Comparative Analysis of Osteosynthesis of Mandibular Anterior Fractures Following Open Reduction Using ‘Stainless Steel Lag Screws and Mini Plates’

Introduction

The purpose of this study was to compare the outcome of open treatment of mandibular fracture (symphysis or parasymphysis) using lag screw or mini plate clinically as well as radiologically in young (age range 12–45 years) and healthy individuals of poor socioeconomic status.

Method

This prospective study was conducted on 30 patients diagnosed as 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 15 patients. Group B: Two 2.5 mm stainless steel mini plates were placed in 15 patients for the fixation of fractures. Subsequent follow up was done on 2nd, 4th, 6th and 8th week postoperatively. During every follow up patient was assessed clinically for infection, malocclusion, loosening of plate/screw, sensory disturbance, plate fracture, malunion/non-union, devitalisation of associated dentoalveolar segment and masticatory efficiency. Radiographs were taken if necessary and patients were further assessed for any complaint. Pain was objectively measured using a visual analogue scale, bite force was measured using a bite force transducer at biweekly interval. The data collected was subjected to unpaired t test and paired t test for statistical analysis.

Results

During follow up period a significant improvement in bite force was present in both the groups, with more improvement seen in the lag screw group (p < 0.01). There was a significant pain reduction present in the lag screw group (p < 0.01) and also masticatory efficiency showed a steadier improvement in lag screw group while mini plate group patients showed a tendency to masticate only food items of medium hard consistency.

Conclusion

The sample size is small to conclude lag screws are better than mini plates but the result of our study provides a basis for further studies done to conclude that the application of LAG SCREW is an effective, inexpensive, quick treatment modality to accelerate healing of fresh, displaced mandibular anterior fracture.     

Use of Miniplates in Parasymphysis Fractures : A Survey Conducted Among Oral and Maxillofacial Surgeons of India

Aim of the study was to find out the number of miniplates used by Indian Oral and Maxillofacial Surgeons for parasymphysis fractures. A survey was done among Oral and Maxillofacial Surgeons of India at the 34th annual meeting of Association of Oral and Maxillofacial Surgeons of India. Four questions were given to each individual to find out their opinion regarding use of miniplates in parasymphysis fractures. Eighty-eight per cent of Indian surgeons were in favour of using intra-operative or post-operative intermaxillary fixation. Thirty-eight per cent responded in favour of using single miniplate for parasymphysis fracture instead of using two miniplates. Fifty-four per cent maxillofacial surgeons use various modifications depending on different conditions. Forty-two per cent of maxillofacial surgeons accepted that lower arch bar can be used as a tension band. Use of miniplates for the treatment of parasymphysis fracture varies from centre to centre and from surgeon to surgeon. Though miniplates are best used following Champy’s principle, still many surgeons use single miniplate. Arch bars placed for intermaxillary fixation can be used as a tension band, again eliminating the need for upper plate.     

Comparative biomechanical study on three miniplates osteosynthesis systems for stabilisation of low condylar fractures of the mandible

Open reduction and fixation of low condylar fractures of the mandible can be achieved by many osteosynthesis systems that differ in size, shape, and site of placement according to the surgical approach. We investigated the maximum load and rigidity of 4 osteosynthesis systems: the standard double 4-hole straight miniplates, the inverted y-miniplate (with and without self-drilling screws), and the TriLock Delta condyle trauma plate. The standard double 4-hole straight miniplate osteosynthesis achieved the best fixation and resistance in view of a mean (SD) maximum load of 539.8 (100.2) N, followed by the inverted y-miniplate with the self-drilling screws (246.5 (23.8) N), the inverted y-miniplate with standard screws (242.4 (27.2) N), and finally the TriLock Delta plate (167.4 (39.2) N). Analysis of the slope of the force–displacement diagram from 80 N to 100 N in each group showed that the TriLock Delta miniplate had the highest values for rigidity (17.3 (5.1) N/μm), followed by the inverted y-miniplate groups with self-drilling screws (14.1 (6.4) N/μm), and with standard screws (12.6 (2.5) N/μm). The double 4-hole straight miniplate osteosynthesis had the lowest rigidity (8.7 1.4) N/μm). Despite the significant difference in the maximum load between the double 4-hole miniplates and other investigated osteosynthesis patterns, all groups had sufficient load for the fixation of low condylar fractures of the mandible when postoperative bite forces and the slowly increasing voluntary clenching during healing were considered.     

Does fixation method affects temporomandibular joints after mandibular advancement?

Purpose

Sagittal split ramus osteotomy (SSRO) is a standard procedure in which miniplates and screws are used to achieve stabilization. Although the titanium plate and screw fixation system is stable, resorbable fixation systems are also used. There is currently no consensus on the ideal fixation technique for SSRO procedures and its effect on the condyle. We aimed to evaluate the stress distribution on temporomandibular joints (TMJ).

The Gillies procedure in the treatment of zygomatic fractures and dislocations

This retrospective study demonstrates the late results of 46 patients with an isolated zygomatic fracture and/or dislocation, who have been treated with the Gillies procedure alone or with stabilizing transosseous wires. The post-reduction stable fractures (78%) treated solely with the Gillies procedure have given satisfactory symmetric results in 72% of the patients. The stabilized zygomatic complexes (22%) could, due to the pull of the m. masseter, still rotate around the axis of stabilization and this causes asymmetry in 60% of the cases. Unstable fractures and dislocations, however, need an open reduction and an adequate stabilization with miniplates at the frontozygomatic suture and infraorbital rim. The amount of dislocation on X-ray will not predict the peroperative instability and the late asymmetry of the treated zygoma fracture.     

Comparison between 3D delta plate and conventional miniplate in treatment of condylar fracture: A randomised clinical trial

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 3^rd-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.     

Versatility of Titanium 3D Plate in Comparison with Conventional Titanium Miniplate Fixation for the Management of Mandibular Fracture

Background

In the present study, 20 patients with mandibular fracture were included to evaluate the versatility of titanium 3D plate in comparison with conventional titanium miniplate fixation.

Methods

The patients were alternatively allocated to either the 3D plate group or Miniplate group. The patients were evaluated for the clinical assessment of mobility after fixation, pre and post-surgical occlusal relationship, adequacy of reduction on post operative radiograph and any post surgical complications.

Results

All 25 fractures in 20 patients were found to be adequately fixed when checked intra-operatively. No post-operative IMF was required in either of the groups. The mean radiographic score at post operative time interval in Miniplate group was found to be 2.80 ± 0.42 and in 3D Plate was found to be 2.90 ± 0.32. The mean radiographic score at 3 months time interval in Miniplate group was found to be 2.70 ± 0.48 and in 3D Plate was found to be 2.70 ± 0.48. Radiolucency at 3 months period was found in 1 patient (10%) in the miniplate group and it was not found in any patients in the 3D plate group. None of the patients in both the groups had complications of non-union or mal-union. In miniplate group, 2 patients (20%) had infections and in 3D plate group 1 patient (10%) had infection. 3 patients in miniplate group had occlusal discrepancies (30%) and 1 patient in 3D plate group had occlusal discrepancies (10%). Overall, complications were found in 6 patients (60%) in miniplate group and 2 patients (20%) in 3D plate group. The data when compared was statistically significant (P < 0.05).

Conclusion

The 3D plating system was found to be advantageous over conventional miniplates. It uses lesser foreign material, reduces the operation time and overall cost of the treatment. Thus 3D plate can be used as an alternative to conventional miniplates. The system is reliable and effective treatment modality for mandibular fractures.     

Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: A randomized controlled trial

Objectives:To evaluate the use of direct miniplate anchorage in conjunction with the Forsus Fatigue Resistant Device (FFRD) in treatment of skeletal Class II malocclusion.Materials and Methods:Forty-eight females with skeletal Class II were randomly allocated to the Forsus plus miniplates (FMP) group (16 patients, age 12.5 ± 0.9 years), Forsus alone (FFRD; 16 patients, age 12.1 ± 0.9 years), or the untreated control group (16 subjects, age 12.1 ± 0.9 years). After leveling and alignment, miniplates were inserted in the mandibular symphysis in the FMP group. The FFRD was inserted directly on the miniplates in the FMP group and onto the mandibular archwires in the FFRD group. The appliances were removed after reaching an edge-to-edge incisor relationship.Results:Data from 46 subjects were analyzed. The effective mandibular length significantly increased in the FMP group only (4.05 ± 0.78). The mandibular incisors showed a significant proclination in the FFRD group (9.17 ± 2.42) and a nonsignificant retroclination in the FMP group (−1.49 ± 4.70). The failure rate of the miniplates was reported to be 13.3%.Conclusions:The use of miniplates with the FFRD was successful in increasing the effective mandibular length in Class II malocclusion subjects in the short term. The miniplate-anchored FFRD eliminated the unfavorable mandibular incisor proclination in contrast to the conventional FFRD.     

Comparison of lag screws and double Y-shaped miniplates in the fixation of anterior mandibular fractures

BACKGROUNDMandibular fractures constitute about 80.79% of maxillofacial injuries in Alexandria University, either as isolated mandibular fractures or as a part of panfacial fractures. The combination of symphyseal and parasymphyseal fractures represent 47.09% of the total mandibular fractures.AIMTo compare the effectiveness of lag screws vs double Y-shaped miniplates in the fixation of anterior mandibular fractures.METHODSThis study is a prospective randomized controlled clinical trial, performed on sixteen patients with anterior mandibular fractures. Patients were divided equally into two groups, each consisting of eight patients. Group 1: Underwent open reduction and internal fixation using two lag screws. Group 2: Underwent open reduction and internal fixation using double Y-shaped plates. The following parameters were assessed: operating time in minutes, pain using a visual analog scale, edema, surgical wound healing for signs and symptoms of infection, occlusion status and stability, maximal mouth opening, and sensory nerve function. Cone beam computed tomography was performed at 3 and 6 mo to measure bone density and assess the progression of fracture healing.RESULTSThe study included 13 males (81.3%) and 3 females (18.8%) aged 26 to 45 years (mean age was 35.69 ± 6.01 years). The cause of trauma was road traffic accidents in 10 patients (62.5%), interpersonal violence in 3 patients (18.8%) and other causes in 3 patients (18.8%). The fractures comprised 10 parasymphyseal fractures (62.5%) and 6 symphyseal fractures (37.5%). The values of all parameters were comparable in both groups with no statistically significant difference except for the mean bone density at 3 mo postoperatively which was 946.38 ± 66.29 in group 1 and 830.36 ± 95.53 in group 2 (P = 0.015).CONCLUSIONBoth lag screws and double Y-shaped miniplates provide favorable means of fixation for mandibular fractures in the anterior region. Fractures fixed with lag screws show greater mean bone density at 3 mo post-operation, indicative of higher primary stability and faster early bone healing. Further studies with larger sample sizes are required to verify these conclusions.     

Mandibular Osteosynthesis: A Comparative Evaluation of Two Different Fixation Systems Using 2.0 mm Titanium Miniplates &; 3-D Locking Plates

Purpose  

To compare & evaluate postoperative complications & treatment outcome in mandibular fracture fixation using 2.0 mm titanium miniplates & 3-D locking plates.