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1.
Open reduction and internal fixation (ORIF) of subcondylar fractures of the mandible is a widely accepted treatment concept aimed at reconstruction of the vertical height of the mandibular ramus and restoration of occlusion.Here, we describe new instruments designed for ORIF via an intraoral approach using a single inverted y-miniplate. The special design allows sufficient visualisation of the fracture site and enables the establishment of a standardised procedure for the treatment of both dislocated and non-dislocated fractures. Several manoeuvres are described and some clinical cases are presented.Challenges frequently met during ORIF of subcondylar fractures via the intraoral approach such as limited exposure and visual control of fracture site can be overcome using the instruments-kit presented, which help to optimise this treatment.  相似文献   

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The aim of the study was to conduct a randomized clinical trial comparing the efficacy of standard non-compression miniplate and 3-dimensional (3D) titanium plate in the open reduction internal fixation (ORIF) of the mandibular condylar fractures.Patients who underwent open reduction of mandibular condylar fracture were recruited for the study. The patients satisfying the inclusion criteria were randomly assigned to two groups in a 1:1 ratio. Group A comprised patients treated using conventional miniplates, and Group B comprised patients treated using 3D Delta Plate. Informed consent was provided. All the patients underwent ORIF under GA via retromandibular approach.The sample size was set at 20 participants, with 10 participants in each group who were randomly allocated. Our study showed that patients in Group A had a significant statistical difference operating time (141.20 ± 2.59 min) than that of Group B (117.2 ± 9.63 min). Mouth opening was significantly greater in the 3rd-month follow-up in Group B (mean = 42.40 ± 1.82) compared to Group A (mean = 35.80 ± 1.30). Biting efficiency in Group B was observed to be clinically and statistically better compared to Group A (P = 0.012). Wound dehiscence was managed efficiently by judicious use of antibiotics and wounds were free of any signs of infections or discharge in the consecutive follow-ups. No plate removal was required in either group.Patients treated with 3D delta plates have superior outcomes with regard to operation time, mouth opening, and biting efficiency compared with miniplates. Hence, it can be concluded that the triangular shape of the 3D Delta plate allows the stress distribution to be superior and multidimensional, leading to better post-operative stability, faster healing, and reduced complications.  相似文献   

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PurposeThe purpose of this study was to investigate the effect of resorbable plate fixation in association with dental arch stabilization in the treatment of displaced mandibular fractures in children.Patients and methodsThirteen children (5 girls and 8 boys, age range 2 years 5 months to 12 years 2 months) with displaced mandibular fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using resorbable plates and monocortical screws placed at the lower border of the mandible. At the same time, an arch bar or orthodontic wire splint was anchored using stainless steel wires or resin on the teeth to stabilize the whole mandibular dental arch. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mandible movement, and mandible growth.ResultsPostoperatively, all patients achieved uneventful healing; premorbid occlusion restoration and wound healing were achieved, along with unimpaired function and normal growth and development of the mandible. Complications such as damage to tooth buds, infection, malunion, and nonunion were not encountered in these patients.ConclusionResorbable plates use in association with dental arch stabilization can provide good stabilization for mandibular fractures and is a promising approach for the treatment of displaced mandibular fractures in children.  相似文献   

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The incidence of diacapitular (intracapsular) fractures of the mandibular condyle has increased in recent years, but their treatment remains inadequate, particularly of type B fractures. To evaluate and compare outcomes of open and closed treatments we created a sheep model of a type B fracture through an osteotomy. Eight sheep were randomly divided into two groups of four each to be given closed treatment or open reduction and internal fixation (ORIF) and were evaluated by veterinary and radiological examinations. Compared with before the osteotomy, there were significant reductions in maximum mouth opening (MMO) and left movement in the closed group, but no significant differences in the range of jaw movements in the ORIF group after 12 weeks of treatment. The two radiological scores that indicated the degree of osteoarthrotic changes and ankylosis of the temporomandibular joint (TMJ) in the ORIF group were significantly lower than those in the closed group. Anatomical observation confirmed the pathological changes in the right TMJ in the closed group and adaptive changes in the ORIF group. We conclude that ORIF is more efficient than closed treatment in restoring the function and shape of the TMJ to after a type B diacapitular condylar fracture.  相似文献   

5.
PurposeThis study compared the clinical success rates of mandibular fracture treatment using reconstruction plates or miniplates and clarified the selection criteria for reconstruction plates.MethodsAll patients who had surgically-treated mandible fractures from 2008 to 2017 with sufficient follow-up were retrospectively analyzed for information about the fracture condition, treatment, and outcomes.ResultsA total of 126 surgically-treated mandible fractures without mandibular condylar fracture in 105 patients (76 male, 29 female) were included. Reconstruction plates were used in 32 fractures with very good postoperative occlusal function. Four cases with complications requiring reoperation were treated using only miniplates. Variables that were statistically associated with follow-up surgery included simple versus comminuted mandible fracture, and the absence of teeth that could be used for intermaxillary fixation (P < 0.05). In the miniplates treatment for comminuted fracture, there was a significant difference in the treatment outcome depending on the number of free bone-fragments and the presence of bone-fragments requiring removal within 1 cm (P < 0.05).ConclusionReconstruction plates provided better treatment outcomes for comminuted fractures and fractures without teeth. Selecting a reconstruction plate that is capable of sufficiently overloading is important in comminuted fractures with multiple free bone-fragments and bone-fragments requiring removal.  相似文献   

6.
陈伟  房睿 《上海口腔医学》2020,29(3):333-336
目的 研究微型钛板内固定术在治疗下颌骨粉碎性骨折中的应用价值。方法 选择2017年3月—2018年2月沈阳市口腔医院收治的下颌骨粉碎性骨折患者21例。所有患者均给予微型钛板坚固内固定,分别在患者下颌骨下缘、上缘、外皮质中部进行固定。观察术后骨折愈合情况及不良反应发生情况。结果 术后3个月内,所有患者均达到骨性愈合,平均时长为(1.53±0.36)个月。21例患者中,6例(28.57%)出现轻微咬合不正,1例(4.76%)发生局部感染,未出现微型钛板断裂、持续疼痛、开口受限、牙损伤、面神经损伤及骨不连患者。结论 微型钛板内固定术适用于无骨缺损的下颌骨粉碎性骨折患者,具有术后骨折愈合良好、时间短、不良反应少的优点。  相似文献   

7.
Our aim was to compare the efficacy and outcome of customised, titanium, CRB (Chandrashekhar Rushiji Bande), omega miniplates with those of conventional titanium miniplates in the management of parasymphyseal fractures of the mandible, with or without involvement of the mental nerve, after clinical and radiographic evaluation. A total of 252 parasymphyseal fractures in 200 patients were selected for the study over the period of seven years (January 2010–January2017) and divided randomly into two groups. The first group included 126 fractures treated with two conventional titanium miniplates (conventional group) and the second 126 fractures treated with one customised, titanium, CRB, omega miniplate (customised group). All operations were done by the same surgeon. Duration of operation (from placement of incision to closure of the defect) was recorded. Postoperative paraesthesia, infection, and acceptability of the plate to patients were also recorded. Postoperative healing was evaluated radiologically at one week and six months postoperatively. Operations were significantly shorter, and significantly fewer patients developed paraesthesia or infection, in the customised group. These patients were also happier with their miniplates, and had good radiological bony healing. In conclusion, a single customised, titanium, CRB, omega miniplate is an effective and economical alternative to two conventional titanium miniplates in the management of parasymphysis fractures of the mandible.  相似文献   

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The aim of this study was to investigate and compare the clinical and radiographic bone gain in guided bone regeneration with titanium mesh, for four different advancement techniques: periosteal releasing incision (PRI), double flap incision (DFI), modified periosteal releasing incision (MPRI), and coronally advanced lingual flap (CALF). Forty patients with a partially edentulous mandible were allocated randomly to four study groups (PRI, DFI, MPRI, CALF; 10 patients in each). Clinical bone gain (primary outcome) and radiographic bone gain were evaluated. In addition, correlations between study variables (clinical and radiographic bone gain, flap advancement, mesh exposure area and percentage exposure, pain, and swelling) were explored. CALF exhibited the highest mean clinical bone gain (4.12 ± 1.37 mm) and PRI the lowest (2.60 ± 1.36 mm); the mean clinical bone gain differed significantly among the groups (P < 0.001). The highest mean radiographic bone gain was seen in the CALF group (3.54 ± 1.65 mm) and the lowest in the PRI group (2.06 ± 1.11 mm); the mean radiographic bone gain also differed significantly among the groups (P < 0.001). The correlation analysis revealed positive correlations between flap advancement and radiographic bone gain (P = 0.003) and between swelling and pain (P = 0.007). An inverse correlation was found between flap advancement and swelling (P = 0.049), mesh exposure area and clinical bone gain (P = 0.022), and mesh exposure percentage and clinical bone gain (P = 0.017). In summary, the highest clinical and radiographic bone gain was observed for CALF, while the lowest was observed for PRI.  相似文献   

10.
Panfacial fractures represent a challenge, even for experienced maxillofacial surgeons, because all references for reconstructing the facial skeleton are missing. Logical reconstructive sequencing based on a clear understanding of the correlation between projection and the widths and lengths of facial subunits should enable the surgeon to achieve correct realignment of the bony framework of the face and to prevent late deformity and functional impairment. Reconstruction is particularly challenging in patients presenting with concomitant fractures at the Le Fort I level and affecting the palate, condyles, and mandibular symphysis. In cases without bony loss and sufficient dentition, we believe that accurate fixation of the mandibular symphysis can represent the starting point of a reconstructive sequence that allows successful reconstruction at the Le Fort I level. Two patients were treated in our department by reconstruction starting in the occlusal area through repair of the mandibular symphysis. Both patients considered the postoperative facial shape and profile to be satisfactory and comparable to the pre-injury situation.  相似文献   

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Objectives: To test whether or not transmucosal healing at two‐piece implants is as successful as submerged placement regarding crestal bone levels and patient satisfaction. Material and methods: Adults requiring implants in the anterior maxilla or mandible in regions 21–25, 11–15, 31–35 or 41–45 (WHO) were recruited for this randomized, controlled multi‐center clinical trial of a 5‐year duration. Randomization was performed at implantation allowing for either submerged or transmucosal healing. Final reconstructions were seated 6 months after implantation. Radiographic interproximal crestal bone levels and peri‐implant soft tissue parameters were measured at implant placement (IP) (baseline), 6 and 12 months. Patient satisfaction was assessed by a questionnaire. A two‐sided t‐test (80% power, significance level α=0.05) was performed on bone‐level changes at 6 and 12 months. Results: One hundred and twenty‐seven subjects were included in the 12‐month analysis (submerged [S]: 52.5%, transmucosal [TM]: 47.2%). From IP to 6 months, the change in the crestal bone level was ?0.32 mm (P<0.001) for the S group and ?0.29 mm (P<0.001) for the TM group. From IP to 12 months, bone‐level changes were statistically significant in both groups (S ?0.47 mm, P<0.001; TM ?0.48 mm, P<0.001). The mean differences of change in the bone levels between the two groups were not statistically significant at either time point, indicating the equivalence of both procedures. For both groups, very good results were obtained for soft tissue parameters and for patient satisfaction. Conclusions: Transmucosal healing of two‐piece implants is as successful as the submerged healing mode with respect to tissue integration and patient satisfaction within the first 12 months after IP. To cite this article:
Hämmerle CHF, Jung RE, Sanz M, Chen S, Martin WC, Jackowski J, Ivanoff CJ, Cordaro L, Ganeles J, Weingart D, Wiltfang J, Gahlert M. Submerged and transmucosal healing yield the same clinical outcomes with two‐piece implants in the anterior maxilla and mandible: interim 1‐year results of a randomized, controlled clinical trial.
Clin. Oral Impl. Res 23 , 2012; 211–219.
doi: 10.1111/j.1600‐0501.2011.02210.x  相似文献   

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Objectives: To compare two different techniques for vertical bone augmentation of the posterior mandible: bone blocs from the iliac crest vs. anorganic bovine bone blocs used as inlays.
Materials and methods: Ten partially edentulous patients having 5–7 mm of residual crestal height above the mandibular canal had their posterior mandibles randomly allocated to both interventions. After 4 months implants were inserted, and after 4 months, provisional prostheses were placed. Definitive prostheses were delivered after 4 months. Histomorphometry of samples trephined at implant placement, prosthesis and implant failures, any complication after loading and peri-implant marginal bone-level changes were assessed by masked assessors. All patients were followed up to 1 year after loading.
Results: Four months after bone augmentation, there was statistically significant more residual graft (between 10% and 13%) in the Bio-Oss group. There were no statistically significant differences in failures and complications. Two implants could not be placed in one patient augmented with autogenous bone because the graft failed whereas one implant and its prosthesis of the Bio-Oss group failed after loading. After implant loading only one complication (peri-implantitis) occurred at one implant of the autogenous bone group. In 16 months (from implant placement to 1 year after loading), both groups lost statistically significant amounts of peri-implant marginal bone: 0.82 mm in the autogenous bone group and 0.59 mm in the Bio-Oss group; however, there were no statistically significant differences between the groups.
Conclusions: Both procedures achieved good results, but the use of bovine blocs was less invasive and may be preferable than harvesting bone from the iliac crest.  相似文献   

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