Comparative evaluation of bite forces in patients after treatment of mandibular fractures with miniplate osteosynthesis and internal locking miniplate osteosynthesis

Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing

The clinical finite element analysis (FEA) application in maxillofacial surgery for mandibular fracture is limited due to the lack of a validated FEA model. Therefore, this study aims to develop a validated FEA model for mandibular fracture treatment, by assessing non-comminuted mandibular fracture fixation. FEA models were created for mandibles with single simple symphysis, parasymphysis, and angle fractures; fixated with 2.0 mm 4-hole titanium miniplates located at three different configurations with clinically known differences in stability, namely: superior border, inferior border, and two plate combinations. The FEA models were validated with series of Synbone polymeric mandible mechanical testing (PMMT) using a mechanical test bench with an identical test set-up. The first outcome was that the current understanding of stable simple mandibular fracture fixation was reproducible in both the FEA and PMMT. Optimal fracture stability was achieved with the two plate combination, followed by superior border, and then inferior border plating. Second, the FEA and the PMMT findings were consistent and comparable (a total displacement difference of 1.13 mm). In conclusion, the FEA and the PMMT outcomes were similar, and hence suitable for simple mandibular fracture treatment analyses. The FEA model can possibly be applied for non-routine complex mandibular fracture management.

Comparison of biting force when using a combination of one microplate and one miniplate versus two miniplates for fixation of parasymphyseal mandibular fracture: the use of microplates for parasymphyseal mandibular fracture

PURPOSE

This study was to assess the efficiency of using a combination of one microplate and one miniplate for management of patients with parasymphyseal mandibular fractures versus two miniplates through measurement of the biting force.

PATIENTS AND METHODS

The study sample consisted of sixteen patients with an isolated mandibular fracture and randomly divided into two groups; group I was managed using two miniplates, while group II was managed using a combination of one microplate at subapical region and one miniplate at the inferior border of the mandible. The biting force was measured at 1 week, 1 month, and 3 months follow-up visits. A control group consisted of 40 healthy adult volunteers was selected to measure the normal biting force.

RESULTS

The mean of the normal biting force of the control group was 435 N ± 219, 103.2 N ± 4.8, and 390.6 N ± 195.4 at right molar, incisor, and left molar regions respectively. There was a statistically non-significant difference regarding the bite force of both study groups, with a progressive increase through the different follow-up visits and a period of 3 months is sufficient for recovery of patients to regain their normal biting force.

CONCLUSION

Consequently a combination of one microplate and one miniplate is efficient for the management of isolated parasymphyseal mandibular fracture in the same way as two miniplates.

Comparison of Bite Force with Locking Plates versus Non-Locking Plates in the Treatment of Mandibular Fractures: A Meta-Analysis

Introduction  Mandibular fractures represent a high percentage of all facial fractures, and the bite force is a fundamental parameter to measure the actual mandibular function and, subsequently, the masticatory efficiency and quality of life. Objectives  The purpose of the present systematic review was to verify if there is any difference in the bite forces of patients with mandibular fractures fixed by locking or non-locking plates, testing the null hypothesis of no difference in this parameter. Data Synthesis  A systematic review of the literature was conducted using four databases (PubMed, Virtual Health Library, Web of Science and Science Direct) without restrictions as to publication date or language. We found 3,039 abstracts, and selected 4 articles for this review. Conclusion  The overall results show better performance in bite force for the locking plates when compared with the non-locking plates in the incisor region (mean deviation [MD]: 1.18; 95% confidence interval [95%CI]: 0.13-2.23), right molar region (MD: 4.71; 95%CI: 0.63-8.79) and left molar region (MD: 10.34; 95%CI: 4.55-16.13). Although the results of this study indicated a better bite force result with the locking plates, there is still no sufficient evidence to support this information safely.

A comparative study on evaluation of role of 1.5 mm microplates and 2.0 mm standard miniplates in management of mandibular fractures using bite force as indicator of recommendation

Aims and Objectives:

To compare the maximum voluntary bite force generated at different periods during mandibular fracture healing using miniplates and microplates as means of rigid internal fixation.

Materials and Methods:

Maximum voluntary bite force was recorded in healthy young individuals of different age group from either gender. Patients suffering from symphyseal and parasymphyseal and body fractures were selected and randomly treated using miniplate and microplate osteosynthesis by open reduction and rigid internal fixation. Postoperative bite forces at intervals of 1^st, 2^nd, 4^th, and 6^th week were recorded and compared with control group.

Observations and Results:

It was noticed that bite forces were significantly reduced in the study groups in comparison to control group and at different intervals of treatment. There was a progressive improvement in the bite force with passage of time. There was no statistical significance in the observed bite force in both the study groups at different intervals of assessment.

Conclusion:

1.5 mm microplates provide adequate stability comparable to miniplates for the treatment of fractured mandible and should be preferred over miniplates. We further suggest that bite forces should be considered for the assessment of clinical union of bone as well as studies pertaining to selection of hardware for rigid internal fixation.