Comparative evaluation of 2.0-mm locking plate system vs 2.0-mm nonlocking plate system for mandibular fracture: a prospective randomized study

Comparison of bite force evaluation for mandibular angle fracture fixation by conventional miniplates versus new design miniplates: a clinical study

PURPOSE

To evaluate postoperative masticatory efficacy of a new design non-compression titanium miniplate compared to conventional non-compression titanium miniplate on the basis of bite force for treatment of mandibular angle fractures.

METHODOLOGY

The prospective study included 20 patients with mandibular angle fractures randomly categorized into 2 groups: Group I, fixation of angle fractures by conventional miniplates, and Group II, fixation of angle fractures by new design miniplates. Evaluation was done for clinical outcome, primarily bite force; radiological outcome; and associated postoperative morbidities at different time intervals.

RESULTS

The results showed to be highly significant in terms of mean operating time for plate adaptation and fixation and bite force adaptation (p = 0.003 at follow-up of 6 months) for the newer miniplate compared to the conventional miniplate. No statistically significant difference was seen for postoperative paresthesia, malunion, non-union, occlusal discrepancy, or hardware failure.

CONCLUSION

Within the limits of the study, it appears that the single, monocortical, non-compression, superior border new design miniplate proved to be a successful procedure for treating non-comminuted mandibular angle fractures specifically in terms of enhanced postoperative masticatory efficiency as compared to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.

Immediate and late inflammatory and bone healing response post implantation of self-tapping and self-drilling osteosynthesis screws

The aim of this study was to comparatively analyse osseointegration after the implantation of self-tapping screws (STS) and self-drilling screws (SDS). Thus, 24 four-month-old male Wistar rats, received SDS and STS screws in their left and right tibias, respectively. Sample collection was performed immediately at 0 hours (0h), two, seven, and 21 days after implantation (2d, 7d, 21d). Samples from immediately and 21 days after were analysed by micro computed tomography (MicroCT). All time points were evaluated by histology (Haematoxylin and Eoisin and Goldner's Trichrome) and immunohistochemistry for tartrate-acid resistant phosphatase positive (TRAP+) osteoclasts. MicroCT images revealed an intimate contact between bone and each type of screw at 0h. However, SDS group presented decreased bone volume (BV, mm3) at 21 days in comparison with STS. Both SDS and STS post implantation presented areas of suitable new bone formation surrounding screw threads from seven days, and inflammation decreased from two to 21 days. Also, TRAP+ osteoclasts were mainly identified at seven days in both STS and SDS groups, particularly surrounding areas of pressure, with significant differences between groups. In conclusion, differences in shape and insertion technique for SDS and STS screws did not affect immediate and late inflammatory and bone healing response post implantation in this animal model. Both osteosynthesis screws allowed satisfactory post-surgical outcomes.

Comparison of three different approaches in treatment of mandibular condylar fractures - Our experience

Background

The principal transfacial routes described to approach condylar process fractures are preauricular, retromandibular, high submandibular, and their various modifications. The selection of a specific surgical approach mainly depends on the level of condylar fracture, displacement/dislocation of the proximal segment and time elapsed from the date of trauma. Not too many studies proclaim a unanimous consensus on "gold standard" approaches for particular levels of fracture.

Aim

This study was conducted with the aim to lay down guidelines for determining the ideal surgical approach for treating different condylar fractures based on different clinical situations.

Methodology

This prospective study was conducted on 60 patients that underwent open reduction internal fixation of condylar fractures according to preset study design. Inclusion criteria were fracture displacement more than 10 degrees, dislocation, shortening of ramal height more than 2 mm. Patients having maxillofacial fractures other than mandible and condylar fractures in edentulous patients were excluded from this study.

Results

The risk of facial nerve injury was more in endaural group and parotid fistula was more evident in retromandibular subparotid group but there was no statistical difference between the groups. The surgical scar was inconspicuous in all three groups. Excellent results were achieved in the other parameters such as mouth opening, range of motion, bite force, and occlusion with all the three approaches. Postoperative CT scan showed satisfactory anatomical reduction.

Conclusion

This study concludes that the decision-making on the approach to be selected for any particular condylar fracture depends on the level of fracture, presence of fracture dislocation, and time elapsed from the date of trauma.

A new classification of mandibular fractures

There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures based on a systematic review of the literature and an internal audit. The classification proposed is: Class I; condyle, II; angle, IIc; II+condyle, III; body/symphysis, IIIc; III+condyle, IV; multiple fractures not including condyle, IVc; IV+condyle, V; bilateral condyle±other fracture(s). A total of 10,971 adult and 914 paediatric cases were analyzed through systematic review, and 833 from the regional audit. Only 32% (14/44) of reported series could be reclassified which, when added to the audit data, showed Class IV was most common (29%), with similar proportions of Class III, Class IIIc and Class II (18-23%). External validation (literature review) in terms of treatment and outcome was non-informative, but the internal validation (audit) demonstrated an increasing requirement for adding maxillomandibular fixation (MMF) to open reduction and internal fixation (ORIF) as class increased. The heterogeneity of data reporting found in the systematic review confirms the need for a classification such as this, likely to enhance comparison of varying management protocols.

Locking versus non-locking plating system in the treatment of mandibular fractures: A randomized comparative study

To evaluate fracture stability and complications such as infections, need for hardware removal, malunion, and nonunion when using 2.0-mm locking plating system in fixation of mandible fractures and to compare these to those associated with the 2.0-mm non-locking plating system. A prospective clinical study was conducted in a cohort of mandible fracture patients who were randomly assigned to two groups. Patients in the non-locking group were treated with 2.0-mm non-locking plating system, and those in locking group were treated with 2.0-mm locking plating system. Fracture stability, need for maxillomandibular fixation (MMF) and postoperative complications were assessed and compared. A total of 60 patients (30 in each group) were recruited. Significant differences were found between the two groups with respect to postoperative fracture stability (P = 0.001) and need for MMF (P = 0.005). Multivariate analysis revealed that type of fixation was not the only dependent variable which affected fracture stability. There were no significant differences in postoperative complications between the two groups. The 2.0-mm locking plating system provides greater stability and early functional restoration than the 2.0-mm non-locking plating system, with similar rates of postoperative complications. Thus, it can be used as a reliable and effective treatment modality for treating mandibular fractures.

Stabilization of anterior mandibular fracture using different osteosynthesis devices: perioperative clinical notes

PURPOSE

There is still no definitive consensus about the ideal technique in the treatment of anterior mandibular fractures. Therefore, this study aimed to determine clinical and radiographic outcomes of four different internal fixation devices used for this type of fractures.

METHODS

This was a cohort study that included 64 fracture cases. Fractures were fixed using four types of open reduction internal fixation devices: single 2.0-mm mini-locking plates, double 2.0-mm miniplates, double lag screw and double microplates. Investigated variables were surgical duration, wound dehiscence, infection, occlusion, mouth opening, patient compliance, nerve damage and postoperative oedema.

RESULTS

Male patients constituted 90.6% of the study sample. A proportion of 33% of the fractures were single symphysis and 67% were parasymphysis fractures. The most time-saving technique was the lag screw followed by microplate with mean/SD of 50.65 ± 4.152 min. Wound dehiscence occurred in 4.7% and 3.1% of the miniplate and the mini-locking groups respectively. Miniplate and microplate groups had small interfragmentary space at 1-month postoperative radiographs, while mini-locking and lag screw groups had no extra-callus formation.

CONCLUSION

The double lag screw and the single mini-locking plate are the most effective devices for primary bone healing of displaced mandibular symphysis/parasymphysis fractures which is attributed to their enhanced stability. Miniplates and microplates gave functionally well-balanced fixation and were also associated with higher patient convenience due to improved adaptability and relatively lower cost than locking plates. Cost-effectiveness of lag screws in comparison to bone plates is particularly beneficial in low-income countries.

In Vitro Evaluation of the Effects of Different Fixation Methods on Stabilization of Mandibular Body Fractures

PURPOSE

Mandibular body fractures are considered to be one of the most affected fracture sites in the maxillofacial region. Although the rates of fracture in this region are high, biomechanical evaluations related to this region are rare. The purpose of this investigation was to reveal the effects of different treatment methods onmandibular body fractures.

METHOD

Twenty-five synthetic polyurethane hemi-mandibles were used in this study. The hemi-mandibles, which simulated simple unfavorable mandibular body fractures, were divided into 5 groups (n = 5/group) according to the treatment method. The bone segments were fixed using different osteosynthesis methods and 2.0 mm miniplate/screw systems. The groups consisted of locking or conventional systems, 5 or 11 mm long screws and 4 or 6 holes. The hemi-mandibles were loaded vertically with compressive strength until they reached 120 N.

RESULTS

The results were analyzed using Tamhane's T2 post hoc test, and the significance level was 0.05. Group 1 had the lowest mechanical resistance of all groups and group 5 had the highest. No significant differences were observed in group 2 or 3.

CONCLUSION

The locking system miniplate group showed better fixation stability than the conventional systems for the same screw length, and the number of holes and screw length seemed to be effective for stabilization.

Evaluation of different stable internal fixation in unfavorable mandible fractures under finite element analysis

INTRODUCTION

The mandibular angle fracture is the most common fracture between this type of injury in jaw bone and also is the type of fracture treatment that presents a larger number of complications, and a series different osteosynthesis types have been studied over the years by the world literature. The finite element method is a form of mathematical analysis, which is based on dividing a structure into a finite number of small areas. It has the ability tomathematically model structures, making it possible to apply forces anywhere.

MATERIAL AND METHODS

For this study, a three-dimensional mandible with an unfavorable angle fracture was simulated. Five different types of fixations were evaluated: group 1, Champy technique with one 4-holes miniplate, 2.0 system; group 2, technique with two parallel 4-holes conventional miniplates, 2.0 system; group 3, technique with two parallel 4-holes locking miniplates, 2.0 system; group 4, technique with one reconstruction 6-holes plate, 2.8 system in base jaw; and group 5, technique with one reconstruction 6-holes plates, 2.8 system in jaw body + one parallel 4-holes conventional miniplate, 2.0 system.

RESULTS

The results showed that strains are better distributed through the locking miniplate and screws system and presented less stress concentration when compared with the conventional ones. The Champy technique had the worst results about of all groups. The use of the locking system shows less stress compared to the non-locking system, and the presence of a reconstruction plate associated with a mini plate does not lead to increased stability compared with an isolated reconstruction plate.

Locking Miniplate Osteosynthesis of Anterior Mandibular Fractures-Quo Vadis?

PURPOSE

This study compared the clinical stability and efficacy of locking miniplates with those of standard miniplates in the osteosynthesis of anterior mandibular fractures using bite force recordings and other clinical parameters.

MATERIALS AND METHODS

A prospective randomized double-blinded clinical trial was carried out in patients from various hospitals of Hassan (India). Patients were randomly divided into 2 groups of locking (test) and standard (control) miniplate osteosynthesis. Bite force measurements were performed preoperatively and postoperatively at weekly intervals for 6 weeks using a bite force recorder. As a secondary outcome, patients also were assessed for other clinical parameters that might interfere with successful osteosynthesis at the fracture site. Appropriate statistical testing for intra- and intergroup measurements was carried out.

RESULTS

Forty-eight men 28 ± 12.3 years old met the inclusion criteria (24 patients in each group). A statistically significant difference (P < .05) was found in the incisor bite force between the 2 groups, with values in the locking group exceeding those in the standard group at postoperative weeks 2 and 5. Duration of surgery was shorter in the locking group (P = .015). No relevant difference was found for the other clinical parameters.

CONCLUSIONS

Bite force statistically increased at progressive follow-up visits compared with the preoperative recording in the locking group. Bite force recordings of patients treated with locking plates were higher and statistically relevant compared with those of patients treated with standard miniplates at the incisor region at postoperative weeks 2 and 5. The clinical outcomes of the 2 miniplate systems in the present study were similar; however, the locking miniplates required a relatively shorter operating time, produced less trauma to the periosteum and soft tissues with less hardware, and can be used as a "1-plate-for-all" system.

Management of Mandibular Fractures Using Locking and Nonlocking Miniplates

PURPOSE

The study proposed to determine the superiority between locking plate and nonlocking miniplate for mandibular fractures (MFs) treatment.

METHODS

A comprehensive electronic search examining Medline-Ovid, Embase, and PubMed databases language without date was performed in February 2018. Inclusion criteria were studies in humans, including randomized controlled trials, controlled clinical trials, with the aim of comparing the 2 techniques. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size.

RESULTS

Thirteen publications were enrolled into the analysis. The results showed that there were significant differences in overall complications (RR, 0.62; 95% CI, 0.351-1.094; P = 0.06), postoperative infection (RR, 0.503, 95% CI, 0.223-1.136) when comparing locking miniplates with nonlocking miniplates in treating mandible fractures. The incidence of malocclusion showed a statistically significant difference in the outcome favoring locking miniplates (fixed: RR, 0.503; 95% CI, 0.125-2.030; P = 0.06). In addition, the use of locking miniplates had a lower postoperative maxillomandibular fixation rate than the use of nonlocking miniplates (RR, 0.414; 95% CI, 0.196-0.872; P = 0.002).

CONCLUSION

The result of meta-analysis revealed that use of locking plate is superior to the nonlocking plate in the reducing of postoperative complication rates in the management of MFs.

Three-dimensional versus standard miniplate, lag screws versus miniplates, locking plate versus non-locking miniplates: Management of mandibular fractures, a systematic review and meta-analysis

Background/purpose

The aims of the present study were to 1) evaluate the clinical outcomes between different fixation methods in the management of mandibular fractures (MFs) and 2) determine which fixation method is the best option for the treatment of mandibular fractures.

Materials and methods

A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. Inclusion criteria were studied in humans, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. In addition, the incidence of complications was evaluated.

Results

Thirty-two publications were included: 20 randomized controlled trials, 4 controlled clinical trials, and 8 retrospective studies. There were statistically significant advantages for 3-dimensional miniplate and lag screws. There was no statistically significant difference between locking plates and standard miniplates (P = 0 0.2). The cumulative odds ratio was 0.64, meaning that the use of locking miniplate in the fixation of MFs decreases the risk for postoperative complications by 36% over the use of standard miniplates.

Conclusion

The results of the three-Dimensional Versus Standard miniplate showed that 3-dimensional miniplate is the best option for mandibular fractures. Regarding Lag Screws Versus Miniplates results of the meta-analysis found that the use of lag screws is superior to using miniplates in reducing the incidence of postoperative complications. And in regards to locking miniplates versus non-locking miniplate, the analysis indicates that the 2.0-mm locking miniplate is a prospective fixation system in the treatment of maxillofacial fractures.

Comparison of 3D plate and locking plate in treatment of mandibular fracture-a clinical study

INTRODUCTION

This study was performed to evaluate the efficacy and post-operative complication of 3-dimensional (3D) titanium miniplate and locking plate in mandibular fractures (parasymphysis, symphysis, body, and angle).

MATERIALS AND METHODS

Forty patients, with non-comminuted mandibular fractures treated with open reduction and internal fixation using 3D titanium miniplate system or locking plate system through an intra-oral approach, were included in this study. All patients were systematically monitored up to 2 months post-operatively. Parameters recorded were infection, occlusal discrepancies, hardware failure, wound dehiscence, sensory disturbance of the inferior alveolar nerve, and stability of fractured segments.

RESULTS

Forty patients with mandibular fracture were divided into two groups randomly without any bias. The fractures of all 40 patients were found to be adequately fixed when checked intra-operatively after fixation. One patient (2.5%) of the 3D plate group developed an infection on the first and second post-operative visit and was treated by antibiotic coverage. One patient in the locking plate group (2.5%) reported wound dehiscence after the first week follow-up.

CONCLUSION

Both 3D titanium miniplates and locking plate are effective in the treatment of mandibular fractures, and overall complication rates are lesser. However, the 3D plating system uses less hardware in cases of parasymphysis and symphysis fractures and more hardware in cases of body and angle fractures.

The 3-dimensional miniplate is more effective than the standard miniplate for the management of mandibular fractures: a meta-analysis

PURPOSE

The study aimed to determine the superiority between 3-dimensional (3D) miniplate and standard miniplate for mandibular fractures (MFs) treatment.

BACKGROUND

Controversial results on the use of standard miniplate and 3D miniplate have remained for management of MFs.

METHODS

Several electronic databases were retrieved up to September 2014 to identify eligible studies. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Subgroup analyses by different fracture regions and different 3D miniplate sizes were performed. Publication bias was measured by a funnel plot.

RESULTS

There were 13 studies included for the meta-analysis, consisting of 593 participants. The 3D miniplate achieved significant lower incidences of malocclusion (RR 0.43, 95% CI 0.24-0.77, P = 0.004) and hardware failure (RR 0.31, 95% CI 0.13-0.74, P = 0.008) than the standard miniplate. There were no significant differences between the two miniplates on the incidence of the remaining outcomes: wound dehiscence, infection, paresthesia, and nonunion/malunion. Subgroup analyses indicated that 3D miniplate caused a lower hardware failure than standard with the size of 8 or 10 holes (RR 0.23, 95% CI 0.08-0.66, P = 0.006). Besides, publication bias was not detected.

CONCLUSION

The 3D miniplate is superior to the standard miniplate on the reduction of postoperative complication rates for the management of MFs. More holes in the 3D miniplate might contribute to a successful treatment.

Retrospective study of mandibular angle fractures treated with three different fixation systems

Aim:

To evaluate the outcomes of mandibular angle fractures treated with metal 2.0 mm locking, metal 2.0 mm nonlocking, and 2.5 mm resorbable systems.

Study Design:

Retrospective cohort study.

Materials and Methods:

Trauma records were screened for linear angle fractures treated with open-reduction and internal semi-rigid fixation with single metal/bioresorbable plates, and baseline variables were tabulated. The outcome variable was the presence or absence of any complication.

Statistical Analysis Used:

The Fisher's exact test and analysis of covariance (ANCOVA) using STATA 11.

Results:

A total of 60 case records of over four years were included. The mean age of the patients was 27.4 (SD 9.7) years. Fifty-five were male and five female. There were 20 nonlocking and 16 locking metal miniplates and 24 bioresorbable plates. In 55 (91.6%) cases there was a third molar in the fracture line. In 51/55 (92.7%) cases the third molar was retained. In seven patients postoperative complications were seen. There was no difference between the complication rates of the three treatment groups. Infection was the most common complication followed by delayed union and hardware failure.

Conclusions:

This retrospective study found no difference in the complication rate when fractures of the mandibular angle were treated with locking or nonlocking miniplates or bioresorbable plates.

Development of a Titanium Plate for Mandibular Angle Fractures with a Bone Defect in the Lower Border: Finite Element Analysis and Mechanical Test

OBJECTIVES

The aim of the present study was to develop a plate to treat mandibular angle fractures using the finite element method and mechanical testing.

MATERIAL AND METHODS

A three-dimensional model of a fractured mandible was generated using Rhinoceros 4.0 software. The models were exported to ANSYS(®), in which a static application of displacement (3 mm) was performed in the first molar region. Three groups were assessed according to the method of internal fixation (2 mm system): two non-locking plates; two locking plates and a new design locking plate. The computational model was transferred to an in vitro experiment with polyurethane mandibles. Each group contained five samples and was subjected to a linear loading test in a universal testing machine.

RESULTS

A balanced distribution of stress was associated with the new plate design. This plate modified the mechanical behavior of the fractured region, with less displacement between the fractured segments. In the mechanical test, the group with two locking plates exhibited greater resistance to the 3 mm displacement, with a statistically significant difference when compared with the new plate group (ANOVA, P = 0.016).

CONCLUSIONS

The new plate exhibited a more balanced distribution of stress. However, the group with two locking plates exhibited greater mechanical resistance.

Reporting of Postoperative Pain Management Protocols in Randomized Clinical Trials of Mandibular Fracture Repair: A Systematic Review

IMPORTANCE

The control of pain associated with mandibular fractures is an important treatment outcome that affects function, adherence to treatment regimens, and patient comfort and satisfaction.

OBJECTIVE

To explore the pain management protocols reported in studies of mandibular fractures, including the reporting of quality-of-life measures.

EVIDENCE REVIEW

PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.gov were searched for randomized clinical trials published from 1970 to July 2014. We followed PRISMA reporting standards to assess study eligibility and extract data. Studies of patients older than 16 years who underwent operative mandibular fracture management were included. The primary data collected included the type of analgesic prescribed, associated adverse effects of the analgesic, method of pain assessment, and use of quality-of-life measures. A pain attentiveness score was assigned to studies based on the comprehensiveness of the information reported. Several variables were reviewed to determine the factors that predict reporting of pain-related data. Assessments of risk for bias were performed using the Cochrane Collaboration's domain-based evaluation method.

FINDINGS

The initial search identified 111 articles, of which 38 met inclusion criteria. Among the 38 reviewed articles, there were 38 trials and 1808 unique patients represented. Among the 38 articles, the procedures reported included maxillomandibular fixation only in 6 (16%), open reduction with internal fixation only in 20 (53%), and both in 12 (32%). Specific analgesics prescribed were reported in only 5 of the 38 studies (13%), and 3 of these used a combination of nonsteroidal anti-inflammatory drugs and acetaminophen (paracetamol). Thirteen studies (34%) reported pain assessments and 5 (13%) included quality-of-life measures. Geographic region was the only variable that predicted pain attentiveness, with studies from Europe (3 of 11 studies [27%]) and Asia (6 of 16 studies [38%]) most likely to have a high pain attentiveness score. A low rating was least common in the United States (2 of 5 studies [40%]) (P = .047, Fisher exact test). Most of the studies had unclear (n = 27) or high (n = 6) risks for bias in the key domains assessed.

CONCLUSIONS AND RELEVANCE

Pain management is a neglected outcome in randomized clinical trials of mandibular trauma; most studies did not describe the specific analgesics used. Many randomized clinical trials (13 [34%]) assessed pain levels among patients without providing information about the agents prescribed. The incorporation of validated pain measures and quality-of-life scores in future studies of mandibular trauma would focus attention on this key outcome measure.

Comparative in vitro mechanical evaluation of techniques using a 2.0 mm locking fixation system for simulated fractures of the mandibular body

PURPOSE

To perform a comparative evaluation of the mechanical resistance of simulated fractures of the mandibular body which were repaired using different fixation techniques with two different brands of 2.0 mm locking fixation systems.

MATERIALS AND METHODS

Four aluminum hemimandibles with linear sectioning simulating a mandibular body fracture were used as the substrates and were fixed using the two techniques and two different brands of fixation plate. These were divided into four groups: groups I and II were fixed with one four-hole plate, with four 6 mm screws in the tension zone and one four-hole plate, with four 10 mm screws in the compression zone; and groups III and IV were fixed with one four-hole plate with four 6 mm screws in the neutral zone. Fixation plates manufactured by Tóride were used for groups I and III, and by Traumec for groups II and IV. The hemimandibles were submitted to vertical, linear load testing in an Instron 4411 servohydraulic mechanical testing unit, and the load/displacement (3 mm, 5 mm and 7 mm) and the peak loads were measured. Means and standard deviations were evaluated applying variance analysis with a significance level of 5%.

RESULTS

The only significant difference between the brands was seen at displacements of 7 mm. Comparing the techniques, groups I and II showed higher mechanical strength than groups III and IV, as expected.

CONCLUSION

For the treatment of mandibular linear body fracture, two locking plates, one in the tension zone and another in the compression zone, have a greater mechanical strength than a single locking plate in the neutral zone.

Study of Efficacy and the Comparison Between 2.0 mm Locking Plating System and 2.0 mm Standard Plating System in Mandibular Fractures

PURPOSE

The purpose of this study was to evaluate the efficacy and comparison between 2.0 mm locking plate system and 2.0 mm Champy's titanium mini plating system in mandible fractures.

MATERIALS AND METHODS

A total of 20 patients with mandibular fractures were selected and divided into two groups A and B on randomized basis. Group A was treated with open reduction internal fixation using 2.0 mm locking plates and group B with 2.0 mm Champy's titanium miniplates. All patients were followed up for 12 weeks postoperatively.

RESULTS

Results of the study show less screw loosening, less precision in plate adaptation and less alteration of the osseous or occlusal relationship upon screw tightening in group A. Chi square test was applied to compare the results between the two groups. Statistical analysis did not show significant difference of incidence of malocclusion between the two groups (p value = 0.606). Statistical analysis using un-paired t test showed significant difference of working time between the two groups (p value = 0.00296). When comparing the overall complication rates according to plates used, the χ(2) test showed no statistically significant difference between the locking and nonlocking plates (p > 0.05).

CONCLUSION

It is observed in our study that the locking plate/screw system offers significant advantages over the conventional plating system. The precise adaptation required for using conventional plates is not needed when this locking plate/screw system is used. Locking plate/screw system provides better stability than the conventional plate/screw system.

A meta-analysis comparing the 2.0-mm locking plate system with the 2.0-mm nonlocking plate system in treatment of mandible fractures

PURPOSE

The purpose of this meta-analysis was to evaluate the efficacy of the 2.0-mm locking miniplate/screw system in comparison with the 2.0-mm nonlocking miniplate/screw system in treatment of mandible fractures.

METHODS

Articles published until March 2013 were searched in the PubMed and EMBASE electronic databases. Eligible studies were restricted to comparative controlled trials.

RESULTS

Four studies with 220 patients and 420 fracture sites were enrolled into the analysis. The results showed that there were no significant differences in overall complications (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.24-1.36; P = 0.21), postoperative infection (OR, 0.43; 95% CI, 0.13-1.41, P = 0.17), and postoperative pain (P > 0.05) when comparing 2.0-mm locking miniplates with 2.0-mm nonlocking miniplates in treating mandible fractures. However, the use of 2.0-mm locking miniplates had a lower postoperative maxillomandibular fixation (MMF) rate than the use of 2.0-mm nonlocking miniplates (OR, 0.18; 95% CI, 0.08-0.41; P < 0.0001).

CONCLUSIONS

Mandible fractures treated with 2.0-mm locking miniplates and nonlocking 2.0-mm miniplates present similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using 2.0-mm locking miniplates also indicates that the 2.0-mm locking miniplate has a promising application in treatment of mandibular fractures.

Effectiveness of 2.0 mm Standard and 2.0 mm Locking Miniplates in Management of Mandibular Fractures: A Clinical Comparative Study

To compare and evaluate the effectiveness of 2.0 mm locking miniplates versus 2.0 mm standard miniplates in treatment of mandible fractures. Sixty randomly selected patients who sustained mandibular fractures were selected for this study. The fractured fragments were stabilized using 2.0 mm locking miniplates in 30 cases and in the remaining 30 cases the fractured fragments were fixed with conventional 2.0 mm miniplates. Post-operative stability was assessed with radiographs at 7th day, 1st, and 3rd months. The stability of the reduced fracture was assessed clinically and both the types of plates were assessed with an OPG or conventional radiographs. This study shows favorable results on use of locking miniplates in mandibular fractures. The results show that there were no significant differences in the post-operative complications between the conventional and the locking plate/screw mandibular systems. The locking plate/screw system was more rigid than conventional plate/screw system, thereby reducing the need and duration of intermaxillary fixation (IMF).

Interventions for the management of mandibular fractures

BACKGROUND

Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach.

OBJECTIVES

The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (non-surgical) that can be used in the management of mandibular fractures, excluding the condyles, in adult patients.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 28 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February 2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7 April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified were checked for further studies. There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that compared different treatment approaches were included.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed trial quality and extracted data. Results were to be expressed 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 to include both clinical and methodological factors.

MAIN RESULTS

Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported. Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome. Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of post-operative infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I(2) = 0%). Similarly, no difference in post-operative infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19 to 8.13, P = 0.81, I(2) = 27%). The included studies involved a small number of participants with a low number of events.

AUTHORS' CONCLUSIONS

This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in the management of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician's prior experience and the individual circumstances.

Evaluation of fracture healing and subimplant bone response following fixation with a locking miniplate and screw system for mandibular angle fractures in a sheep model

This study aims to establish a mandible fracture model, and to review fracture healing following fixation with a locking miniplate system. Eighteen 2-year-old sheep were divided into three groups of six. Each animal had a single fracture that was anatomically reduced and internally fixed by a single 4-hole plate with two monocortical screws each side of the fracture. The fractures were internally fixed with poorly contoured conventional miniplates or poorly contoured mini-locking plate or well contoured conventional miniplates. Two sheep in each of the three groups were killed at 2, 4 and 8 weeks after surgery. The mandibles were radiographed then decalcified specimens were reviewed microscopically. No clinical difference was observed between the groups. All fractures were at an advanced stage of bony union by 4 weeks. Fracture union appeared radiographically more advanced with the locking plate system. This study established a protocol for simulating a fracture model for the study of fracture healing. A more advanced stage of union was seen for fractures internally fixed with locking plates/screws than with a conventional system. The observations suggest the purported biological benefits of locking miniplate system do exist.

Conventional versus 3-Dimensional Miniplate in Management of Mandibular Fracture

Objective

The aim of this study was to compare conventional miniplate (Champy’s) and 3-dimensional miniplate fixation in the management of mandibular fracture.

Study Design

Prospective study.

Setting

The study was carried out in the Department of Oral and Maxillofacial Surgery, Govt. Dental College, Pt. B.D. Sharma University of Health Sciences, Rohtak, India.

Subjects and Methods

A prospective randomized clinical trial was carried out in 50 patients. Patients were randomly assigned to receive a 2.0-mm 3-dimensional miniplate (group A) or a 2.0-mm conventional miniplate (group B). All patients were followed up for 12 weeks postoperatively. Complications were analyzed according to the type of plate used and the site of fracture.

Results

Twenty-eight fracture sites were treated with the 3-dimensional miniplate and 28 with the conventional miniplate. Five complications occurred, representing 8.9% of the total. Two complications occurred in group A and 3 in group B, with complication rates equaling 7.14% and 10.71%, respectively. When comparing the overall complication rates according to plates used, the χ2 test showed no statistically significant difference between the 2 groups ( P > .05).

Conclusion

No major difference in terms of treatment outcome is observed in both systems, and both are equally effective in managing mandibular fracture.