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Batbayar EO, Bos RRM, van Minnen B. A Treatment Protocol for Fractures of the Edentulous Mandible. J Oral Maxillofac Surg 2018; 76:2151-2160. [PMID: 29746839 DOI: 10.1016/j.joms.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE The incidence of fractures of edentulous mandibles is relatively low. Knowledge about the management of these fractured edentulous mandibles relies heavily on case reports and observational studies. On the basis of the current literature, we compiled a treatment protocol for fractures of the edentulous mandible and hypothesized that this protocol would result in fewer complications. PATIENTS AND METHODS We conducted a retrospective cohort study of edentulous patients with mandibular fractures. The predictor variable was the fulfillment of the treatment protocol (yes or no). The outcome variables were postoperative complications and reoperations. Patient demographic characteristics were collected from patient records. The χ2 test was used for statistical analysis between predictor and outcome variables. RESULTS Of 61 edentulous mandibular fractures (36 patients), 53 were treated according to the protocol and 8 were not. We observed 4 complications in the first group (complication rate, 7.5% [4 of 53]) and 4 in the second group (complication rate, 50% [4 of 8]). The fracture treatments that followed the protocol had a significantly lower postoperative complication rate (P = .001; odds ratio, 0.082) and needed fewer reoperations (P = .0001; odds ratio, 0.019) compared with the treatments that did not follow the protocol. CONCLUSIONS The results of this study show that following the compiled treatment protocol for fractures of edentulous mandibles significantly reduces postoperative complications and reoperations.
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Affiliation(s)
- Enkh-Orchlon Batbayar
- Research Assistant, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruud R M Bos
- Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Baucke van Minnen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Vieira Santos ZTB, Goulart DR, Sigua-Rodriguez EA, Pozzer L, Olate S, Albergaria-Barbosa JR. Mechanical evaluation of the use of conventional and locking miniplate/screw systems used in sagittal split ramus osteotomy. J Korean Assoc Oral Maxillofac Surg 2017; 43:77-82. [PMID: 28462190 PMCID: PMC5410431 DOI: 10.5125/jkaoms.2017.43.2.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/06/2016] [Accepted: 11/30/2016] [Indexed: 11/08/2022] Open
Abstract
Objectives The aim of this study was to compare the mechanical resistance of four different osteosyntheses modeled in two different sagittal split ramus osteotomy (SSRO) designs and to determine the linear loading in a universal testing machine. Materials and Methods An in vitro experiment was conducted with 40 polyurethane hemimandibles. The samples were divided into two groups based on osteotomy design; Group I, right angles between osteotomies and Group II, no right angles between osteotomies. In each group, the hemimandibles were distributed into four subgroups according to the osteosynthesis method, using one 4-hole 2.0 mm conventional or locking plate, with or without one bicortical screw with a length of 12.0 mm (hybrid technique). Each subgroup contained five samples and was subjected to a linear loading test in a universal testing machine. Results The peak load and peak displacement were compared for statistical significance using PASW Statistics 18.0 (IBM Co., USA). In general, there was no difference between the peak load and peak displacement related to osteotomy design. However, when the subgroups were compared, the osteotomy without right angles offered higher mechanical resistance when one conventional or locking 2.0 mm plate was used. One locking plate with one bicortical screw showed higher mechanical resistance (162.72±42.55 N), and these results were statistically significantly compared to one conventional plate with monocortical screws (P=0.016) and one locking plate with monocortical screws (P=0.012). The difference in peak displacement was not statistically significant based on osteotomy design or internal fixation system configuration. Conclusion The placement of one bicortical screw in the distal region promoted better stabilization of SSRO. The osteotomy design did not influence the mechanical behavior of SSRO when the hybrid technique was applied.
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Affiliation(s)
| | - Douglas Rangel Goulart
- Division of Oral and Maxillofacial Surgery, State University of Campinas, Campinas, Brazil
| | | | - Leandro Pozzer
- Division of Oral and Maxillofacial Surgery, State University of Campinas, Campinas, Brazil
| | - Sergio Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco, Chile.,Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
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de Medeiros RC, Sigua EA, Navarro P, Olate S, Albergaria Barbosa JR. In Vitro Mechanical Analysis of Different Techniques of Internal Fixation of Combined Mandibular Angle and Body Fractures. J Oral Maxillofac Surg 2015; 74:778-85. [PMID: 26701138 DOI: 10.1016/j.joms.2015.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate in vitro resistance of 5 techniques of internal fixation of bilateral fractures involving the mandibular angle and body. MATERIALS AND METHODS Twenty-five polyurethane mandibles were used as substrates, fixed with a 2-mm fixation system, and divided into 5 groups: I, 1 4-hole plate, without intermediate space, in the neutral zone of the mandibular body and another similar plate in the external oblique ridge of the contralateral mandibular angle; II, 1 6-hole plate, with intermediate space, in the neutral zone of the mandibular body and a similar plate in the external oblique ridge of the left mandibular angle; III, 1 4-hole locking plate, with intermediate space, in the right neutral zone and another similar plate in the left external oblique ridge; IV, 2 4-hole plates, with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body, and 1 4-hole plate, with intermediate space, in the external oblique ridge of the contralateral mandibular angle; V, 2 4-hole plates with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body and similarly in the buccal side of the left mandibular angle. Mandibles were subjected to vertical linear load tests by a mechanical testing machine (Instron 4411, Instron Corp, Norwood, MA) to record peak load and load for displacements of 3, 5, and 7 mm. RESULTS Group I had the least mechanical resistance of all groups, regardless of displacement, and group IV had the greatest mechanical resistance. Among groups II, III, and V, there was no statistically meaningful difference. CONCLUSION Fixation of bilateral mandibular fractures involving the mandibular angle and body using 2 plates in the region of the body and 1 plate in the tension zone in the region of the mandibular angle was the technique that presented the best mechanical resistance.
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Affiliation(s)
- Raquel Correia de Medeiros
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil.
| | - Eder Alberto Sigua
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Pablo Navarro
- Assistant Professor, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile
| | - Sergio Olate
- Assistant Professor and Head, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco; Associated Research, Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
| | - Jose Ricardo Albergaria Barbosa
- Adjunct Professor, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
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Kanno T, Sukegawa S, Nariai Y, Tatsumi H, Ishibashi H, Furuki Y, Sekine J. Surgical treatment of comminuted mandibular fractures using a low-profile locking mandibular reconstruction plate system. Ann Maxillofac Surg 2015; 4:144-9. [PMID: 25593862 PMCID: PMC4293833 DOI: 10.4103/2231-0746.147103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: The treatment of comminuted mandibular fractures is challenging due to the severity of associated injuries and the need for a careful diagnosis with adequate treatment planning. Recently, open reduction and stable internal fixation (OR-IF) with a load-bearing reconstruction plate have been advocated for reliable clinical outcomes with minimal complications. This clinical prospective study evaluated OR-IF in the surgical management of comminuted mandibular fractures with a new low-profile, thin, mandibular locking reconstruction plate. Materials and Methods: We prospectively assessed OR-IF of comminuted mandibular fractures with a low-profile locking mandibular reconstruction plate in 12 patients (nine men, three women; mean age 32.2 [range 16-71] years) between April 2010 and December 2011. The clinical characteristics and associated clinical parameters of patients were evaluated over a minimum follow-up period of 12 months. Results: Traffic accidents caused 50% of the fractures, followed by falls (25%). Four patients (33.3%) had associated midfacial maxillofacial fractures, while five patients had other mandibular fractures. Seven patients (58.3%) needed emergency surgery, mostly for airway management. Anatomical reduction of the comminuted segments re-established the mandibular skeleton in stable occlusion with rigid IF via extraoral (33.3%), intraoral (50%), or combined (16.7%) approaches. Immediate functional recovery was achieved. Sound bone healing was confirmed in all patients, with no complications such as malocclusion, surgical site infection, or malunion with a mean follow-up of 16.3 (range 12-24) months. Conclusions: OR-IF using a low-profile reconstruction plate system is a reliable treatment for comminuted mandibular fractures, enabling immediate functional recovery with good clinical results.
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Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan ; Division of Oral-Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Shintaro Sukegawa
- Division of Oral-Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Yoshiki Nariai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hiroaki Ishibashi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshihiko Furuki
- Division of Oral-Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Bujtár P, Simonovics J, Váradi K, Sándor GK, Avery C. The biomechanical aspects of reconstruction for segmental defects of the mandible: A finite element study to assess the optimisation of plate and screw factors. J Craniomaxillofac Surg 2014; 42:855-62. [DOI: 10.1016/j.jcms.2013.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/09/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022] Open
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Experimental biomechanical study of the primary stability of different osteosynthesis systems for mandibular reconstruction with an iliac crest graft. Br J Oral Maxillofac Surg 2013; 51:942-7. [DOI: 10.1016/j.bjoms.2013.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/15/2013] [Indexed: 11/17/2022]
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Locking versus nonlocking plates in mandibular reconstruction with fibular graft—a biomechanical ex vivo study. Clin Oral Investig 2013; 18:1291-1298. [DOI: 10.1007/s00784-013-1105-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
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Pereira-Filho V, da Silva B, Nunes Reis J, Spin-Neto R, Real Gabrielli M, Monnazzi M. Effect of the number of screws on the stability of locking mandibular reconstruction plates. Int J Oral Maxillofac Surg 2013; 42:732-5. [DOI: 10.1016/j.ijom.2013.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/16/2013] [Accepted: 02/18/2013] [Indexed: 11/30/2022]
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Haug RH, Serafin BL. Mandibular Angle Fractures: A Clinical and Biomechanical Comparison-the Works of Ellis and Haug. Craniomaxillofac Trauma Reconstr 2011; 1:31-8. [PMID: 22110787 DOI: 10.1055/s-0028-1098961] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In a series of articles spanning 8 years, Ed Ellis reviewed the clinical results of the treatment of 478 mandibular angle fractures managed by eight different techniques. During a series of benchtop investigations employing polyurethane synthetic mandible replicas, Rich Haug investigated the biomechanical behavior of approximately 15 different techniques designed to reconstruct mandibular angle fractures. This article reviews these two series of investigations in an attempt to gain insight into the biomechanical and biological factors that affect the successful reconstruction of mandibular angle fractures. It appears that the current techniques used to reconstruct mandibular angle fractures are sound from the standpoint of biomechanics within a range of forces encountered during clinical function. It also appears that an unsuccessful reconstruction is based on a biological result of a behavioral issue such as noncompliance, substance abuse, and/or nutritional or immune compromise.
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Erkmen E, Simşek B, Yücel E, Kurt A. Comparison of different fixation methods following sagittal split ramus osteotomies using three-dimensional finite elements analysis. Part 1: advancement surgery-posterior loading. Int J Oral Maxillofac Surg 2005; 34:551-8. [PMID: 16053877 DOI: 10.1016/j.ijom.2004.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Revised: 06/08/2004] [Accepted: 10/18/2004] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate the mechanical behavior of different fixation methods used in bilateral sagittal split ramus osteotomy (BSSRO). Part 1 comprises of the results of the analysis for mandibular advancement, four different fixation configurations of six hole fragmentation mini plates with monocortical screws and lag screws and posterior loading conditions in the molar and premolar region. The finite element analysis method (FEA) appears suitable for simulating complex mechanical stress situations in the maxillofacial region. The mechanical behavior of selected lag screws with linear or triangular configuration and double parallel or single oblique six hole mini plates with monocortical screws were compared by FEA after 5 mm BSSRO advancement procedure. Four separate three-dimensional finite element models of the mandible were created to simulate the BSSRO and corresponding fixation methods. These models consisted of 122,717 elements and 25,048 nodes. The mechanical parameters of the materials studied were adopted from the literature or were based on manufacturer's information. 500 N posterior occlusal loads were simulated on the distal segments. The commercial finite element solver MSC Marc software was utilized to calculate the stress fields on both the segments and fixative appliances. It was concluded that the use of 2.0mm lag screws placed in a triangular configuration following the BSSRO advancement surgery provides sufficient stability with any rotational movement and less stress fields at the osteotomy site, when compared with the other rigid fixation methods used in the current study.
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Affiliation(s)
- E Erkmen
- Gazi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey.
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Lindqvist C, Söderholm AL, Salo A, Subasinghe J, Ylijoki S, Skutnabb K, Hallikainen D. A comparative study on four screw-plate locking systems in sheep: a clinical and radiological study. Int J Oral Maxillofac Surg 2001; 30:160-6. [PMID: 11405453 DOI: 10.1054/ijom.2000.0037] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Four mandibular screw-plate locking systems were studied in sheep. Three to four centimetres angular continuity resections of the mandible were performed and the defects bridged with pre-bent angular reconstruction plates fixed with four screws in the body part and three in the ramus. Each type was used four times. Clinical and radiological examinations were carried out 1 and 2 months later. All sheep were able to eat and ruminate normally throughout the postoperative period. Radiology revealed that 6/16 plates and 5/112 screws fractured during the follow-up period. In one type, no fracture occurred. Screw fracture was confined to just one reconstruction system. Six of 16 mandibles showed slight to moderate bone resorption under the plate. The results point to the internal shortcomings of the systems tested.
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Affiliation(s)
- C Lindqvist
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Finland.
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Armstrong JE, Lapointe HJ, Hogg NJ, Kwok AD. Preliminary investigation of the biomechanics of internal fixation of sagittal split osteotomies with miniplates using a newly designed in vitro testing model. J Oral Maxillofac Surg 2001; 59:191-5. [PMID: 11213988 DOI: 10.1053/joms.2001.20492] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This article reports a preliminary study undertaken to investigate the biomechanics of internal fixation systems for sagittal split ramus osteotomy of the mandible with advancement, using a newly designed 3-point bovine rib testing model. MATERIALS AND METHODS After 1 of 5 different miniplates internal fixation systems was placed, a vertical load was applied just below the superior border of sagittal split osteotomy gaps in bovine ribs positioned in a custom-made cradle using a compound cantilered bar device. Load/displacement data were gathered, and the mean elastic limits of the 5 miniplate designs were compared by using a 1-way analysis of variance (ANOVA) with Tukey multiple comparisons. RESULTS The elastic limit of the rigid fixation system was higher when using a curved plate design than with a straight plate design. CONCLUSION The 3-point bovine rib model used in this study is an inexpensive, discriminating, and reproducible method for testing internal fixation systems on sagittal ramus osteotomies under conditions that more accurately represent the human mandible in function.
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Affiliation(s)
- J E Armstrong
- The University of Western Ontario and The London Health Sciences Center, Ontario, Canada.
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Sikes JW, Smith BR, Mukherjee DP, Coward KA. Comparison of fixation strengths of locking head and conventional screws, in fracture and reconstruction models. J Oral Maxillofac Surg 1998; 56:468-73. [PMID: 9541347 DOI: 10.1016/s0278-2391(98)90715-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Claimed clinical advantages of the locking-head mandibular reconstruction plating system include the ability to achieve stability with fewer numbers of screws per bony segment as compared with conventional screws. The purpose of this study was to test the hypothesis that increased resistance to displacement will be obtained when using locking-head as compared with the same number of conventional screws per segment in both fracture and reconstruction models. MATERIALS AND METHODS Eight groups were tested based on the screw number (two or four), screw type (locking-head or conventional), and fracture (bony apposition) or reconstruction model (1-cm defect). Two-dimensional beam mechanics using adult bovine ribs and the Instron machine were used to develop a load-displacement curve up to 150 N for each specimen. An osteotomy was then created and the segments were reduced, with preload (fracture model) or with a 1-cm defect (reconstruction model), and plated using the Synthes locking-head plate with either two or four bicortical locking-head (4.0-mm) or conventional (2.7-mm) screws per segment. The fixed ribs were loaded to 150 N, and the displacement was recorded. RESULTS Locking-head screws provided superior resistance when using two screws per segment in the reconstruction model as compared with conventional screws. Minimal difference was seen between other screw types within a model. The fracture model offered significantly greater (3.1 to 3.7X) resistance to displacement than did the reconstruction model. CONCLUSIONS Locking-head screws provided significantly increased resistance to displacement when only two screws per segment were used in the reconstruction model. When four screws per segment were used, there was no significant difference between locking-head and conventional screw types in either model. The effect of bony buttressing is significant and may explain why miniplates often fail in the atrophic mandible but are successful in the fully dentate patient.
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Affiliation(s)
- J W Sikes
- Department of Surgery, Louisiana State University Medical Center at Shreveport, 71130, USA
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Haug RH, Barber JE, Reifeis R. A comparison of mandibular angle fracture plating techniques. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:257-63. [PMID: 8884822 DOI: 10.1016/s1079-2104(96)80349-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this investigation was to compare the conventional technique of mandibular angle fracture plating with two biomechanically dissimilar techniques in their abilities to resist vertical loads similar to masticatory forces. STUDY DESIGN Three groups of five synthetic hemimandibles with simulated fracture repairs were compared for their capabilities to resist vertical deformation. The conventional group was stabilized with a thin tension band system at the superior border and thick stabilization plate system at the inferior border. The nontraditional group was stabilized with a thick tension band system at the superior border and thin stabilization plate system at the inferior border. The two miniplate group was stabilized with a thin tension band system at the superior border and thin stabilization plate at the inferior border. A cantilever beam design was used. Testing was performed with an instron 8511.20 (Instron Corp., Canton, Mass.) mechanical testing device. The three groups were compared with a two way analysis of variance. RESULTS The forces resisted by the conventional group (167.6 +/- 18.2 N), the nontraditional group (156.3 +/- 33.9 N), and two miniplate group (154.0 +/- 18.4 N) were not statistically different (F = 0.44, p > 0.66). All failures occurred at the tension bands secured with monocortical screws. CONCLUSIONS Under the conditions described in this in vitro investigation, plate thickness or pattern made no difference. All failures in this experiment occurred with monocortical screws in the superior border tension band system.
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Affiliation(s)
- R H Haug
- Division of Oral and Maxillofacial Surgery, Metrohealth Medical Center, Cleveland, Ohio, USA
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