I. Holland

The fractured edentulous atrophic mandible--open or closed treatment?

Data sourcesThe Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were used for searches. The Internet was searched for potentially relevant meta-analyses and non-Cochrane systematic reviews, ongoing clinical trials and published dissertations. Reference lists of identified studies were cross-checked for any potentially relevant clinical trials. There were no language restrictions.Study selectionStudies were selected if they were randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoid process of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were selected.Data extraction and synthesisScreening of eligible studies was conducted in duplicate and independently by two review authors. It was intended to express results as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.ResultsNo eligible randomised controlled trials were identified.ConclusionsThis review illustrates that there is currently inadequate evidence to support the effectiveness of any single approach, either open or closed, in the management of fractured atrophic edentulous mandibles and that, until high-level evidence is available, treatment decisions should continue to be based on clinicians prior experience. This absence of evidence may in part reflect a certain lack of clarity and the apparent diversity and lack of reliability in some of the traditional and normative predictors of successful outcomes.

A randomized trial of brief intervention strategies in patients with alcohol-related facial trauma as a result of interpersonal violence

Facial trauma is associated with male gender, low socioeconomic status, alcohol misuse, and violence. Brief intervention (BI) for alcohol is effective at reducing consumption in patients presenting with facial trauma. Single-session control of violence for angry impulsive drinkers (SS-COVAID) is a new intervention that attempts to address alcohol-related violence. This study assessed the effect of SS-COVAID and BI on drinking and aggression in facial trauma patients. Male facial trauma patients who sustained their injuries as a result of interpersonal violence while drinking and who had Alcohol Use Disorders Identification Test (AUDIT) scores of ≥8 were randomized to either BI or SS-COVAID. Patients were followed up at six and 12 months, and drinking and aggression outcomes were analyzed. One hundred ninety-nine patients entered the trial, and 187 were included in the analysis. Of these, 165 (89%) considered themselves to be victims, 92 (51%) had sustained a previous alcohol-related injury, and 28 (15%) had previous convictions for violence. Both interventions resulted in a significant decrease in negative drinking outcomes over 12 months of follow-up (p < 0.001). Neither intervention had a significant effect on aggression scores, nor was there a significant difference between interventions in terms of either outcome. Both SS-COVAID and BI had a significant effect on drinking variables in this patient cohort. No effect on aggression was seen despite the fact that SS-COVAID specifically addresses the relationship between alcohol and violence. One reason for this may be that the facial trauma patients in this study considered themselves to be victims rather than aggressors. Another possibility is that, while BI may successfully address lifestyle factors such as hazardous or harmful drinking, it may not be effective in modifying personality traits such as aggression.