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Das MK, Mishra M, Singh G, Mondal S. Single linear miniplate versus rectangular grid plate in the treatment of mandibular angle fractures: A prospective, clinico-radiographic, comparative study. Natl J Maxillofac Surg 2023; 14:47-54. [PMID: 37273441 PMCID: PMC10235730 DOI: 10.4103/njms.njms_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/03/2022] [Accepted: 10/03/2022] [Indexed: 06/06/2023] Open
Abstract
Study Design Randomized Control Trial. Objective A prospective, clinico-radiographic, comparative study was planned to evaluate the treatment outcome and postoperative complications in isolated mandibular angle fractures using 2.0-mm system single linear 4 hole with gap miniplate versus 4 hole rectangular grid plate, both stabilized with 4 8-mm monocortical screws. Methods Thirty patients with isolated mandibular angle fractures were randomly categorized into two groups with 15 patients each. Group 1 patients were treated with single 2.0 mm × 4 hole linear miniplate along the superior border and Group 2 patients were treated with a 2.0 mm × 4 hole rectangular grid plate on lateral cortex of mandible. Pain, swelling, occlusion, bite force, maximum inter-incisal opening, intraoperative time, facial nerve injury, fracture stability, and postoperative complications were assessed and compared at regular intervals up to 12 months. Results There was no major difference in terms of treatment outcome in both systems and both were equally effective without any statistically significant difference in any of the parameters. None of the patients presented with any of the complications except for postoperative infection which was reported by 1 patient from each group at 3 months postoperatively and were managed conservatively. Conclusion Both plating systems are equally effective; however, the rectangular grid plate could be a safe and effective alternative to the single miniplate when adaptation and fixation is not possible along the external oblique ridge of the mandible (e.g., fracture with bone loss along the superior border).
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Affiliation(s)
- Manthan Kumar Das
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madan Mishra
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gaurav Singh
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shubhamoy Mondal
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
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Mathew N, Singh I, Gandhi S, Solanki M, Bedi NS. The Efficacy of Fixation of Unilateral Mandibular Angle Fracture with Single 3D Plate vs Single Miniplate Using Transbuccal Approach. J Maxillofac Oral Surg 2022; 21:405-412. [DOI: 10.1007/s12663-020-01465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022] Open
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Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures. J Craniofac Surg 2021; 32:e728-e735. [PMID: 34172684 DOI: 10.1097/scs.0000000000007709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits. MATERIALS AND METHODS A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus). RESULTS Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture. CONCLUSIONS The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.
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Falci SGM, de Souza GM, Fernandes IA, Galvão EL, Al-Moraissi EA. Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2021; 50:1450-1463. [PMID: 33676800 DOI: 10.1016/j.ijom.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
The aim of this review was to compare mandibular angle fracture fixation methods that were evaluated through randomized clinical trials considering postoperative complications. Additionally, different treatment methods were ranked based on their performance. A systematic review was performed based on the Cochrane and PRISMA guidelines. The quality of evidence and network meta-analysis were conducted using the GRADE tool and R software, respectively. Four databases were searched, and the papers were selected based on the PICOS strategy. A total of 3584 papers were found. After screening 15 papers were included. One plate placed on lateral border (tension zone) presented lower risk than one plate placed on superior border (tension zone) for infection [risk ratio (RR): 0.48, 95% confidence interval (CI): 0.33 to 0.71] and plate removal necessity (RR: 0.44, 95% CI: 0.28 to 0.69), with moderate quality of evidence. There were no significant differences among the mandibular angle fracture treatments for malocclusion and paraesthesia outcomes. In conclusion, one plate placed on the lateral border in the tension zone is the best choice regarding postoperative infection and plate removal necessity when fixing mandibular angle fractures. None of the tested fixation methods were associated with a significant risk of malocclusion and paraesthesia events.
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Affiliation(s)
- S G M Falci
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - G M de Souza
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - I A Fernandes
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E L Galvão
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
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Guastaldi FPS, Martini AP, Rocha EP, Hochuli-Vieira E, Guastaldi AC. Ti-15Mo Alloy Decreases the Stress Concentration in Mandibular Angle Fracture Internal Fixation Hardware. J Maxillofac Oral Surg 2020; 19:314-320. [PMID: 32346246 DOI: 10.1007/s12663-019-01251-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/29/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives Comparison of the mechanical stability of 2.0 plates made of commercially pure titanium (cpTi) and a titanium-molybdenum (Ti-15Mo) alloy and two methods of internal fixation employed mandibular angle fractures, using 3D finite element analysis. Materials and Methods Four groups were evaluated. For the cpTi: group Eng 1P, one 4-hole plate and 4 screws 6 mm long, in the tension zone of the mandible; group Eng 2P, two 4-hole plates, one in the tension zone of the mandible and the other in the compression zone, both were fixed with 8 screws 6 mm long. The same groups were created for the Ti-15Mo alloy. A 100 N compressive load was applied to the occlusal surface of the mandibular first molar on the plated side. Results When considering the von Mises equivalent stress (σ vM) values for the comparison between both groups with one plate, a decrease of 10.5% in the plate and a decrease of 29.0% in the screws for the Ti-15Mo group was observed. Comparing the same groups with two plates, a decrease of 28.5% in the screws was shown for the Ti-15Mo alloy group. No significant differences were observed when considering maximum and minimum principal stresses (σ max, σ min), and maximum principal strain (ε max) to the mandibular bone. The Ti-15Mo alloy plates substantially decreased the stress concentration in the screws for both internal fixation techniques and in the plate for the Ti-15Mo 1 plate group. Conclusion From a clinical standpoint, the use of Ti-Mo alloy with reduced stiffness will decrease the stress shielding between the hardware and bone, influencing the outcome of the treatment.
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Affiliation(s)
- F P S Guastaldi
- 1Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Humaitá Street, 1680, Araraquara, SP 14801-903 Brazil
| | - A P Martini
- 2Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP Brazil
| | - E P Rocha
- 2Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP Brazil
| | - E Hochuli-Vieira
- 1Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Humaitá Street, 1680, Araraquara, SP 14801-903 Brazil
| | - A C Guastaldi
- 3Department of Physical Chemistry, Institute of Chemistry, São Paulo State University (Unesp), Araraquara, SP Brazil
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de Oliveira JCS, Moura LB, de Menezes JDS, Gabrielli MAC, Pereira Filho VA, Hochuli-Vieira E. Three-dimensional strut plate for the treatment of mandibular fractures: a systematic review. Int J Oral Maxillofac Surg 2017; 47:330-338. [PMID: 28928010 DOI: 10.1016/j.ijom.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/12/2017] [Accepted: 08/30/2017] [Indexed: 11/25/2022]
Abstract
The treatment of mandibular fractures by open reduction and internal fixation is very variable. Thus, there are many controversies about the best fixation system in terms of stability, functional recovery, and postoperative complications. This systematic review sought scientific evidence regarding the best indication for the use of three-dimensional (3D) plates in the treatment of mandibular fractures. A systematic search of the PubMed/MEDLINE, Elsevier/Scopus, and Cochrane Library databases was conducted to include articles published up until November 2016. Following the application of the inclusion criteria, 25 scientific articles were selected for detailed analysis. These studies included a total of 1036 patients (mean age 29 years), with a higher prevalence of males. The anatomical location most involved was the mandibular angle. The success rate of 3D plates was high at this location compared to other methods of fixation. In conclusion, the use of 3D plates for the treatment of mandibular fractures is recommended, since they result in little or no displacement between bone fragments.
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Affiliation(s)
- J C S de Oliveira
- Oral and Maxillofacial Surgery Residency Program, Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil.
| | - L B Moura
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - J D S de Menezes
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - M A C Gabrielli
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - V A Pereira Filho
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - E Hochuli-Vieira
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
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Abstract
The goal of maxillofacial surgery is to restore the shape and functionality of maxillofacial region. In the past years, there has been a tremendous progress in this field because of significant advances in biotechnology that provided innovative biomaterials to efficiently reconstruct the maxillofacial injured region. By using appropriate selection of the implant biomaterial, it is possible to reconstruct the native tissue, both in form and function. The ideal biomaterial should mimic native tissues regarding density, strength, and modulus of elasticity. Autografts are currently the gold standard for replacement of missing tissues, but synthetic biomaterials have been widely used because they eliminate the discomfort to take the replacement tissue from the donor site. Among synthetic biomaterials, different metals may be utilized to efficiently reconstruct the maxillofacial injured region. This article makes an effort to summarize the most important metals in use in maxillofacial surgery, and point out advantages and disadvantage of each type.
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Affiliation(s)
- L Pacifici
- Department of Oral and Maxillofacial Science, "Sapienza" University of Rome, Rome, Italy
| | - F DE Angelis
- Department of Oral and Maxillofacial Science, "Sapienza" University of Rome, Rome, Italy
| | | | - A Cielo
- Private Practice, Rome, Italy
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