Pediatric mandibular fractures are not commonly encountered. The elasticity of bones in a child prevents loss of continuity of bone and rather results in a bending of a cortex termed as a greenstick fracture. Occlusion is rarely a problem as there is no disruption or mild changes are remodeled during the development of permanent dentition. In case of a severely displaced fracture the treatment option can vary from intermaxillary fixation, cap splints to plating with mini plates or resorbable plates.
In full deciduous dentition, the arch bar fixation or wiring is difficult due to the morphology of the deciduous teeth as the area of maximum convexity is at the gingival third of the crown resulting in slipping of wires. The roots of the deciduous teeth do not tolerate force needed to tighten the wires . Miniplates needs caution so as not to injure the toothbuds of the permanent teeth and may need to be removed after osteosynthesis in growing children. Resorbable plates, eliminates the need for the second surgical procedure for the removal but the risk of damage to the tooth buds do exist.
As far as the healing of wounds in general is concerned, the jaws and face have one great advantage, and that is their copious blood supply; consequently, in major injuries of the jaws it is possible to be much more conservative with comminuted bone fragments and lacerated soft tissue than it is in other regions of the body. On the other hand, the jaws have one great disadvantage in this respect, and that is the presence of teeth; teeth adjacent to the site of fracture may be the cause of complications if they are fractured themselves, displaced, have their adjacent mucoperiosteum detached, or even if they are intact. It is remarkable to see how much more readily healing and union occur in a grossly comminuted fracture of an edentulous mandible than in a similar fracture where teeth are present.
Cap splints are the good old remedy that comes in handy to manage paediatric fractures. The traditional cap splints made of steel or acrylic are cumbersome to make and will need a technician to make them. They are also very thick and may interfere with occlusion. They also consume lot of time in fitting them on to the teeth to reduce the fracture. On the other hand the thermo forming splints which were initially used as bleaching trays, can be used as Splints..