下颌骨骨折的小型钛板坚固内固定技术

目的 评估下颌骨骨折小型钛板坚固内固定的可靠性及其效果,探讨其优缺点。方法 ３１例患者共５１例下颌骨骨折行小型钛板复位坚固内固定。复位技术及小型钛板的固定位置均参考Ｃｈａｍｐｙ方法。结果 ３１例患者术后伤口均无感染,２例局部缝线裂开,其余均Ⅰ期愈合。２９例恢复到术前咬合关系,仅２例出现局部咬合关系不良。术后张口度≥３７ｍｍ者２８例。Ｘ线复查未见骨愈合不良或假关节形成。结论 下颌骨骨折的小型钛板坚固     

下颌骨骨折坚固内固定61例临床分析

目的 探讨下颌骨骨折小钛板坚固内固定的临床效果。方法 61例83处下颌骨骨折中有77处行切开复位小钛板坚固内固定术。结果 61例中2例局部伤口裂开，其余均1期愈合。54例术后面形及咬合关系均恢复满意，7例经颌间牵引、调牙台，术后1个月基本恢复正常咬合关系。56例术后张口度≥37mm，全部病例3个月后复查X线片骨折愈合良好。结论 下颌骨骨折小钛板坚固内固定效果可靠，较传统的颌间结扎固定和钢丝结扎内固定效果好。     

Evaluation of condylar position in anterior mandibular fractures using 3 dimensional miniplate osteosynthesis versus conventional miniplates: Randomized clinical trial

To compare clinically and radiographically between the 3-D plates and the conventional two Champy's miniplates in the treatment of anterior mandibular fractures.It is a randomized clinical and radiographic comparative study between 2 equal groups of patients with isolated anterior mandibular fractures. Open reduction and internal rigid fixation was accomplished in the study group using 3D miniplates fixation while in the control group using the two Champy's miniplates.The 3D miniplate osteosynthesis consumed less operative time than the two miniplates osteosynthesis. Independent t-test revealed that the difference between the 2 groups was 8.4 ± 3.11 min. This difference was statistically significant (p=0.012).Occlusion was slightly disturbed in two patients in the study group in comparison to three patients in the control group. The difference between the 2 groups was not statistically significant (p=0.62).None of the cases of both groups showed mobility between the reduced and fixed fractured segments, immediately post-operatively and at the end of follow-up intervals.The 3D miniplate osteosynthesis (study group) recorded less intercondylar distance than two miniplates osteosynthesis (control group) immediately post-operatively and after 3 months. Independent t-test revealed that the difference between the 2 groups was not statistically significant, immediately postoperative (p=0.322) and after 3 months (p=0.263).Pre-operatively to 3 months postoperatively, the 3D miniplate osteosynthesis (study group) recorded a lower median percent increase in the intercondylar distance than the two miniplates osteosynthesis (control group). The difference between the 2 groups was not statistically significant (p=0.917).Regarding the intercondylar angle, the3D miniplate osteosynthesis (study group) recorded higher intercondylar angle than the two miniplates osteosynthesis (control group) immediately post-operative (p=0.333) and after 3 months (p=0.255). Independent t-test revealed that the difference between the 2 groups was not statistically significant.The 3-Dimensional strut miniplates should be considered an alternative for internal rigid fixation of anterior mandibular fractures for their ease of adaptation and insertion, while providing the advantage of reduced operative time compared to the conventional two Champy's miniplates.     

Re-attachment of anterior fractured teeth: fracture strength using different materials

This study compared the fracture strength of two different techniques (bonded only and buccal chamfer) and different material combinations used to reattach tooth fragments. An axial load applied to the buccal area fractured 110 sound permanent lower incisors. Fifty teeth were designated for the bonded only group (no additional preparation) and 50 teeth were designated for a buccal chamfer group. For each group teeth were subdivided into five subgroups (n = 10) according to the restorative material combinations used: 1) adhesive system (A); 2) A + light cured luting cement; 3) A + dual cured luting cement; 4) A + flowable resin and 5) A + hybrid resin. In a control group (resin composite build-up), in the remaining 10 teeth, the crown portion was rebuilt with adhesive and resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedures for all groups was expressed as a percentage of the original fracture strength and the results were analyzed by two-way ANOVA and Tukey's test for pair-wise comparison. The interaction and the material factor were not statistically significant (p = 0.140 and p = 0.943, respectively). The chamfer group showed higher fracture strength recovery (67.9%) than the bonded only group (41.1%), and both were statistically lower than the resin composite build-up (103.2%). It was concluded that the material used to reattach the fragment is less important than the chosen technique.     

Re-attachment of anterior fractured teeth: fracture strength using different techniques

Fracture of anterior teeth by trauma is a common problem in children and teenagers. Complex metal-ceramic crowns with considerable loss of remaining sound structure are no longer necessary due to adhesive techniques, such as composite restorations and re-attachment techniques. This study compared the fracture strength of sound and restored anterior teeth using a resin composite and four re-attachment techniques. A "one bottle" adhesive system (One-Step, BISCO) and a dual cure resin cement (Duo-Link, BISCO) were applied. Thirty-five sound permanent lower central incisors were fractured by an axial load applied to the buccal area and randomly divided into five groups. The teeth were restored as follows: 1) bonded only = just bonding the fragment; 2) chamfer-group = after bonding, a chamfer was prepared on the enamel at the bonding line and filled with composite; 3) overcontour group = after bonding, a thin composite overcontour was applied on the buccal surface around the fracture line; 4) internal dentinal groove = before bonding, an internal groove was made and filled with a resin composite; 5) resin composite group = after a bevel preparation on the enamel edge, the adhesive system was applied and the fractured part of the teeth rebuilt by resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedure was expressed as a percentage of the original fracture strength and the results analyzed by Kruskal-Wallis statistical analysis. The mean percentages of fracture strength were: Group 1: 37.09%, Group 2: 60.62%, Group 3: 97.2%, Group 4: 90.54% and Group 5: 95.8%. It was concluded that the re-attachment techniques used in Groups 3 and 4, as well as the composite restored group (Group 5), were statistically similar and reached the highest fracture resistance, similar to the fracture resistance of sound teeth.     

Classifications of methods for osteosynthesis in mandibular fractures and of the devices for its performance

The authors review the known classifications of methods and devices for direct and direct osteosynthesis for the treatment of mandibular fractures. They suggest a classification of their own, including all current osteosynthesis methods and auxiliary devices and instruments used in osteosynthesis.     

Comparative evaluation of ten different condylar base fracture osteosynthesis techniques

The aim of this study on the mandibles of minipigs was to compare the biomechanical stability of different methods of osteosynthesis that are used in the operative treatment of fractures of the base of the condyle. Ten different systems of osteosynthesis were used to fix 164 fractures, which were tested by a two-point bending test after repositioning and fixing. This stress test was applied in four directions: lateral to medial, anterior to distal, distal to anterior, and medial to lateral. The Eckelt lag screw, one or two 2.0 mm miniplates, one miniplate with bar (KLS Martin), minicompression plates (Medicon), zygoma compression plates (Medartis), condylus fracture plates (Medartis), square 4-hole plates (KLS Martin), and either one or two resorbable 4-hole miniplates (Resorb-X, Martin) were used for osteosynthesis. A total of 164 tests were done using a universal test machine that measured forces until the osteosynthesis failed. Advantages in mechanical load capacity were also measured for the Eckelt lag screw when force was applied from medial to lateral. Fixation with one resorbable miniplate was not functionally stable. Irrespective of the direction of force applied, two miniplates were the most stable technique. There were pronounced differences depending on the direction of force applied. The results suggest that treatment with a single resorbable miniplate is not functionally stable.     

Miniplate osteosynthesis of infected mandibular fractures

Miniplate osteosynthesis in cases of infected mandibular fractures in patients with reduced healing capacity and lack of cooperation has been evaluated. Thirty seven patients with 42 potentially infected mandibular fractures were treated by internal fixation with miniplates. Healing occurred in all cases. Postoperative infection was noted in 9 patients. Aspects of healing and indications for the method are discussed.     

Small plate osteosynthesis of mandibular fractures

Small plate osteosynthesis has been evaluated by comparing 50 successive cases of mandibular fracture treated by this technique alone with 50 successive cases of mandibular fracture treated by intermaxillary fixation. The plates show considerable advantages over other forms of fixation in that they are small, malleable and easy to insert. Furthermore, they achieve a high degree of stability. The rate of recovery of normal jaw function and normal body weight is significantly greater than with intermaxillary fixation.     

Compression osteosynthesis of mandibular fractures: a retrospective study

A retrospective study was performed on 35 patients who had a total of 43 fractures of the mandible that had been treated using bone plates for internal fixation. The data suggest that the procedure has a high degree of success and low rate of morbidity.     

Biodegradable osteosynthesis in mandibular advancement: a pilot study

In this pilot study four patients are presented who underwent bilateral sagittal split osteotomies of the mandibular ramus for mandibular advancement. Biodegradable osteosyntheses were used for internal fixation. All patients were from the same dentofacial category: mandibular retrognathia with a low to normal mandibular plane angle. In two patients cylindrical self-reinforced polyglycolide (PGA) rods were used for internal fixation of the osteotomy segments. Long-term evaluation showed a complete ossification at the sites of biodegradable rods. In two other patients, self-reinforced poly(L-lactide) (PLLA) screws with a diameter of 2 mm were used to stabilize osteotomy segments. The two different techniques of osteosynthesis and the problems encountered are discussed.     

下颌骨骨折诊治的临床探讨

目的：寻求一种可靠的下颌骨骨折诊断手段及符合生理的有效治疗方法。方法：在不同时期,分别对203例患者选用5种不同方法的治疗,并结合临床给予正确评价。结果：203例下颌骨骨折中,优良率为92．6％;差率为7．4％。结论：通过五种治疗方法的临床探讨及疗效评价,微型钢板内固定治疗下颌骨骨折是一种较理想的方法,符合动静结合的生理要求。     

Complications in bilateral mandibular distraction osteogenesis using internal devices

OBJECTIVE: We sought to evaluate the possibility of distraction osteogenesis as an alternative to conventional bilateral sagittal split osteotomy. Complications (intraoperative, intradistraction, and postdistraction) were evaluated retrospectively. STUDY DESIGN: Seventy consecutive patients (40 males and 30 females, 11.2-37.3 years old; mean, 14.2 years) underwent distraction osteogenesis to lengthen the mandible. The surgical procedure was carried out with the patient under general anesthesia. After the osteotomy was performed, 2 intraoral monodirectional distraction devices were placed on the mandibular cortex in the third molar region. The rate of distraction was 1 mm/day. The different complications encountered during all phases of the distraction procedure were recorded. RESULTS: A total of 28 complications (40%) were recorded. In 10 patients (14.3%), the complications were technique- or device-related, or both, and occurred early in the learning period. Five patients (7.1%) had infection occur, and 3 patients (4.3%) had prolonged sensory loss in the distribution of the alveolar nerve. Severe complications occurred in 6 patients (8.6%). Rehospitalization was necessary in 5 patients (7.1%), 4 of whom (5.7% of the series) required further surgery under general anesthesia. CONCLUSION: Distraction osteogenesis can be considered a safe and predictable procedure for lengthening the mandible, with a low incidence of major complications. The infection rate and the incidence of damage to the inferior alveolar nerve (2.1%) are low. Compliance of both patients and parents during the whole treatment period is of the utmost importance.     

下颌骨前段骨折伴发髁突骨折的诊治现状

下颌骨前段骨折（包括正中联合及旁正中的骨折）是下颌骨骨折最常见的类型之一,且常常与髁突骨折同时发生。受解剖因素的影响,这类骨折一旦处理不当容易出现包括面下部增宽,咬合紊乱,甚至关节强直等多种并发症。本文就这类骨折的特点、常见并发症、诊断方法以及治疗过程中应注意的问题作一综述。