post 4, 07743, Jena, Germany. This research received no external funding.