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Fahy E, Carr R, Moore E, Min A, Harrington CI, Murphy C, Ekanayake K, Kearns G. Mandibular angle fractures: a demographic review, with particular reference to post-operative complications. Ir J Med Sci 2024; 193:533-537. [PMID: 37462894 DOI: 10.1007/s11845-023-03433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/15/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Mandibular angle fractures (MAF) have a recognized complexity of treatment and an increased risk of incurring complications. METHODS This retrospective study included 45 consecutive patients who were diagnosed with an isolated MAF and no other facial fractures. The average age was 27.3 (SD = 7.7). RESULTS A comparatively low rate of complications (11.1%) and a low rate of reoperation (1.8%) are reported, along with a significant role of smoking in complications (p = 0.022). A non-significant association was noted between complications, male gender and assault as an aetiological factor. CONCLUSIONS Review of the data from this study confirms that complication rates for patients attending the National Maxillofacial Unit are similar to or better than that of international studies. An overview of the aetiology of fracture complications is included.
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Affiliation(s)
- Edward Fahy
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland.
| | - Richard Carr
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Emma Moore
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Arimie Min
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | | | - Colm Murphy
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Kumara Ekanayake
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Gerry Kearns
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
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Walker LJ, Koba S, Demiroglu A, Saulacic N, Burkhard JP. Retention of teeth in the fracture gaps of the mandible: a retrospective analysis. Clin Oral Investig 2023; 27:6055-6061. [PMID: 37610459 PMCID: PMC10560179 DOI: 10.1007/s00784-023-05218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Since the introduction of miniplate osteosynthesis and the use of prophylactic antibiotics, the complication rate related to the teeth in the fracture gap has significantly decreased. Currently, there are still no established guidelines for the management of such teeth in mandibular fracture lines. However, the long-term viability of these teeth within the fracture gap remains uncertain. Therefore, this study aimed to assess the survival rate of teeth located within the mandibular fracture line and evaluate related follow-up treatments over a minimum period of one year. MATERIALS AND METHODS This retrospective study examined 184 patients who underwent surgical treatment for mandibular fractures between January 2018 and December 2021. A total of 189 teeth located in the fracture line were analyzed. Clinical and radiological parameters were collected, including patient age and gender, fracture etiology and location, intraoperative tooth treatment, as well as complications related to both the fracture and the affected teeth in long term. RESULTS Most of the examined teeth remained uneventful, with postoperative tooth-related complications seen in 14 (7.4%) teeth. The most common complications were symptomatic apical periodontitis (n = 9, 4.8%) and increased tooth mobility (n = 3, 1.5%). A correlation was found between complications and trauma-related tooth luxation (p = 0.002, OR = 15.2), as well as prior teeth connected to retainers or orthodontic appliances (p = 0.001, OR = 10.32). CONCLUSION Tooth-related complications are rare when intact teeth are retained within the fracture gap. Therefore, unless there is a definitive intraoperative indication for extraction, it is recommended to preserve the teeth in the fracture line. CLINICAL RELEVANCE Intact teeth in the fracture line of the mandible should not be primarily extracted.
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Affiliation(s)
- Linus Josef Walker
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Sabine Koba
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Aktug Demiroglu
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
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Sahoo NK, Dubey P, Vaswani H, Pandey S. Incidence and Management of Tooth Root Fracture in Mandibular Fracture Line - A Retrospective Study. Ann Maxillofac Surg 2023; 13:216-219. [PMID: 38405552 PMCID: PMC10883222 DOI: 10.4103/ams.ams_136_23] [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: 07/25/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction In cases of trauma, the most common fractures of the facial region are the nasal bone fractures followed by mandibular fractures. About 60% of mandible fractures are associated with teeth in the fracture line; however conversely, the dentulous mandible has a higher susceptibility of fracture in any impact. Whenever a tooth is involved in the fracture line, it is not unlikely that the tooth root fracture will be associated with it. The prognosis and treatment of such a tooth persistent in a fracture line depends upon the level of tooth root fracture. Materials and Methods This retrospective study was conducted in the Department of Oral and Maxillofacial Surgery in a Meerut hospital. The eligibility criteria were based on the cases involving fracture line passing through the teeth bearing area of mandible. Total of 56 cases of mandibular fracture treated from January 2021 till December 2022 by open reduction and fixation were included in the study. Results A total of 56 patients (66 fracture lines) with mandibular fractures were selected, out of which 18 (32%) patients had fracture of the root of the tooth in the fracture line. Third molar root fracture were present in 12 cases (66.6%), first premolars in 4 cases (22.2%), and first molars in 2 cases (11.1%). There were 14 multi rooted teeth (77.7%) and 4 single rooted teeth (22.2%) involvement. All the multi rooted teeth fracture were treated by extraction during open reduction and fracture fixation. The single rooted teeth were successfully treated by endodontic treatment postoperatively. Discussion The fracture line passing through the dentate segment may fracture the tooth crown and/or root or propagate through the socket without any injury to the root. Root fracture at cervical and middle third is constantly exposed to oral fluids. The affected tooth may be mobile and lose vitality. Teeth in the line of fracture must be removed when they preclude the correct reduction of the segments or if they represent a risk for infection. If the tooth or root does not cause any hindrance during reduction or it is not infected, the tooth can be salvaged by endodontic therapy. The incidence of root fracture was seen in 32% of cases. Fracture of the third molar roots was the single largest group (66.6%). No root fracture was observed in the anterior segment.
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Affiliation(s)
- Nanda Kishore Sahoo
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Prajesh Dubey
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Himani Vaswani
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Swati Pandey
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
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Pankratov AS, Gotsiridze ZP, Karalkina MA. Experience Of Using Internal Fixation In The Treatment Of Patients With Inflammatory Complications Of Mandibular Fractures: A Retrospective Study. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Study goal — To evaluate the efficacy of plate osteosynthesis in the treatment of patients with inflammatory complications of mandibular fractures on a large sample. Material and Methods — We conducted a retrospective analysis of medical records collected over 15 years in a group of patients with inflammatory complications of mandibular fractures. The analysis included medical records of patients who underwent plate osteosynthesis operations performed according to the surgical algorithm adopted in the clinic, in combination with a simultaneous directed antibacterial effect on the microflora of the pathological focus and osteoplastic replacement of defects. We identified 164 medical records meeting the search criteria distributed among two study groups. Group A included hospitalized patients with developed abscesses and phlegmons of soft tissues surrounding the fracture area. For them, two-stage surgical intervention was performed. Group B consisted of patients who had no suppurative process in soft tissues, which allowed them undergoing one-stage surgical treatment. Results — Good, satisfactory, and unsatisfactory surgical outcomes were obtained in 82.6%, 14.9%, and 2.4% of the patients, respectively. The differences between the comparison groups were not statistically significant. Conclusion — The clinical effectiveness of an integrated approach to the surgical treatment of patients with inflammatory complications of mandibular fractures, based on providing stable fixation of connected fragments as a critical factor in bone wound healing via osteosynthesis, was confirmed on large samples in both comparison groups.
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Affiliation(s)
- Alexander S. Pankratov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | | | - Maria A. Karalkina
- A.L. Myasnikov Research Institute of Clinical Cardiology, Moscow, Russia
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Rothweiler RM, Zankovic S, Brandenburg LS, Fuessinger MA, Gross C, Voss PJ, Metzger MC. Feasibility of Implant Strain Measurement for Assessing Mandible Bone Regeneration. MICROMACHINES 2022; 13:1602. [PMID: 36295956 PMCID: PMC9610677 DOI: 10.3390/mi13101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Nonunion is one of the most dreaded complications after operative treatment of mandible fractures or after mandible reconstruction using vascularized and non-vascularized bone grafts. Often diagnosis is made at advanced stage of disease when pain or complications occur. Devices that monitor fracture healing and bone regeneration continuously are therefore urgently needed in the craniomaxillofacial area. One promising approach is the strain measurement of plates. An advanced prototype of an implantable strain measurement device was tested after fixation to a locking mandible reconstruction plate in multiple compression experiments to investigate the potential functionality of strain measurement in the mandibular region. Compression experiments show that strain measurement devices work well under experimental conditions in the mandibular angle and detect plate deformation in a reliable way. For monitoring in the mandibular body, the device used in its current configuration was not suitable. Implant strain measurement of reconstruction plates is a promising methodical approach for permanent monitoring of bone regeneration and fracture healing in the mandible. The method helps to avoid or detect complications at an early point in time after operative treatment.
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Affiliation(s)
- René Marcel Rothweiler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Sergej Zankovic
- G.E.R.N. Center for Tissue Replacement, Regeneration & Neogenesis, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79108 Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marc-Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christian Gross
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marc-Christian Metzger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg 2021; 35:238-249. [PMID: 34819805 DOI: 10.1055/s-0041-1735818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.
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Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington.,Divisions of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
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Hosgor H, Coskunses FM, Akin D. Evaluation of the Prognosis of the Teeth in the Mandibular Fracture Line. Craniomaxillofac Trauma Reconstr 2021; 14:144-149. [PMID: 33995835 PMCID: PMC8108096 DOI: 10.1177/1943387520952673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prognosis of the teeth in the mandibular fracture line and to analyze the relationship between the degree of displacement of fracture fragments, the relationship of the fracture line to the periodontium, and the relationship between the condition of the teeth at the first postoperative (post-op) year. METHODS A total of 60 teeth from 38 patients (11 female and 27 male) who had erupted teeth in the line of mandibular fracture and were treated with open reduction were examined. The data were collected from the patients' clinical records and radiographs. Age at the time of injury, gender, cause of trauma, site of fracture, the relationship of the fracture line to the periodontium, the degree of displacement of fracture fragments, and the condition of the teeth in the line of the fracture at the first post-op year were evaluated. RESULTS The degree of displacement of fracture fragments had an effect on the condition of the teeth at the first post-op year (P = .036) and the regions of the mandible had an effect on the degree of displacement of the fracture fragments (P = .000). The survival rate of the pulp of the teeth was 69.8%. CONCLUSIONS A preventive approach should be preferred for teeth in the mandibular fracture line. Retained teeth in the fracture line should be monitored clinically and radiologically for at least 1 year, and unnecessary endodontic treatments should be avoided.
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Affiliation(s)
- Hatice Hosgor
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Fatih Mehmet Coskunses
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Deniz Akin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Beret M, Nicot R, Roland-Billecart T, Ramdane N, Ferri J, Schlund M. Impacted lower third molar relationship with mandibular angle fracture complications. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:149-154. [PMID: 34000436 DOI: 10.1016/j.jormas.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mandibular angle fractures are very common and are associated with the highest risk of complications. The aim of this study is to evaluate the correlation between impacted lower third molar and mandibular angle fracture complications. MATERIAL AND METHODS All patients presenting with a mandibular angle fracture and at least 2 months follow up were retrospectively included. The following complications were recorded: post-traumatic malocclusion, mouth opening limitation, inferior alveolar nerve hypoesthesia, infection, delayed union, hardware loosening. The patients were divided in two groups: impacted lower third molar or erupted/absent lower third molar. RESULTS A total of 68 patients were included, lower third molar was impacted in 36 cases and erupted/absent in 32 cases. 40 complications were recorded in 27 patients at 2 months. No statistically significant difference could be found about malocclusion, mouth opening limitation and inferior alveolar nerve hypoesthesia. A lower rate of persistent inferior alveolar nerve hypoesthesia (p = 0.0557) in patients with impacted lower third molar (19.4%) was observed compared to patients without impacted lower third molar (40.6%). There was no occurrence of delayed union and hardware loosening in impacted lower third molar group, whereas 5 delayed unions and 4 hardware loosening were recorded in erupted/absent lower third molar group. Finally, the rate of patients with at least one of the 6 complications is significantly higher in the erupted/absent lower third molar group (17/32, 53.1%) than in the impacted lower third molar group (10/36, 27.8%), p = 0.033. DISCUSSION The risk of overall complication is decreased when lower third molar is impacted in mandibular angle fracture. This supports the idea of a role of the impacted lower third molar in fracture reduction and stability.
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Affiliation(s)
- Marie Beret
- Univ. Lille, CHU Lille, Service de Chirurgie Maxillo-Faciale et Stomatologie, F-59000 Lille, France.
| | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterial, F-59000 Lille, France
| | | | - Nassima Ramdane
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Joël Ferri
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterial, F-59000 Lille, France
| | - Matthias Schlund
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterial, F-59000 Lille, France
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The influence of wisdom tooth impaction and occlusal support on mandibular angle and condyle fractures. Sci Rep 2021; 11:8335. [PMID: 33863971 PMCID: PMC8052439 DOI: 10.1038/s41598-021-87820-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/31/2021] [Indexed: 02/05/2023] Open
Abstract
This study aimed to analyze the relationship of the occlusal support together with the lower third molars to the mandibular fractures of the angle and condyle among patients in our medical institutions. This was a retrospective study that reviewed the medical records and radiographs of all patients treated for mandibular fractures from 2015 to 2019. The data collected by using picture archiving and communicating system. Only records with mandibular angle or condyle fractures were included. The dependent variable was the presence of the fractures of the mandibular angle or condyle. The independent variables were epidemiological data, third molar characteristics, existence or absence of occlusal support. The data was analyzed through Univariate logistic regression and multivariate logistic regression. From a total of 187 mandibular fractures, 44 presented mandibular angle fracture and 29 shown condyle fractures. The average age was 40.34 ± 13.47 years. The absence of occlusal support increased the chance of condyle fractures by 5.1 times (95% CI 1.61-17.29). The lack of occlusal support is more associated with condyle fractures than the presence of occlusal support, regardless of third molar presence and characteristics and other variables evaluated.
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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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