## 4 Discussion  
The management of atrophic jaw fractures has always been a topic of discussion in the literature. [PERSON] et al. [10] in 1996 already classified the atrophic mandibles into three categories, according to the degree of atrophy and the mandibular height: Class I, 16 to 20 mm; Class II, 11 to 15 mm; Class III, \(<\)10 mm. In the Class III, bone quality diminished because of a possible sclerotic and because of blood flow decrease. After [PERSON] et al. 's studies, several authors focused on the correct management and treatment of Class III fractures that often are atrophic pluri-fragmentary mandibular fractures. The problems related to these fractures are associated with patient's age, medical comorbidities, poor bone quality, and decreased vascularity, as well as reduced contact area between the fracture ends [7]. In addition, mandibular atrophy is often the result of complete edentulism: this condition determines the loss of the occlusal reference, which is the guide for the correct reduction of these fractures [6; 7; 11]. In the literature, the possible treatments for atrophic edentulous mandibular fractures are:  
(1) Observation: in case of not dislocated fractures in patients with severe anesthetic risk. The most frequent complication is the non-union of the bone stumps [1];  
(2) Closed reduction (mandibulomaxillary fixation--MMF): in case of edentulous atrophic fractures in patients with high anesthetic risk; postoperative malunions and nonunions were very frequent [12];  
(3) Gunning splints: the use of gunning splints is preferred in case of edentulous atrophic patients because the open reduction is not helpful due to compromised medical condition of these patients. However, as [PERSON] et al. have shown, there is the possibility of ankylosis, induced by joint blockage (5-6%) [13];  
(4) External fixation: it is indicated as a temporary fixation when the patient needs earlier medical treatment. External fixators do not guarantee permanent stability, so malunion and nonunion are common [14];  
(5) Open Reduction Internal Fixation (ORIF): with titanium mesh, locking miniplate, or 2.4-reconstruction plate, with or without simultaneous bone grafting. It is indicated for all atrophic surgical mandible fractures. In all cases, the aim of the treatment of edentulous \begin{table}
\begin{tabular}{c c c c c c} \hline  & **CASE 1** & **CASE 2** & **CASE 3** & **CASE 4** & **Average \(\pm\) SD** \\ \hline  & **Discrepancy mm** & **Discrepancy mm** & **Discrepancy mm** & **Discrepancy mm** & **Discrepancy mm** \\ \hline Whole cloud point & 0.63 & 0.48 & 0.72 & 0.94 & 0.69 \(\pm\) 0.33 \\ \hline Menton & 0.46 & 0.24 & 0.72 & 0.88 & 0.57 \(\pm\) 0.49 \\ \hline Pogonion & 0.48 & 0.32 & 0.67 & 0.84 & 0.58 \(\pm\) 0.34 \\ \hline B Point & 0.44 & 0.28 & 0.69 & 0.81 & 0.55 \(\pm\) 0.41 \\ \hline Right Condyle & 0.72 & 0.67 & 0.81 & 1.01 & 0.80 \(\pm\) 0.26 \\ \hline Left Condyle & 0.71 & 0.63 & 0.79 & 1.05 & 0.79 \(\pm\) 0.32 \\ \hline Right Conion & 0.55 & 0.46 & 0.57 & 0.92 & 0.62 \(\pm\) 0.35 \\ \hline Left Gonion & 0.58 & 0.44 & 0.54 & 0.89 & 0.61 \(\pm\) 0.34 \\ \hline Right Mental Foramen & 0.67 & 0.35 & 0.61 & 0.82 & 0.61 \(\pm\) 0.34 \\ \hline Left Mental Foramen & 0.64 & 0.33 & 0.63 & 0.79 & 0.60 \(\pm\) 0.33 \\ \hline Right Lingula & 0.66 & 0.49 & 0.66 & 0.94 & 0.69 \(\pm\) 0.32 \\ \hline Left Lingula & 0.65 & 0.41 & 0.68 & 0.97 & 0.68 \(\pm\) 0.40 \\ \hline \end{tabular}
\end{table} 
Table 1: Discrepancies analysis. atrophic mandibular fracture should be to improve patient's quality of life with the minimal risk, ensuring fracture stability [15; 16]. [PERSON] and [PERSON] (1993) in their review concluded that the optimal treatment for this kind of fractures is an open reduction and stable fixation with large osteosynthesis plates (ORIF) [17].