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Sobrero F, Roccia F, Omedè M, Merlo F, Dubron K, Politis C, Rabufetti A, Scolozzi P, Ramieri G, Birk A, Vesnaver A, Rizvi AO, Laverick S, Jelovac D, Konstantinovic VS, Vilaplana V, Roig AM, Goetzinger M, Bottini GB, Knežević P, Dediol E, Kordić M, Sivrić A, Derkuş FE, Yilmaz UN, Ganasouli D, Zanakis SN. Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study. J Craniofac Surg 2024; 35:1120-1124. [PMID: 38713082 DOI: 10.1097/scs.0000000000010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/22/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF). MATERIAL AND METHODS This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded. RESULTS Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type. CONCLUSION Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.
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Affiliation(s)
- Federica Sobrero
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Fabio Roccia
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Michela Omedè
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Francesca Merlo
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Kathia Dubron
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Alessandro Rabufetti
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Guglielmo Ramieri
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Ali O Rizvi
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Drago Jelovac
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vitomir S Konstantinovic
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Valentines Vilaplana
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Antonio Mari Roig
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Maximilian Goetzinger
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Predrag Knežević
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Fatma Eriş Derkuş
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Utku Nezih Yilmaz
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Dimitra Ganasouli
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Stylianos N Zanakis
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
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Matchin AA, Nosov EV, Stadnikov AA, Klevtsov GV, Rezyapova LR, Sayapina NA, Blinova EV, Valiev RZ. In Vivo Studies of Medical Implants for Maxillofacial Surgery Produced from Nanostructured Titanium. ACS Biomater Sci Eng 2023; 9:6138-6145. [PMID: 37803938 DOI: 10.1021/acsbiomaterials.3c00813] [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] [Indexed: 10/08/2023]
Abstract
This paper presents the results of comprehensive in vivo studies into the osseointegration behavior of medical implants for maxillofacial surgery produced from nanostructured grade 4 titanium. Special attention is given to the phenomenology of bone tissue formation with consideration of its surface relief features and to evaluating the quantitative parameters of the morphological indicators of osteoblast and endothelial cells in the osseointegration zone. These parameters were compared with their measurement data for standard factory-made implants, and considerable acceleration in the fixation of nanotitanium implants due to osseointegation was found. The obtained results indicate a better osseointegration of implants made of nanotitanium in comparison to similar standard products.
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Affiliation(s)
- Alexander A Matchin
- Department of Dentistry and Maxillofacial Surgery, Orenburg State Medical University, Orenburg 460000, Russia
| | - Evgeniy V Nosov
- Department of Dentistry and Maxillofacial Surgery, Orenburg State Medical University, Orenburg 460000, Russia
| | - Alexander A Stadnikov
- Department of Histology, Cytology and Embryology, Orenburg State Medical University, Orenburg 460000, Russia
| | - Gennadiy V Klevtsov
- Department of Nanotechnology, Materials Science and Mechanics, Togliatti State University, Togliatti 445020, Russia
| | - Luiza R Rezyapova
- Institute of Physics of Advanced Materials, Ufa University of Science and Technology, Ufa 450076, Russia
| | - Natalia A Sayapina
- Institute of Physics of Advanced Materials, Ufa University of Science and Technology, Ufa 450076, Russia
| | - Elena V Blinova
- Department of Histology, Cytology and Embryology, Orenburg State Medical University, Orenburg 460000, Russia
| | - Ruslan Z Valiev
- Institute of Physics of Advanced Materials, Ufa University of Science and Technology, Ufa 450076, Russia
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Grippaudo C, Lo Giudice A, Saponaro G, Todaro M, Moro A, D’Addona A. The Use of a CAD/CAM Thermoformed Splints System in Closed Reduction of Condylar Fractures. Bioengineering (Basel) 2023; 10:1023. [PMID: 37760125 PMCID: PMC10525750 DOI: 10.3390/bioengineering10091023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Mandibular fractures are very common. Common indications of closed treatment for mandibular fractures are non-displaced or minimally displaced simple fractures in adult compliant patients with good dentition, the absence of occlusal disruption, and fractures in growing children. In closed treatment, the mandible is maintained in centric occlusion with a maxillomandibular fixation (MMF) with orthodontic elastics. Many methods of MMF have been described, often using orthodontic appliances. In recent years, CAD-CAM technology has improved many procedures used in maxillofacial surgery and orthodontics. The device we present is manufactured following a digital workflow, and was designed specifically for MMF. (2) Materials: Two patients with mandibular fractures were treated with an MMF method whose procedure comprised scanning of the dental arches, followed by construction of thermoformed splints on which buttons for the elastics and retention holes are made. The splints were fixed on the dental arches with composite resin at the level of the holes, and were kept in place for the period of healing of the fracture, with the intermaxillary elastics hooked to the buttons. (3) Results: The application time of the splints was very quick. The splints remained stable for the necessary time, without causing particular discomfort to the patients. (4) Conclusions: From our experience, this technique has proved to be reliable and reproducible and could represent a valid tool in the closed treatment of mandibular fractures.
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Affiliation(s)
- Cristina Grippaudo
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, 95123 Catania, Italy;
| | - Gianmarco Saponaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Mattia Todaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Alessandro Moro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio D’Addona
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
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Polizzi A, Ronsivalle V, Lo Giudice A, Isola G, Bianchi A, Santonocito S, Leonardi R, Mummolo S. Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:605. [PMID: 36980163 PMCID: PMC10047072 DOI: 10.3390/children10030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.
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Affiliation(s)
- Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy (S.S.)
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L’Aquila, 67100 L’Aquila, Italy
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy (S.S.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy (S.S.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy (S.S.)
| | - Alberto Bianchi
- Department of General Surgery and Medical Surgery Specialties, Section of Maxillofacial Surgery, University of Catania, 95100 Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy (S.S.)
| | - Rosalia Leonardi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy (S.S.)
| | - Stefano Mummolo
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L’Aquila, 67100 L’Aquila, Italy
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Sobrero F, Roccia F, Zavattero E, Raveggi E. Letter to the Editor: a lesson from "European multicenter prospective analysis of the use of maxillomandibular fixation for mandibular fractures treated with open reduction and internal fixation". JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101390. [PMID: 36657720 DOI: 10.1016/j.jormas.2023.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Federica Sobrero
- Division of Maxillofacial Surgery (head: Prof. G. Ramieri), Surgical Science dpt., Città della Salute e della Scienza Hospital, University of Turin, Italy.
| | - Fabio Roccia
- Division of Maxillofacial Surgery (head: Prof. G. Ramieri), Surgical Science dpt., Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Emanuele Zavattero
- Division of Maxillofacial Surgery (head: Prof. G. Ramieri), Surgical Science dpt., Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Elisa Raveggi
- Division of Maxillofacial Surgery (head: Prof. G. Ramieri), Surgical Science dpt., Città della Salute e della Scienza Hospital, University of Turin, Italy
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