Comparison Between Conventional Titanium Miniplates and Indigenous Detachable Custom made 3D Titanium Plates (VAS 3D Bone Plate) for Fixation of Mandibular Fracture in Mental Foramen Region: A Randomized Clinical Trial and Finite Element Analysis

Evaluation of accuracy of three-dimensional printing and three-dimensional miniplates in treatment of anterior mandibular fractures: a prospective clinical study

BACKGROUND

There are strong torsional forces acting on the anterior mandible fractures. Maxillofacial surgery makes extensive use of digital technology, and three-dimensional printing is now an integral element of the workflow in several areas of oral and maxillofacial surgery. Three-dimensional (3D) miniplates had been proposed by several researchers as a good option for mandibular fracture fixation. This clinical trial was conducted to evaluate the accuracy of virtual planning in anterior mandibular fixation by comparing postoperative outcomes with preoperative virtual planning and to evaluate bone healing by measuring bone density after using pre-bent 3D miniplates on a 3D model to complete a 3D workflow and to fix the mandible in 3D.

METHODS

15 Patients with anterior mandibular fractures were included in the study. All patients underwent computer tomography (CT) scan, and the data were imported into Mimics software. The unaffected healthy side was mirrored to the fractured side. Bone fixation three-dimensional plates were prebent and adapted on the model printed by the three-dimensional printing machine, submitted to sterilization, and were used for bone reduction and fixation. An immediate postoperative CT scan was taken to evaluate the accuracy of virtual planning and after 3 months for evaluation of bone healing.

RESULTS

Clinical observation revealed good stable occlusion, and there was no significant difference between the postoperative three-dimensional image of the mandible and the virtually reduced mandible in the preoperative plan, as there was no significant difference between the length and width between anatomical landmarks of the virtually reduced mandible and the postoperative plan (p > 0.05). The bone density measured by Hounsfield units (HU) measured on CT images after 3 months revealed good bone healing as compared to immediate postoperative values (P value < 0.05).

CONCLUSION

Digital workflow provides an accurate method for the reduction and fixation of anterior mandibular fractures. Also, 3D miniplates provide a good option for symphyseal and parasymphyseal fractures despite their limitations, as in some cases, like comminuted fractures and fractures in and around the mental foramen.

TRIAL REGISTRATION

This clinical trial was registered at Alexandria university, on 02/11/2021 under the registration number 0308 - 10/2021. All procedures involving human participants were performed in accordance with Research Ethics Committee, Faculty of Dentistry, Alexandria University under IRB No 00010556 and IORG No 0008839. The current study was retrospectively registered at ClinicalTrials.gov with the identification number NCT06898736 on 27/3/2025. However, all study protocols were predefined, with no deviations from the original methodology.

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review

Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.

Z-shaped Miniplates vs Conventional Miniplates for Fixation of Mandibular Parasymphyseal Fractures

AIM

The aim of this study was to evaluate a clinically and radiographically Z-shaped miniplate for the fixation of the parasymphyseal fractures.

PATIENTS AND METHODS

Twenty patients (10 patients in each group) who had parasymphseal mandibular fractures were randomly selected for this study. In this study, open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using two miniplates as group I, and open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using a newly designed Z-shaped miniplate as group II. Clinical and radiographic evaluations were made. Each patient was evaluated: (1) clinically evaluated preoperatively and postoperatively for operating time, ease of placement of the miniplate, and occlusion and (2) radiological: postoperative reduction of fracture was evaluated radiologically at 5-day, 1-month, 2-month, and 3-month intervals with orthopantomogram, and lingual splaying was evaluated by cone-beam computed tomography (CBCT) immediately postoperatively and at an interval of 3 months. The collected data were subjected to statistical analysis. Data analysis was performed by SPSS software, version 25 (SPSS Inc., PASW statistics for Windows version 25). Chicago: SPSS Inc.

RESULTS

There was a statistically significant difference (p < 0.001) between the mean intraoperative time. This indicates that group I had a longer time for fracture fixation than group II. Group I had a longer time elapsed for plate adaptation and definitive fixation than group II. Occlusion and reduction stability in both groups were similar. There was a statistically significant difference in postoperative lingual display control after 5 days and 3 months between the studied groups. This indicates that lingual display control in group II is better than in group I.

CONCLUSION

The Z-shaped miniplate is effective and provides three-dimensional stability for the fixation of parasymphyseal fractures, ease of use, easily adapted in cases of fractures near the mental nerve reduced operative time, and better control of lingual splaying than conventional miniplates.

CLINICAL SIGNIFICANCE

The newly designed Z-shaped miniplate is a valuable option for fixation parasymphysis fractures that need open reduction and internal fixation instead of using conventional miniplates, which are less successful in controlling lingual splaying.