Comparison of three-dimensional plate versus double miniplate osteosynthesis for treatment of unfavorable mandibular angle fractures

Clinical efficacy of three plating systems in management of mandibular parasymphyseal fractures: a retrospective study

BACKGROUND

The main goal of management of the mandibular fracture is to obtain the pre-injury contour of the bone and pre-injury occlusion as well as regain function early. For Parasymphyseal fractures, the ideal fixation method is still debatable. It could range from rigid to semi-rigid fixation. The current study aimed to compare the clinical and radiographic effect of two miniplates, 2.3 high-profile Miniplates, and three-dimensional (3D) Miniplates for internal fixation treatment of mandibular para-symphyseal fractures.

METHODS

The study reviewed 240 medical records, dividing 60 patients into three treatment groups: Group I (25 patients received 2.0 mini plates), Group II (22 patients received 2.3 high profile miniplate), and Group III (13 patients received 3D miniplate). Data included demographics, fracture diagnosis, radiographs, maxillomandibular fixation use, surgical time, intervention, postoperative stability, and complications.

RESULTS

The present study included 60 patients with mandibular parasymphyseal fractures, divided into three treatment groups: Group I (n = 25, 41.67%), Group II (n = 22, 36.67%), and Group III (n = 13, 21.67%). The study found no significant differences in age and sex distribution among the three groups, but the mean surgery time varied significantly. Group II had the highest rate of complications at 22.73%, followed by Group I at 20% and Group III at 7.69%.

CONCLUSION

In conclusion, the (3D) Miniplates could provide better internal fixation treatment of mandibular para-symphyseal fractures in terms of easy use, short surgery time and less complication such as malocclusion and infection.

Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial)

Background

Mandibular angle is the most common site for fractures, accounting for 23-42% of all cases of mandibular fractures. A customized fixation system is designed directly for a specific patient, which reduces the time spent bending and fixing the plate during the operation. This study was designed to assess the effect of CAD/CAM customized V pattern plate versus standard miniplates fixation in mandibular angle fracture.

Materials and Methods

This prospective randomized clinical trial included 26 patients suffering from mandibular angle fracture. Patients were selected from Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University and Ahmed Maher Teaching Hospital. Study group (13) needed open reduction and internal fixation by using CAD/CAM V plate with surgical guide, while control group (13) needed open reduction and internal fixation by using standard superior-inferior miniplate fixation. The patients were then followed up for one year postoperatively.

Results

It showed that there was a statistical difference between the study group and the control group regarding postoperative pain, occlusion, and maximal interincisal opening (p value < 0.05%). There was no statistical difference (p value > 0.05%) in the postoperative panoramic radiograph that was taken within the postoperative 1st week in both groups, while the increase in mean bone density was statistically significant (p value < 0.05%) from 6 months to one year postoperatively.

Conclusion

CAD/CAM customized V pattern plate is a suitable plate design because it offers sufficient stability for normal bone healing, the creation of an ideal occlusion, an early return to function, and adequate postoperative radiographic outcomes.

Trial Registration

It was registered at ClinicalTrials.gov. Registration number: NCT03761524. Registration date: 03.12.2018.

Resistance and Stress Analysis of 3D Plate and Locking Plate Fixation in Bilateral Sagittal Split Osteotomy: A Comparative Finite Element Study

Aim

This study evaluates the biomechanical properties of 3D plates and compares it with locking plates, in both set back and advancement models of bilateral sagittal split osteotomy (BSSO) using finite element model analysis.

Design

A stereolithography model of mandibular structure was imported to hypermesh to create 3D solid finite model. A BSSO was simulated on hemimandibular model and advancement and setback simulations were carried out for a distance of 4, 6, and 8 mm each. 3D plates for the right side and locking plates for the left side were simulated for fixation. Meshing of the model was carried out. After meshing, the model was imported to Ansys V18.1 for analysis of it. Forces simulating the masticatory muscles were applied on both sides. The values for stress and resistance in the screws and plates were measured and the lowest and highest deformation regions were estimated using von Mises analysis.

Results

The results suggest that the tension and resistance as measured through were better distributed in 3D plates when compared with that of locking plates; the stress concentration was shown to be higher in the locking plates and deformation resistance was greater in 3D plates.

Conclusion

The application of 3D plating system has found its place in the field of maxillofacial trauma. However, its application in the field of orthognathic surgery is yet to be explored and this study encourages us to conduct in vivo studies.

Assessment of biomechanical properties of specially-designed miniplate patterns in a mandibular subcondylar fracture model with finite element analysis and a servohydraulic testing unit

The aim of our study was to compare the biomechanical stability of three different systems used to fix mandibular condylar fractures on synthetic polyurethane mandibles using a servohydraulic testing unit and finite element analysis (FEA). We measured the resistance to displacement loads causing 1.75 and 3.5mm displacements of the fragments, and the maximum resistance values before failure of the fixation system in 30 condylar necks of 15 polyurethane mandible models. The three subgroups investigated were arranged as a triangular plate (n=10), a quadrangular plate (n=10), and a straight miniplate (n=10). The most successful fixation pattern was achieved with two straight four-hole miniplates. However, the triangular plate can easily be applied as a second option by an endoscopic approach. The rectangular plates showed no success in mandibular condylar fractures.

Comparison of single versus two non-compression miniplates in the management of unfavourable angle fracture of the mandible: a prospective randomized clinical study

PURPOSE

The purpose of this study was to compare the efficacy of single versus two non-compression miniplates in the management of unfavourable angle fracture of mandible.

MATERIALS AND METHODS

A total of 28 patients who required open reduction of mandibular angle fracture were included in the study. The patients were randomly divided into two groups. Group I comprised of patients treated with two miniplates and those in group II were treated with single non-compression miniplate. The parameters of assessment were malocclusion, surgical site infection, need for implant removal, duration of surgery, inter-incisal mouth opening and cost of implants used, in both the groups. Statistical analysis was carried out to compare all the parameters.

RESULTS

Out of 14 patients in group II, inadequate reduction was noticed in three patients, whereas screw loosening had occurred in two cases. Screw loosening was always associated with chronic infection. In these cases, hardware removal was deemed necessary. Plate bending was observed in two cases resulting in malocclusion and difficulty in eating. Non-union of fracture occurred in one patient treated in group II. In group I, no plate bending, screw loosening, surgical site infection, non-union or malocclusion was observed. No patient had to undergo implant removal in group I.

CONCLUSION

In the management of unfavourable mandibular angle fracture, two miniplates must be preferred over the use of single miniplate as using two miniplates results in better results with minimal complications.