Evaluation of Surface Changes of Stainless Steel Miniplates and Screws Following Retrieval from Maxillofacial Trauma and Orthognathic Surgery Patients: A Comparative Study

Background

This study examines the surface changes of stainless steel miniplates and screws after their retrieval from patients who underwent maxillofacial trauma and orthognathic surgery. The assessment focuses on comparing the alterations in these materials, aiming to contribute to our understanding of their durability and performance in clinical settings.

Materials and Methods

A total of 60 stainless steel miniplates and screws were collected from 30 patients who had previously undergone either maxillofacial trauma or orthognathic surgery. The retrieved miniplates and screws were carefully removed from the patients and cleaned to remove any organic debris. Each specimen was then examined for surface changes. Surface changes were evaluated using visual inspection, scanning electron microscopy (SEM), and roughness measurements. Visual inspection provided a qualitative assessment, while SEM allowed for a more detailed examination of the surfaces. Roughness measurements were conducted using a profilometer.

Results

Visual inspection revealed varying degrees of surface changes in the retrieved miniplates and screws. These changes included scratches, corrosion, and discoloration. SEM analysis confirmed the presence of surface alterations, with some specimens showing more significant damage, such as pitting and cracks. Roughness measurements indicated an increase in surface roughness for both miniplates and screws, suggesting that the surfaces had become less smooth.

Conclusion

This comparative study of stainless steel miniplates and screws retrieved from maxillofacial trauma and orthognathic surgery patients demonstrated that these materials undergo surface changes over time.

Comparative evaluation of different osteosynthesis modalities with respect to lingual splaying in mandibular interforaminal fractures using CBCT: A prospective study

Introduction

The management of interforaminal fracture can prove to be challenging because of its unique anatomy and muscular forces. Often, lingual splaying has been found either postoperatively or even during the procedures in such fractures and can be challenging when it comes to managing them. Various modalities such as miniplates, lag screws, and three-dimensional (3D) miniplates have been utilized to manage these fractures. This article compares these three modalities in the management of lingual splaying.

Material and Methods

Thirty patients were allotted randomly to either of the aforementioned modalities randomly in this prospective study. The patients were operated and followed up for the period of 6 months.

Results

It was found that no significant difference exists between the modalities in terms of reduction in lingual splay.

Conclusion

All three modalities have different ventures to offer. A larger sample size study may be warranted to elucidate the obtained results.

Impacted Mandibular Fracture: A Report of a Rare Case

Representing unusual fracture patterns is extremely important to understand. A 27-year-old male patient with a known history of a road traffic accident with sustained injury reported to the Department of Oral and Maxillofacial Surgery in Saveetha Dental College with pain in the left and right lower jaw region of three days duration. The patient provided a history of frontal impact in the symphysis region after a fall from a two-wheel vehicle. Clinical examination revealed a laceration of 2 cm in the chin region with bilateral pre-auricular swelling and trismus with an anterior open bite. The computed tomography scan revealed a bilateral dicapitular condyle fracture with an oblique impacted fracture of the symphysis with a displaced inferior border and left lingual cortical displacement. Apart from this, an incomplete fracture was evidenced, extending along the inferior border to the right body of the mandible. The fracture site was exposed through the laceration. The impacted mandibular fracture segments were mobilized and fixation was done using a 2 mm five-hole plate at the lower border across the sagittally split segment after placement of maxillomandibular fixation with an arch bar at the alveolar border as a part of tension banding. The oblique lingual fracture was reduced and fixed with a 2 x 14 mm bicortical screw. The primary objective of the current case report is to elucidate an unusual fracture of the mandible and discuss the management of such impacted mandibular fractures.

Mandibular fracture repair techniques in cats: a dentist's perspective

PRACTICAL RELEVANCE

Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular fracture repair will facilitate evidence-based decision-making in clinical practice.

CLINICAL CHALLENGES

Feline maxillofacial and oral anatomy brings unique challenges in comparison with dogs. It has been commonplace to adapt techniques and equipment that are better suited to other body regions or are species-inappropriate for use in feline maxillofacial surgery, and this has traditionally resulted in high morbidity.

AIMS

This review presents an overview of the diagnosis of, and decison-making for, maxillofacial trauma in cats, specifically with reference to the feline mandible. The challenges associated with the management of these injuries are presented. Techniques for repair that can be employed in general practice, as well as more advanced surgical options, are discussed, as well as the indications for invasive vs non-invasive management. Underutilised methods involving composite dental materials and their versatility for the repair of mandibular fractures in cats, and miniplates for caudal mandibular fractures in cats, are specifically covered, as well as other recent advances in the field, including three-dimensional printing and custom-printed implants.

EVIDENCE BASE

Management of feline facial fractures is an often neglected topic, with very few published studies choosing to focus on head trauma outcomes in cats. Where available, however, this review draws on the published literature, as well as the authors' own clinical experience.

Titanium Miniplates in a Mandible Fracture Model in Sheep

In fractures of the mandible, osteosynthesis with titanium plates is considered the gold standard. Titanium is an established and reliable material, its main disadvantages being metal artefacts and the need for removal in case of osteosynthesis complications. Magnesium, as a resorbable material with an elastic modulus close to cortical bone, offers a resorbable alternative osteosynthesis material, yet mechanical studies in mandible fracture fixation are still missing. The hypothesis of this study was that magnesium miniplates show no significant difference in the mechanical integrity provided for fracture fixation in mandible fractures under load-sharing indications. In a non-inferiority test, a continuous load was applied to a sheep mandible fracture model with osteosynthesis using either titanium miniplates of 1.0 mm thickness (Ti1.0), magnesium plates of 1.75 mm (Mg1.75), or magnesium plates of 1.5 mm thickness (Mg1.5). No significant difference (p > 0.05) was found in the peak force at failure, stiffness, or force at vertical displacement of 1.0 mm between Mg1.75, Mg1.5, and Ti1.0. This study shows the non-inferiority of WE43 magnesium miniplates compared to the clinical gold standard titanium miniplates.

Comparison of standard miniplates and locked miniplates in post-traumatic fracture stabilization

BACKGROUND

Bicortical screws (lag and positional) or miniplates with monocortical screws are generally used for the rigid fixa-tion of the sagittal split ramus osteotomy (SSRO) in maxillofacial surgery. However, in this osteosynthesis method, the plate must be perfectly adapted to the bone to prevent misalignment of the bone segment and occlusal changes. In addition, it is necessary to prevent the position of the condyle in the mandibular fossa from changing after fixation. In recent years, locked miniplate systems have been used to overcome these complications.

METHODS

The aim of this study is to compare the commonly used 2.0 mm standard miniplate/screw systems and 2.0 mm locking miniplate/screw systems in fresh sheep jaws with Obwegeser-Dal Pont (OD) and Hunsuck-Epker (HE) modifications, by evaluating standard parameters.

RESULTS

Our study consists of two main groups and two subgroups. 40 sheep hemimandibulae were randomly divided into two main groups. Each group was randomly divided into two subgroups. There are ten hemimandibulae (n=10) in each subgroup. Linear force test was applied using 4-hole standard miniplate and 4-hole locking miniplate systems on sheep jaws with 5 mm advancement by applying OD and HE techniques, which are two frequently preferred modifications in SSRO. For statistical analysis SPSS® 16.0 (Sta-tistical Package for the Social Sciences, SPSS Inc. Chicago, Illinois, USA) package program was used. It was statistically compared with the 95% confidence interval using the Pearson coefficient, and p<0.05 was interpreted as significant. The values of the loading forces applied to the samples in the groups were subjected to analysis of variance (ANOVA) to confirm the normality of the sample. Multiple comparisons were made between groups using the Tukey test. The mean loadings in the groups were analyzed by one-way ANOVA.

CONCLUSION

In general, as the strength of the force increases, the displacement values increase in all groups, but although it was observed that the locked miniplate/screw system was more stable than the standard miniplate/screw system, no statistically significant difference was found.

Skeletal and Soft-Tissue Stability Following Advancement Genioplasty: A Comparative Analysis between Wire and Miniplate Osteosynthesis

Background:

Genioplasty has nowadays become a routine procedure in the correction of dentofacial deformities. The present study aimed to evaluate and compare the osseous and soft-tissue stability after advancement genioplasties, stabilized using wire and plate osteosynthesis.

Methodology:

The study was conducted on ten patients who underwent advanced genioplasty. The patients were divided equally into two groups. In the Group I patients, plates and in Group II, wires were used for stabilization. Lateral cephalograms preoperative and 6 months postoperative were analyzed using Park et al. method of cephalometric analysis.

Results:

All the ten patients experienced a reliable improvement in esthetics. Although statistically not significant, Group II wire patients have slightly more relapse in the horizontal direction than Group I. The mean ratio of sagittal changes of osseous soft tissue for Group I was 1:0.88 and for Group II wires was 1:0.80.

Conclusion:

The choice of method of fixation following genioplasty would entirely be based on the merits of the individual cases. The marginal edge of advantage seen in miniplate osteosynthesis when compared to wire osteosynthesis is seen in cases that require larger chin advancements.

Significance of Microbial Analysis during Removal of Miniplates at Infected Sites in the Craniomaxillofacial Region - An Evaluative Study

Introduction:

Open reduction and internal fixation (ORIF) can be complicated by miniplate exposure, loosening, or infection. Infected miniplates lead to exposure, extrusion, fistula formation, bony nonunion, and osteomyelitis. Whenever any posttreated cases of ORIF become infected, it is treated blindly with a high dose of antibiotics and surgical removal of infected miniplates or screws. The aim and objectives of the study were to identify the frequency and site of infection in craniomaxillofacial implants and significance of microbes isolated from the infected region.

Materials and Methods:

Removal of miniplates was being performed on 19 patients. Among them, 14 had infection or sinus opening, 3 had plate exposure, and 2 were removed asymptomatically according to patient willingness. Aspirated fluid/pus was collected and sent for microbial culture and sensitivity test. Test of significance of individual microbes was done using Z-test and the value of P was calculated.

Results:

Among 14 patients associated with miniplate infection, 11 (78%) had infection in the mandible and 3 at zygoma. The bacteria isolated were mainly Staphylococcus aureus (7) along with coagulase-negative Staphylococcus (2), Pseudomonas aeruginosa (3), Escherichia coli (2), Streptococcus salivarius (2), and Acinetobacter genre (1). S. aureus was predominantly present in majority of the samples and statistically significant at P = 0.023.

Discussion:

The present study observed that in contrast to other sites in the body, there is versatility in microbial flora in the craniomaxillofacial region. It is essential for routine microbial analysis of samples and antibiotic susceptibility test for proper treatment of such cases.

Comparative evaluation of 2D miniplates and 3D miniplates fixation in mandibular angle fracture - A clinical study

Introduction

Mandibular angle fracture is common in road traffic accidents. This study was conducted to compare 3D miniplate system with 2D plates for treatment of mandibular angle fractures.

Materials and Methods

The study was conducted on 120 patients with mandibular angle fracture of both genders. After selecting patients, patients were divided into 2 groups of 60 each. In group I, patients were treated with 3D, 2.0-mm titanium plates, and in group II, patients were treated with 2D, 2.0-mm titanium miniplate in mandibular angle fracture. Patients were evaluated regularly after 1, 3, and 6 months for outcome of treatment.

Results

In group I, males were 22 and females were 38. In group II, males were 40 and females were 20. Right angle fracture was seen in 32 patients in group I and 26 in group II. Left angle fracture was seen in 24 in group I and 28 in group II. Right angle and left parasymphysis fracture was seen in 3 in group I and 4 in group II. Left angle and right parasymphysis fracture was seen in 1 in group I and 2 in group II. [Table 3], [Graph 1] shows that in group I, after 1 month sensory deficit was present in 5 patients and in group II in 12 patients. After 3 months, there were no patients with sensory deficit in group I and 2 in group II. Preoperatively in group I, mouth opening was 24 mm and in group II patients was 25.80 mm, which increased to 31.20 mm in group I and 28.20 mm in group II at 1 month, 32 mm in group I and 30 mm in group II at 3 months, and 37.20 and 32.12 mm in groups I and II, respectively, at 6 months. The difference was significant (P < 0.05).

Conclusion

3D miniplate system is reliable and effective treatment modality for mandibular angle fractures as compared with traditional 2D miniplates.[INLINE:1].

Histological Change in Soft Tissue Surrounding Titanium Plates after Jaw Surgery

The aim of this study was to evaluate the microscopic structure of soft tissue covering titanium plates and screws used in jaw surgery (mandible fracture and orthognathic surgery), after a minimum period of 12 months from insertion, and to quantify the presence of any metallic particles. Periosteum covering the osteosynthesis plates was removed from 20 patients and examined by light microscopy in order to assess the cell morphological changes and the possibility of metal particles presence in the soft tissue. Local signs of tissue toxicity or inflammation were taken into consideration when evaluating the routine removal of titanium maxillofacial miniplates. No signs of screw loosening or acute inflammation were detected on the osteosynthesis site, but de-coloration of the periosteum was seen, and metallic particles were observed to have migrated into the soft tissues. Even if the titanium is well-tolerated by the human body in time, without severe local or general complications, our findings suggest that plate removal should be considered after bone healing has occurred.

Principle of Lag-Screw Fixation in Mandibular Trauma

Aims and Objectives:

The aim of the study is to assess the effectiveness of lag screw fixation in mandibular fractures with respect to parameters such as stability of the occlusion, functional stability, infection rates, neurosensory deficit, ease of technique, and maximum interincisal opening.

Materials and Methods:

Our study was carried out on 13 patients with mandibular fractures. Selected cases were treated with lag screw technique and 2.7 mm titanium screws were used. Postoperative complications such as wound dehiscence, infection, neurosensory disturbance, nonunion, malocclusion, postoperative mouth opening, and occlusal discrepancies were assessed.

Results:

All the patients were male, aged between 17 and 50 years. The cause of the injury was road traffic accidents in all, except for two assaults. Our study of 13 cases of fractured mandible included five symphyses, five parasymphyses, two angle, and one body fracture cases. Our observation with open reduction and rigid internal fixation with 1–2 lag screws revealed close approximation of fractured fragments in all the cases, except in three patients who had mild discrepancy of occlusion.

Conclusion:

Lag screw technique provides good interfragmentary compression and restoration of premorbid anatomic alignment of fracture fragments. In displaced mandibular fractures, especially in oblique fractures, the use of lag screw has proven to be ideal. The complications were found to be low. It was concluded that the lag screw provided excellent stability and occlusion.

Successful Treatment of Mandibular Nonunion With Cortical Allograft, Cancellous Autograft, and Locking Titanium Miniplates in a Dog

Discontinuities of the mandible can occur for a variety of reasons including primary pathology of bone, pathologic fracture secondary to periodontal disease, and segmental resection for the treatment of neoplasia. Surgical intervention is necessary in many cases to establish normal occlusion and normal mandibular function. Rigid stabilization and treatment of these defects can be challenging due to the limited availability of bone for fixation as well as limited soft tissue coverage. This case report describes successful treatment of a nonunion fracture using cortical allograft and locking titanium miniplates. Complete osseointegration and bone healing were achieved, allowing for complete return to normal occlusion and function.

A clinical prospective randomized comparative study on ostyeosynthesis of mandibular anterior fractures following open reduction using lag screws and miniplates

Introduction

The aim of the present study was to compare fixation of mandibular anterior fractures following open reduction using lag screws or miniplates.

Materials and Methods

This prospective study was conducted on 20 patients diagnosed with cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups - Group A: two 2.5 mm stainless steel lag screws were placed in 10 patients. Group B: two 2.5 mm miniplates were placed in 10 patients for the fixation of fractures. Subsequent follow-up was done on the 1^st day, 1^st, 4^th, and 36^th week postoperatively. During every follow-up, patient was assessed clinically for infection, malocclusion, loosening of plate/screw, malunion/nonunion, and masticatory efficiency. Radiographs (orthopantogram) were taken preoperative, 1^st, 4^th, and 36^th postoperative week to compare the osteosynthesis between the two groups. Pain was objectively measured using a visual analog scale. The data collected was subjected to unpaired t-test and paired t-test for statistical analysis.

Result

It was found that lag screw placement was rapid in comparison of miniplate placement. 3rd month postoperative assessment revealed Lag screw group to have better biting efficiency, and better bone healing which was statistically significant when compared with miniplate group.

Conculsion

Our study suggests that lag screw osteosynthesis can be advocated as a valid treatment modality in the management of mandibular symphysis and parasymphysis fractures.

Assessment of sagittal split ramus osteotomy rigid internal fixation techniques using a finite element method

In this study, finite element analysis (FEA) was used to evaluate nine rigid internal fixation techniques for sagittal split ramus osteotomy. To achieve this, a computed tomography (CT) scan of a healthy patient was obtained and used to generate the geometry of a half-mandible. The geometries of bicortical screws, miniplates, and monocortical screws were designed and combined with the mandible in nine models simulating various techniques. Four models used bicortical screws in various arrangements and four used miniplates of various designs. One model represented a hybrid technique. A load of 500 N was applied to the posterior teeth and FEA was applied. The most stable techniques were the hybrid technique and a single straight miniplate, presenting the least displacement among all models. Bicortical screws, while presenting reasonable stability, showed high strain areas near the anterior ramus ridge, superoposterior to the screws, implying a risk of bone fracture in this area. On the other hand, the T-shaped and double Y-shaped miniplates were associated with high von Mises stresses that would impair their rigidity, especially where angles appeared in their designs. We recommend the use of a single straight miniplate because it provides sufficient stable fixation with minimal risks or disadvantages.

Comparative effectiveness of different types of cervical laminoplasty

Study Design Systematic review.

Study Rationale Numerous cervical laminoplasty techniques have been described but there are few studies that have compared these to determine the superiority of one over another.

Clinical Questions The clinical questions include key question (KQ)1: In adults with cervical myelopathy from ossification of the posterior longitudinal ligament (OPLL) or spondylosis, what is the comparative effectiveness of open door cervical laminoplasty versus French door cervical laminoplasty? KQ2: In adults with cervical myelopathy from OPLL or spondylosis, are postoperative complications, including pain and infection, different for the use of miniplates versus the use of no plates following laminoplasty? KQ3: Do these results vary based on early active postoperative cervical motion?

Materials and Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and March 11, 2013. Electronic databases and reference lists of key articles were searched to identify studies evaluating (1) open door cervical laminoplasty and French door cervical laminoplasty and (2) the use of miniplates or no plates in cervical laminoplasty for the treatment of cervical spondylotic myelopathy or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers (A.L.R., J.R.D.) assessed the level of evidence quality using the Grades of Recommendations Assessment, Development and Evaluation system, and disagreements were resolved by consensus.

Results We identified three studies (one of class of evidence [CoE] II and two of CoE III) meeting our inclusion criteria comparing open door cervical laminoplasty with French door laminoplasty and two studies (one CoE II and one CoE III) comparing the use of miniplates with no plates. Data from one randomized controlled trial (RCT) and two retrospective cohort studies suggest no difference between treatment groups regarding improvement in myelopathy. One RCT reported significant improvement in axial pain and significantly higher short-form 36 scores in the French door laminoplasty treatment group. Overall, complications appear to be higher in the open door group than the French door group, although complete reporting of complications was poor in all studies. Overall, data from one RCT and one retrospective cohort study suggest that the incidence of complications (including reoperation, radiculopathy, and infection) is higher in the no plate treatment group compared with the miniplate group. One RCT reported greater pain as measured by the visual analog scale score in the no plate treatment group. There was no evidence available to assess the effect of early cervical motion for open door cervical laminoplasty compared with French door laminoplasty. Both studies comparing the use of miniplates and no plates reported early postoperative motion. Evidence from one RCT suggests that earlier postoperative cervical motion might reduce pain.

Conclusion Data from three comparative studies are not sufficient to support the superiority of open door cervical laminoplasty or French door cervical laminoplasty. Data from two comparative studies are not sufficient to support the superiority of the use of miniplates or no plates following cervical laminoplasty. The overall strength of evidence to support any conclusions is low or insufficient. Thus, the debate continues while opportunity exists for the spine surgery community to resolve these issues with appropriately designed clinical studies.

The effect of multi-level laminoplasty and laminectomy on the biomechanics of the cervical spine: a finite element study

Laminectomy has been regarded as a standard treatment for multi-level cervical stenosis. Concern for complications such as kyphosis has limited the indication of multi-level laminectomy; hence it is often augmented with an instrumented fusion. Laminoplasty has emerged as a motion preserving alternative. The purpose of this study was to compare the multidirectional flexibility of the cervical spine in response to a plate-only open door laminoplasty, double door laminoplasty, and laminectomy using a computational model. A validated three-dimensional finite element model of a specimen-specific intact cervical spine (C2-T1) was modified to simulate each surgical procedure at levels C3-C6. An additional goal of this work was to compare the instrumented computational model to our multi-specimen experimental findings to ensure similar trends in response to the surgical procedures. Model predictions indicate that mobility was retained following open and double door laminoplasty with a 5.4% and 20% increase in flexion, respectively, compared to the intact state. Laminectomy resulted in 57% increase in flexion as compared to the intact state, creating a concern for eventual kyphosis--a known risk/complication of multi-level laminectomy in the absence of fusion. Increased disc stresses were observed at the altered and adjacent segments post-laminectomy in flexion.

The role of 3D plating system in mandibular fractures: A prospective study

Aim:

The aim of our study was to evaluate the advantages and disadvantages of 3D plating system in the treatment of mandibular fractures.

Patients and Methods:

20 mandibular fractures in 18 patients at various anatomic locations and were treated by open reduction and internal fixation using 3D plates. All patients were followed at regular intervals of 4^th, 8^th and 12^th weeks respectively. Patients were assessed post-operatively for lingual splay and occlusal stability. The incidence of neurosensory deficit, infection, masticatory difficulty, non-union, malunion was also assessed.

Results:

A significant reduction in lingual splay (72.2%) and occlusal stability (72.2%) was seen. The overall complication rate was (16.6%) which included two patients who developed post-operative paresthesia of lip, three patients had infection and two cases of masticatory difficulty which later subsided by higher antibiotics and 4 weeks of MMF. No evidence of non-union, malunion was noted.

Conclusion:

A single 3D 2 mm miniplate with 2 mm × 8 mm screws is a reliable and an effective treatment modality for mandibular fracture.

A comparative analysis of the efficacy of cortical screws as lag screws and miniplates for internal fixation of mandibular symphyseal region fractures: a randomized prospective study

The management of facial trauma is one of the most rewarding and demanding aspects of oral and maxillofacial surgery. Being the most prominent mobile bone of the facial skeleton, mandible fracture occurs more frequently than any other fracture. In this study, open reduction and internal fixation was performed for isolated mandibular symphyseal region fractures using cortical screws (as lag screws) in 40 patients and using miniplates in 40 patients. Clinical and radiological evaluations were made at 6 months postoperatively. Primary stability of fracture segments, postoperative swelling, restricted lip mobility, infection, wound dehiscence, implant removal, and mal-union or non-union of fracture segments was evaluated. Primary stability was achieved in 100% of cases treated with cortical screws, whereas for patients treated with miniplates, 97.5% attained primary stability, while one case (2.5%) showed persistent clinical mobility. Postoperative complications were noted in 13 (16.25%) of the total 80 patients. The duration of postoperative swelling was less in patients treated with cortical screws compared to patients treated with miniplates. It is concluded that cortical screw fixation is an effective procedure for the treatment of symphyseal region fractures, but the procedure is somewhat technically sensitive.

An analysis of postoperative complications and efficacy of 3-D miniplates in fixation of mandibular fractures

BACKGROUND

Recently, various modifications in transorally placed miniplates for direct fixation of the mandibular fracture are gaining popularity. The modifications have various advantages like more rigidity, less foreign material, less time in application, etc. Among the various modifications of miniplates, three-dimensional (3-D) plating system is also gaining popularity. Thus, in the present study, we tried to evaluate the efficacy and postoperative complications of 3-D titanium miniplates in the treatment of mandibular fractures.

MATERIALS AND METHODS

A prospective study was conducted on 40 patients with non-comminuted mandibular fractures. They were treated using a 2-mm 3-D titanium miniplate through intraoral approach. All patients were systematically monitored 6 months postoperatively. Outcome parameters like infection, hardware failure, wound dehiscence, sensory disturbance of the inferior alveolar nerve, occlusion, and 3-D plate stability were recorded. The statistical tests used in study were mean, standard deviation, and Chi-square test. P values less than 0.05 were considered significant and values less than 0.001 were considered very highly significant.

RESULTS

Two patients had a postoperative infection with no consequences. All patients had normal sensory function 3 months after surgery. Plate fracture had not occurred in any patient. Occlusal was normal and wound dehiscence was not reported. 3-D plate was stable in all the patients.

CONCLUSIONS

It was seen that 3-D titanium miniplates were effective in the treatment of mandibular fractures and overall complication rates were lesser. In symphysis and parasymphysis regions, 3-D plating system uses lesser foreign material than the conventional miniplates using Champy's principle.