Edoardo Staderini, Raffaella Castagnola, Irene Cavalcanti, Marianna Balacco, Anastasio Spera, Cosimo Rupe, Gioele Gioco, Massimo Cordaro
Combined dento-mandibular trauma requires coordinated interdisciplinary management. A revised algorithm is proposed to integrate AO-CMF fracture principles with International Association of Dental Traumatology (IADT)-based dental trauma care, emphasizing systematic dental screening, selective imaging, safe fixation planning, biologically appropriate splinting, staged endodontic decision-making, and long-term follow-up for pulp necrosis, resorption, ankylosis, malocclusion, and neurosensory complications.
BACKGROUND: Mandibular fractures are among the most common maxillofacial injuries and are frequently associated with traumatic dental injuries (TDIs), creating combined skeletal, occlusal, periodontal, and pulpal treatment priorities. Integrated protocols addressing both the fracture and the dental component remain limited.
METHODS: The present literature review was conducted by means of a structured search of PubMed/MEDLINE, Scopus, and Web of Science Core Collection from 2000 to 2026, complemented by manual reference-list screening. A structured Population, Intervention/Exposure, Comparison, and Outcomes (PICO) framework and predefined eligibility criteria were added, and an overall assessment of methodological quality was undertaken for the included primary studies to improve transparency.
RESULTS: Mandibular fractures range from minimally displaced injuries with preserved occlusion to complex patterns associated with malocclusion, neurosensory impairment, temporomandibular joint dysfunction, and concomitant TDIs. The evidence supports individualized decision-making based on fracture displacement, occlusal stability, patient age, dentition status, tooth prognosis, and biological priorities of periodontal and pulpal healing. Teeth in the fracture line should not be extracted routinely; retention is generally favored when the tooth is intact, strategically useful for occlusion, and not infected, whereas extraction is indicated in cases of vertical/root fracture, advanced periodontal disease, severe caries, infection, or interference with reduction/fixation.
CONCLUSION: Combined dento-mandibular trauma requires coordinated interdisciplinary management. A revised algorithm is proposed to integrate AO-CMF fracture principles with International Association of Dental Traumatology (IADT)-based dental trauma care, emphasizing systematic dental screening, selective imaging, safe fixation planning, biologically appropriate splinting, staged endodontic decision-making, and long-term follow-up for pulp necrosis, resorption, ankylosis, malocclusion, and neurosensory complications.