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Shah A, Perez-Otero S, Tran D, Aponte HA, Oh C, Agrawal N. Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2024; 82:449-460. [PMID: 38336352 DOI: 10.1016/j.joms.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This study investigates whether the intraoral approach to mandibular open reduction and internal fixation, through exposure to the oral cavity's microbiome, results in higher infection rates compared to the extraoral approach, thus addressing a critical public health concern, potentially offering an opportunity to reduce health-care costs, and aiming to guide effective clinical practice. METHODS In this systematic review with meta-analyses, a review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was conducted using Embase and PubMed for articles published between 1989 and 2023. Inclusion criteria targeted studies on open reduction and internal fixation mandibular fractures comparing intraoral and extraoral approaches and reporting infection rates. Exclusion criteria eliminated non-English articles, case reports, and studies with insufficient approach-specific data. The primary outcome was the postoperative infection rate, with surgical approach as the predictor. Covariates such as age, sex, diabetes, and smoking status were included when reported. Data were analyzed using R software, employing random-effects models due to anticipated heterogeneity (I2 statistics). RESULTS From 61 studies, 11 provided direct comparisons involving 1,317 patients-937 intraoral and 380 extraoral. Infection rates were 5.9% for intraoral and 10% for extraoral approaches. Pooled relative risk was 0.94 [95% confidence interval, 0.63, 1.39], suggesting no significant risk difference. Prevalence of infections was estimated at 9% for intraoral and 6.1% for extraoral procedures, with significant heterogeneity (I2 = 84% for intraoral and 56% for extraoral). CONCLUSION Our meta-analysis found no significant difference in infection rates between the two approaches. There is opportunity to expand on reporting complication rates comparing the various approaches to mandibular fixation. Until these data are presented, surgeon preference may dictate the operative approach to expose the mandible for reduction and fixation.
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Affiliation(s)
- Alay Shah
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY.
| | - Sofia Perez-Otero
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - David Tran
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Hermes A Aponte
- Post-Doctoral Research Assistant, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR
| | - Cheongeun Oh
- Clinical Assistant Professor, Biostatistics Division, Department of Population Health (Biostatistics), New York University Grossman School of Medicine, New York, NY
| | - Nikhil Agrawal
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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Saleh HO, Moussa BG, Salah Eddin KA, Noman SA, Salah AM. Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial). J Maxillofac Oral Surg 2023; 22:995-1005. [PMID: 38105847 PMCID: PMC10719228 DOI: 10.1007/s12663-023-02027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/22/2023] [Indexed: 12/19/2023] Open
Abstract
Background Mandibular angle is the most common site for fractures, accounting for 23-42% of all cases of mandibular fractures. A customized fixation system is designed directly for a specific patient, which reduces the time spent bending and fixing the plate during the operation. This study was designed to assess the effect of CAD/CAM customized V pattern plate versus standard miniplates fixation in mandibular angle fracture. Materials and Methods This prospective randomized clinical trial included 26 patients suffering from mandibular angle fracture. Patients were selected from Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University and Ahmed Maher Teaching Hospital. Study group (13) needed open reduction and internal fixation by using CAD/CAM V plate with surgical guide, while control group (13) needed open reduction and internal fixation by using standard superior-inferior miniplate fixation. The patients were then followed up for one year postoperatively. Results It showed that there was a statistical difference between the study group and the control group regarding postoperative pain, occlusion, and maximal interincisal opening (p value < 0.05%). There was no statistical difference (p value > 0.05%) in the postoperative panoramic radiograph that was taken within the postoperative 1st week in both groups, while the increase in mean bone density was statistically significant (p value < 0.05%) from 6 months to one year postoperatively. Conclusion CAD/CAM customized V pattern plate is a suitable plate design because it offers sufficient stability for normal bone healing, the creation of an ideal occlusion, an early return to function, and adequate postoperative radiographic outcomes. Trial Registration It was registered at ClinicalTrials.gov. Registration number: NCT03761524. Registration date: 03.12.2018.
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Affiliation(s)
- Hiba Obad Saleh
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Department of Oral & Maxillofacial Surgery, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Basma Gamal Moussa
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Khaled Amr Salah Eddin
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Samer Abduljabar Noman
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Ahmed Mohammed Salah
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Sana’a University, Sana’a, Yemen
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Virk SK, Gumber TK, Dhawan A, Bhullar RS, Kapila S. Comparative Evaluation of Masticatory Bite Force in Mandible Fractures Treated with Three-Dimensional Curved Locking Strut Plate Versus Straight Locking Miniplate. J Maxillofac Oral Surg 2023; 22:1006-1021. [PMID: 38105849 PMCID: PMC10719182 DOI: 10.1007/s12663-023-01996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/05/2023] [Indexed: 12/19/2023] Open
Abstract
Aims and Objectives To compare the efficacy of titanium 2.0-mm curved locking strut plate and 2.0-mm straight locking miniplate with regard to their intraoperative use and the stability of fixation achieved both, clinically and radiographically. Materials and Methods Forty patients with 62 sites of mandibular fractures requiring open reduction and internal fixation were included in the study. The sample was divided into two groups of twenty patients each depending upon whether patient received three-dimensional 2.0-mm locking curved strut plate (group A) or 2.0-mm straight locking miniplates (group B). Mouth opening, teeth in the fracture line, degree of displacement, time taken, neurosensory and bite force evaluation were done preoperatively, 1st, 7th day, 2nd week, 4th week, 6th week and 12th week postoperatively. Results Positive correlation was found between preoperative and postoperative bite force values at subsequent follow-up weeks. At 3rd month evaluation, the change in bite force from the previous follow-up visit was significantly greater in group A (locking strut plate) than group B (locking miniplate) in the incisor, left molar and right molar region. Statistically significant difference was observed between the two groups regarding time taken (P < 0.016) depicting less time taken for placement of three-dimensional 2.0-mm locking curved strut plate(group A) 20.30 ± 4.85 min as compared to 27.30 ± 6.82 min for fixation with 2.0 mm straight locking miniplates in group B. Conclusion The findings were suggestive that the both systems had better adaptation during fixation, comparable radiographic reduction and increased stability in postoperative period. However, 3D locking strut plate took relatively lesser operative time, offered good rigidity and better stabilization of fractured segments in three dimensions along with significant improvement in the masticatory bite force postoperatively.
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Affiliation(s)
- Sukhpreet Kaur Virk
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Tejinder Kaur Gumber
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Amit Dhawan
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Ramandeep Singh Bhullar
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Sarika Kapila
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
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Abdou Ata MAER, Marzook HAEM, Tawfik MAM, Elmissiry ZMA. Z-shaped Miniplates vs Conventional Miniplates for Fixation of Mandibular Parasymphyseal Fractures. J Contemp Dent Pract 2023; 24:761-770. [PMID: 38152909 DOI: 10.5005/jp-journals-10024-3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
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.
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Affiliation(s)
- Mohamed Abd El-Rahman Abdou Ata
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Phone: +201001706755, e-mail: , https://orcid.org/0009-0009-0298-8335
| | | | - Mohamed Abdel-Monem Tawfik
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ziad Mohamed Amr Elmissiry
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Kostares E, Kostare G, Kostares M, Kantzanou M. Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and meta-analysis. Sci Rep 2023; 13:11174. [PMID: 37430033 DOI: 10.1038/s41598-023-37652-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023] Open
Abstract
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
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Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece.
| | - Georgia Kostare
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Michael Kostares
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
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Soliman L, King V, Yeoh MS, Woo AS. Update on ladder plates for mandibular angle fractures. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00056. [PMID: 36977126 DOI: 10.1097/moo.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE OF REVIEW Fractures of the mandibular angle are surgically challenging with high rates of postoperative complications. Among established fixation techniques for these injuries, Champy's tension band approach with miniplate fixation has held prominence. Rigid fixation, using two plates, also remains commonly used. More recently, geometric ladder plates, which confer greater three-dimensional stability have been developed to overcome the shortcomings of conventional fixation approaches. Herein, we aim to summarize the recent evidence surrounding the use of ladder plates and offer our own opinion for optimal treatment of these fractures. RECENT FINDINGS In high-powered studies, the rates of hardware failure, malocclusion, and malunion are lower among cohorts managed with ladder plates relative to miniplate groups. Rates of infection and paresthesia remain similar. Ladder plates have also been shown to decrease operative time in preliminary study. SUMMARY Ladder plates show superiority to miniplate approaches across several outcomes. However, the relatively larger strut plate constructs may not be necessary for minor, uncomplicated fractures. It is our belief that reasonable outcomes may be achieved with either approach depending on surgeon experience and comfort with the given fixation technique.
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Affiliation(s)
- Luke Soliman
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Victor King
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melvyn S Yeoh
- Division of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Das MK, Mishra M, Singh G, Mondal S. Single linear miniplate versus rectangular grid plate in the treatment of mandibular angle fractures: A prospective, clinico-radiographic, comparative study. Natl J Maxillofac Surg 2023; 14:47-54. [PMID: 37273441 PMCID: PMC10235730 DOI: 10.4103/njms.njms_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/03/2022] [Accepted: 10/03/2022] [Indexed: 06/06/2023] Open
Abstract
Study Design Randomized Control Trial. Objective A prospective, clinico-radiographic, comparative study was planned to evaluate the treatment outcome and postoperative complications in isolated mandibular angle fractures using 2.0-mm system single linear 4 hole with gap miniplate versus 4 hole rectangular grid plate, both stabilized with 4 8-mm monocortical screws. Methods Thirty patients with isolated mandibular angle fractures were randomly categorized into two groups with 15 patients each. Group 1 patients were treated with single 2.0 mm × 4 hole linear miniplate along the superior border and Group 2 patients were treated with a 2.0 mm × 4 hole rectangular grid plate on lateral cortex of mandible. Pain, swelling, occlusion, bite force, maximum inter-incisal opening, intraoperative time, facial nerve injury, fracture stability, and postoperative complications were assessed and compared at regular intervals up to 12 months. Results There was no major difference in terms of treatment outcome in both systems and both were equally effective without any statistically significant difference in any of the parameters. None of the patients presented with any of the complications except for postoperative infection which was reported by 1 patient from each group at 3 months postoperatively and were managed conservatively. Conclusion Both plating systems are equally effective; however, the rectangular grid plate could be a safe and effective alternative to the single miniplate when adaptation and fixation is not possible along the external oblique ridge of the mandible (e.g., fracture with bone loss along the superior border).
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Affiliation(s)
- Manthan Kumar Das
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madan Mishra
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gaurav Singh
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shubhamoy Mondal
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
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Erdoğan MM, Şimşek T, Ugur L. Using Single Miniplate in Mandibular Angle Fractures: Finite Elements Analysis. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kaur T, Dhawan A, Bhullar RS, Kapila S, Gupta S, Resham R. Are Embrasure Wires Effective and Reliable Method for Intraoperative Maxillomandibular Fixation in Mandibular Fractures? J Maxillofac Oral Surg 2022; 21:433-441. [DOI: 10.1007/s12663-021-01528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 02/03/2021] [Indexed: 11/28/2022] Open
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Mathew N, Singh I, Gandhi S, Solanki M, Bedi NS. The Efficacy of Fixation of Unilateral Mandibular Angle Fracture with Single 3D Plate vs Single Miniplate Using Transbuccal Approach. J Maxillofac Oral Surg 2022; 21:405-412. [DOI: 10.1007/s12663-020-01465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022] Open
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Antonio Pereira-Filho V, Fernando de Oliveira Gorla L, Cleveilton Dos Santos J, Silva Monnazzi M, Maurício dos Santos Nunes Reis J, de Moraes M, Francisco Real G M. In vitro mechanical test of grid plates for mandibular angle fractures. Br J Oral Maxillofac Surg 2022; 60:1125-1130. [DOI: 10.1016/j.bjoms.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
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SANCAR B, ÜSTÜNDAĞ İ. Comparison of self-tapping and self-drilling screws in open reduction of mandible fracture. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1021921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Salavadi RK, Sinha R, Vadepally AK, Uppada UK. Comparative Evaluation of Conventional Miniplates, Three-Dimensional Miniplates and Lag Screws for Internal Fixation of Parasymphysis Fracture of Mandible-A Double-Blind Randomized Clinical Study. J Maxillofac Oral Surg 2022; 21:283-289. [PMID: 35400928 PMCID: PMC8934819 DOI: 10.1007/s12663-021-01647-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of this study is to clinically and radiographically evaluate the stability of parasymphysis fracture managed with lag screws, miniplates and 3D miniplates. Materials and Method Ninety- eight patients diagnosed with parasymphysis fracture were treated using lag screws in group 1, two 4-hole miniplates in group 2 and 3D miniplates in group 3. Intraoperative stability and duration of fixation was assessed. Postoperative clinical evaluation was done at 1 week, 1 month, 3rd month, 6th month and 1 year for complications and oral function. Radiological evaluation was done at 3rd and 6th month. Only 92 patients were considered for statistical analysis since 6 patients were lost during follow-up. Results Road traffic accident (65.3%) was the primary cause of mandibular fractures. Postoperative pain score showed a statistically significant difference after 1 week and 1 month duration (P value < 0.001). ANOVA test showed VAS was significantly higher at pre-op followed by 1st day and 1 week, but no significant difference after 3 months in all groups. Radiographic analysis did not show significant difference in approximation of fracture segment among 3 groups after 6 months (P-value = 0.117). Chewing efficiency at 6 months and occlusion by surgeon evaluation at 3 months showed a significant difference (P value < 0.001). Conclusion Lag screw fixation was technique-sensitive, relatively inexpensive and was less time consuming method when compared to miniplates and 3D plates. Lag screws and 3D plates are superior in reducing the incidence of complications and better in oblique or sagitally displaced mandibular fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-021-01647-5.
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Affiliation(s)
- Revanth Kumar Salavadi
- Department of Dentistry, ESIC Medical College and Hospital, Sanathnagar, Hyderabad, Telanagana 500038 India
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
| | - Ashwant Kumar Vadepally
- Department of Oral and Maxillofacial Surgery, VSK’s Sri Sai Superspeciality Dental Hospital, Uppal, Hyderabad, Telangana India
| | - Uday Kiran Uppada
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
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Thapliyal S, Mowar A, Bansal V. 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. J Maxillofac Oral Surg 2022; 21:211-218. [PMID: 35400927 PMCID: PMC8934805 DOI: 10.1007/s12663-020-01397-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To overcome limitation of 3D plate for fracture fixation in mental foramen region, by designing an indigenous custom made detachable 3D titanium plate (VAS 3D bone plate) and comparing it with two miniplate fixations for fractures of aforementioned region. Methodology Finite element analysis (FEA) of VAS plate and randomised clinical trial was performed and compared with miniplates. Twenty fractures in 19 patients with fracture in mental foramen region were divided randomly into two groups (Group I-fixation by miniplates and Group II with VAS plate) and evaluated for ease of fixation, neurosensory deficit, bite forces, occlusion and adequacy of fracture fixation. Results FEA of VAS plate revealed better performance for stress distribution, deformation and rigidity. A total of 20 mental foramen region fractures in 19 patients (18 male and 1 female) were treated. Group II had better results for bite forces and lingual control. Except for two patients with screw exposure in Group II and transient neurosensory deficit (resolved by 6 months), no other complications were observed. Ease of fixation was significantly better in miniplate group. Conclusion VAS plate was successful in providing satisfactory fixation and was observed to be better in terms of lingual control and masticatory efficiency.
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Affiliation(s)
- Sanchita Thapliyal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, India
| | - Apoorva Mowar
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, India
| | - Vishal Bansal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, India
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Sarepally G, Seethamsetty S, Karpe T, Nasyam FA, Fatima U, Fatema R. A Comparative Evaluation of 2.0mm Two-Dimensional Miniplates Versus 2.0mm Three-Dimensional Miniplates in Mandibular Fractures. Cureus 2022; 14:e21325. [PMID: 35186584 PMCID: PMC8849431 DOI: 10.7759/cureus.21325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/08/2022] Open
Abstract
Background: In the past few decades, there has been an increasing interest in obtaining a more instantaneous return to normal function using diverse methods of direct fixation. Aims and Objectives: To compare the conventional 2-mm 2D (two-dimensional) miniplates and 2-mm 3D (three-dimensional) miniplates in terms of treatment outcome, stability, duration of surgery, and complications of treatment of symphysis and parasymphysis mandibular fractures. Materials and Methods: 16 patients with clinical and radiological evidence of fractures of the mandible in symphysis and parasymphysis areas treated by open reduction and internal fixation with 2D miniplates and 3D miniplates. The patients were followed up for three months and assessed clinically and radiographically by taking orthopantomograms. The assessment was made on the immediate postoperative day, third day, fifth day, the seventh day, two weeks, three weeks, four weeks, two months, and three months. Results: Mean intraoperative time taken for 2D miniplate was 54.8 min and for 3D miniplate was 40.6 min. Mild paraesthesia at the soft tissue region supplied by mental nerve was noticed in two patients (25%) of group I, whereas there was no such paraesthesia observed in group II patients. Wound dehiscence and infection were noticed in one patient in group I. Conclusion: 3D plates seem to be better than conventional 2-mm miniplates for symphysis and parasymphysis fractures.
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Press SG, Miller AJ, Luschen MC. Is There a Safe Zone for Lateral Border Fixation of Mandibular Angle Fractures? Craniomaxillofac Trauma Reconstr 2021; 14:284-288. [PMID: 34707788 DOI: 10.1177/1943387520983118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Cross-sectional study design. Objective There are multiple accepted treatment options for internal fixation of mandibular angle fractures. The purpose of this study was to determine if there is a safe zone for lateral border fixation of mandibular angle fractures. Methods One hundred coronal images of facial computed tomography (CT) scans were reviewed on patients between the ages of 18 to 48. Measurements were taken in the area of the second and third molar region related to the inferior border to the superior extent of the inferior alveolar canal and apex of the second molar root, along with buccal cortical measurements to the inferior alveolar canal and apical third of the second molar root. Results The average measurement of the inferior border in the second molar area to the inferior alveolar canal and apex of the root was 1.12 cm (0.70-1.77) and 1.39 cm (0.91-2.30), respectively. The average measurement of the inferior border of the third molar to the inferior alveolar canal was 1.26 cm (0.78-1.83). The average measurement of the buccal cortex of the second molar to the inferior alveolar canal and apical one-third of the root was 0.64 cm (0.34-1.25) and 0.59 cm (0.33-0.98), respectively. The average measurement of the third molar buccal cortex to the inferior alveolar canal was 0.45 cm (0.18-0.98). Conclusion In the area of the second molar region, there is no ubiquitous safe zone for screw placement, cortical bone thickness is more critical than vertical placement of the fixation plate and screws. In the third molar region, cortical bone thickness and vertical orientation may provide a safe zone for screw placement.
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Affiliation(s)
- Steven G Press
- Envison Physician Services, Department of Facial Trauma, TriStar Skyline Medical Center, Nashville, TN, USA
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Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures. J Craniofac Surg 2021; 32:e728-e735. [PMID: 34172684 DOI: 10.1097/scs.0000000000007709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits. MATERIALS AND METHODS A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus). RESULTS Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture. CONCLUSIONS The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.
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Amjad S, Kalim Ansari MD, Ahmad SS, Rahman T. Comparative study of outcomes between locking plates and three-dimensional plates in mandibular fractures. Natl J Maxillofac Surg 2020; 11:263-269. [PMID: 33897192 PMCID: PMC8051647 DOI: 10.4103/njms.njms_53_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/03/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives The objective was to compare the efficiency and assess postoperative complications of 2.00 mm unicortical locking plates and three-dimensional (3D) plates in surgical correction of uncomplicated mandibular fracture. Materials and Methods A prospective cohort study of twenty patients of uncomplicated mandibular fractures, who were operated either by noncompression unicortical 2-mm locking mini-plate or by noncompression unicortical 2-mm 3D mini-plate, were enrolled and followed up for the study outcomes such as operative time, postoperative infection, and postoperative occlusion. Results Majority of the patients (90%) were male who had road traffic accident. In 80% of cases, mandibular fracture site was parasymphysis. The mean operating time for 3D plates (43.20 min) was significantly lower than that for locking plates (54.82 min), P < 0.001. All cases operated by 3D plates compared to 60% by locking mini-plates did not need intermaxillary fixation, P = 0.025. The 80% of cases operated by 3D plates did not require postoperative occlusion correction compared to 30% in another group, P = 0.01. For other parameters such as postoperative sensory disturbance, postoperative infection, incidence tooth damage, vertical displacement of mandible, feeling of plate after platting, and chewing efficiency after 1 week, there were no statistical significant differences between the two groups. Conclusions The outcome of 2.0mm 3D mini-plate is better in terms of operating time required, post-operative need of intermaxillary fixation and occlusal correction. While the outcome is similar to the use of non-compression unicortical 2.00mm locking miniplate in parameters like infection rate and incidence of tooth damage etc.
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Affiliation(s)
- Shaikh Amjad
- Department of Dentistry, Indian Institute of Medical Sciences and Research, Jalna, Maharashtra, India
| | - M D Kalim Ansari
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Syed S Ahmad
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Tabishur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Kanala S, Gudipalli S, Perumalla P, Jagalanki K, Polamarasetty PV, Guntaka S, Gudala A, Boyapati RP. Aetiology, prevalence, fracture site and management of maxillofacial trauma. Ann R Coll Surg Engl 2020; 103:18-22. [PMID: 32808805 DOI: 10.1308/rcsann.2020.0171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Maxillofacial fractures are often associated with severe morbidity, functional deficit, disfigurement and significant financial implications. The aim of this review was to investigate whether the aetiology, prevalence and management modalities of facial trauma can identify the common causes of facial trauma with a view to recommending measures to the appropriate governing bodies to change the current practice wherever possible. METHODS The records of 1,112 patients referred to our oral and maxillofacial unit in Andhra Pradesh, India, between February 2008 and October 2017 were analysed retrospectively. Data including age, sex, aetiology, fracture site and treatment were evaluated. RESULTS Men aged 20-40 years were the most common victims of facial trauma. Road traffic accidents (RTAs) were responsible in 70% of cases. Mandibular fractures constituted 47% of the overall fractures, and 55% of the total fractures were treated with open reduction and internal fixation. CONCLUSIONS The main cause of maxillofacial injury among patients reporting to our hospital was RTAs. Mandibular fractures were the most common, accounting for almost half of the cases. Over half (55%) of all maxillofacial fractures were treated with open reduction and internal fixation. Reasons for this high frequency may include the large number of poorly maintained, overloaded vehicles on unsuitable roads, violation of traffic regulations (particularly by inexperienced young drivers), abuse of alcohol or other intoxicating agents and the sociocultural behaviours of some drivers.
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Affiliation(s)
- S Kanala
- Government Dental College and Hospital, Vijayawada, India
| | - S Gudipalli
- Government Dental College and Hospital, Vijayawada, India
| | - P Perumalla
- Government Dental College and Hospital, Vijayawada, India
| | - K Jagalanki
- Government Dental College and Hospital, Vijayawada, India
| | | | - S Guntaka
- Government Dental College and Hospital, Vijayawada, India
| | - A Gudala
- Government Dental College and Hospital, Vijayawada, India
| | - R P Boyapati
- Queen Victoria Hospital NHS Foundation Trust, UK
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Burkhard JPM, Koba S, Schlittler F, Iizuka T, Schaller B. Clinical results of two different three-dimensional titanium plates in the treatment of condylar neck and base fractures: A retrospective study. J Craniomaxillofac Surg 2020; 48:756-764. [DOI: 10.1016/j.jcms.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
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Fernandes I, Souza G, Silva de Rezende V, Al-Sharani H, Douglas-de-Oliveira D, Galvão E, Falci S. Effect of third molars in the line of mandibular angle fractures on postoperative complications: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2020; 49:471-482. [DOI: 10.1016/j.ijom.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/10/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Kaushik S, Ali I, Dubey M, Bajpai N. 2 mm Conventional Miniplates with Three-Dimensional Strut Plate in Mandibular Fractures. Ann Maxillofac Surg 2020; 10:10-15. [PMID: 32855908 PMCID: PMC7433946 DOI: 10.4103/ams.ams_73_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/05/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022] Open
Abstract
AIM The aim of this study was to compare 2 mm conventional miniplates with three-dimensional (3D) strut plates in the treatment of mandibular fractures treated in the Department of Oral and Maxillofacial Surgery of a college in India, during 2012-2015. MATERIALS AND METHODS All 20 patients with mandible fracture requiring open reduction and internal fixation of the fracture were reported and reviewed in the Department of Oral and Maxillofacial Surgery of the same dental college in India, during 2012-2015. We classified the data according to the gender, age, etiology, fracture site, and method of treatment of the fractures. Fixation done in 10 patients with 2 mm conventional miniplates kept in Group I, while 10 patients with 3D strut miniplate system considered in Group II. RESULTS Assessment of patient was done under the following parameters with follow-up at regular intervals at 2nd day postoperatively and at 1st, 3rd, and 6th weeks postoperatively: pain, swelling, infection, interincisal mouth opening in millimeters, paresthesia/anesthesia, mobility between fracture fragments, overall occlusion, need for any supplemental fixation, fate of implant, and complications. CONCLUSIONS 3D titanium miniplates showed similar results when compared to standard titanium miniplates with advantages such as reduction in operative time, ease of placement, and cost-effective over the conventional plate system.
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Affiliation(s)
- Shishir Kaushik
- Department of Oral and Maxillofacial Surgery, ITS Dental College, Greater Noida, Lucknow, Uttar Pradesh, India
| | - Iqbal Ali
- Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Manish Dubey
- Department of Dentistry, TS Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Neha Bajpai
- Department of Dentistry, TS Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Three-dimensional versus standard miniplate, lag screws versus miniplates, locking plate versus non-locking miniplates: Management of mandibular fractures, a systematic review and meta-analysis. J Dent Sci 2019; 14:66-80. [PMID: 30988882 PMCID: PMC6445977 DOI: 10.1016/j.jds.2018.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 03/31/2018] [Indexed: 11/27/2022] Open
Abstract
Background/purpose The aims of the present study were to 1) evaluate the clinical outcomes between different fixation methods in the management of mandibular fractures (MFs) and 2) determine which fixation method is the best option for the treatment of mandibular fractures. Materials and methods A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. Inclusion criteria were studied in humans, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. In addition, the incidence of complications was evaluated. Results Thirty-two publications were included: 20 randomized controlled trials, 4 controlled clinical trials, and 8 retrospective studies. There were statistically significant advantages for 3-dimensional miniplate and lag screws. There was no statistically significant difference between locking plates and standard miniplates (P = 0 0.2). The cumulative odds ratio was 0.64, meaning that the use of locking miniplate in the fixation of MFs decreases the risk for postoperative complications by 36% over the use of standard miniplates. Conclusion The results of the three-Dimensional Versus Standard miniplate showed that 3-dimensional miniplate is the best option for mandibular fractures. Regarding Lag Screws Versus Miniplates results of the meta-analysis found that the use of lag screws is superior to using miniplates in reducing the incidence of postoperative complications. And in regards to locking miniplates versus non-locking miniplate, the analysis indicates that the 2.0-mm locking miniplate is a prospective fixation system in the treatment of maxillofacial fractures.
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Mohd YQ, Reddy S, Sinha R, Agarwal A, Fatima U, Abidullah M. Three-Dimensional Miniplate: For the Management of Mandibular Parasymphysis Fractures. Ann Maxillofac Surg 2019; 9:333-339. [PMID: 31909011 PMCID: PMC6933987 DOI: 10.4103/ams.ams_172_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) miniplates to treat mandibular fractures. Aims The aim of the study is to evaluate the efficacy of 3D-miniplates over standard miniplates in the management of mandibular parasymphysis fracture. Materials and Methods Forty patients with mandibular parasymphysis fractures were divided into two groups of 20 patients each. Group I patients underwent osteosynthesis of mandibular fracture by noncompression, unicortical, and stainless steel 3D miniplates, and Group II patients underwent osteosynthesis by noncompression, unicortical, and stainless steel Champy's miniplates. All the patients were followed up 6 months' postoperatively, evaluating occlusion, mobility of fracture segment, pain, wound dehiscence, neurological deficit, and infection. Statistical Analysis Used The data were analyzed by SPSS for windows (version 17) statistical package (SPSS Inc., Chicago, IL, USA). Chi-square test was carried out to determine the statistical difference between the groups. Results Mobility of the fractured site was evaluated postoperatively after 2 weeks, and it was found that mobility was absent in all the cases of Group I and 36 (80%) cases in Group II. There was significant difference in the mean visual analog scale scores among the Group I and II when compared from preoperative to 4-week follow-up. In Group II, two patients showed wound dehiscence. After 2 weeks, infection was seen in two patients of Group II. Conclusion 3D plates in mandibular parasymphysis fractures give dimensional stability and carry low morbidity and infection rates.
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Affiliation(s)
- Yousuf Qureshi Mohd
- Department of Oral and Maxillofacial Surgery, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Sreenatha Reddy
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
| | - Anmol Agarwal
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences and Technologies, Modinagar, Uttar Pradesh, India
| | - Umayra Fatima
- Department of Dental, Princess Esra Hospital, Hyderabad, Telangana, India
| | - Mohammed Abidullah
- Departemnt of Oral Pathology, S. B. Patil Dental College, Bidar, Karnataka, India
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Budhraja NJ, Shenoi RS, Badjate SJ, Bang KO, Ingole PD, Kolte VS. Three-dimensional Locking Plate and Conventional Miniplates in the Treatment of Mandibular Anterior Fractures. Ann Maxillofac Surg 2018; 8:73-77. [PMID: 29963428 PMCID: PMC6018293 DOI: 10.4103/ams.ams_175_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Three-dimensional (3D) locking plates has been designed with the hypothesis that this will overcome the disadvantages of both the systems and also advantages of both systems will be combined for the management of mandibular fractures. Aims The purpose of this study was to evaluate the efficacy of 2-mm 3D locking miniplate in the management of anterior mandibular fracture and to compare it with Champy's miniplate. Settings and Design A prospective, randomized, clinical trial was carried out in thirty patients who were divided equally in two groups. Subjects and Methods Group I and Group II patients were treated with 2-mm 3D locking plates and 2-mm standard miniplates, respectively. They were evaluated according to the outcomes of the study, that is, working time, wound dehiscence, infection, segmental mobility, postoperative occlusion, need for postoperative intermaxillary fixation (IMF), and radiological evaluation of reduction and fixation. Statistical Analysis Used Student's t-test and Mann-Whitney test were used to compare the two systems. The data were analyzed using Statistical Package for the Social Science version 14.0. The P value was taken as significant when <0.05 (confidence interval of 95% was taken). Results The mean duration of procedure for Group I was found to be 49.33 min, whereas for Group II was 59.67 min. There was significantly greater pain on day 1 and at 1 week in Group II patients. 6.7% (n = 1) of both groups showed incidence of infection. Postoperative stability was adequate in most cases except in one patient (n = 1) of 3D locking system, which was revealed as postoperative occlusal disharmony, unsatisfactory radiological reduction of the fracture fragments, and the segmental mobility. There was no incidence of wound dehiscence, tooth damage, and nerve damage in either group. Conclusions The result of the study can conclude that there is no major difference between both systems in terms of treatment outcome.
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Affiliation(s)
- Nilima J Budhraja
- Department of Oral and Maxillofacial Surgery, VSPM's Dental College and Research Center, Nagpur, Maharashtra, India
| | - Ramakrishna S Shenoi
- Department of Oral and Maxillofacial Surgery, VSPM's Dental College and Research Center, Nagpur, Maharashtra, India
| | - Samprati J Badjate
- Department of Oral and Maxillofacial Surgery, VSPM's Dental College and Research Center, Nagpur, Maharashtra, India
| | - Kshitij O Bang
- Department of Oral and Maxillofacial Surgery, VSPM's Dental College and Research Center, Nagpur, Maharashtra, India
| | - Pranav D Ingole
- Department of Oral and Maxillofacial Surgery, VSPM's Dental College and Research Center, Nagpur, Maharashtra, India
| | - Vrinda S Kolte
- Department of Oral and Maxillofacial Surgery, VSPM's Dental College and Research Center, Nagpur, Maharashtra, India
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Jain MK, Kerur P. Bite Force as a Parameter for Comparison Between Three-Dimensional and Standard Titanium Miniplates for the Management of Anterior Mandibular Fractures: A Prospective Randomized Double-Blinded Clinical Trial. J Maxillofac Oral Surg 2018; 18:249-255. [PMID: 30996547 DOI: 10.1007/s12663-018-1091-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 02/05/2018] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives To compare the efficacy of three-dimensional (3D) miniplates with standard miniplates in the osteosynthesis of anterior mandibular fractures on the basis of bite force recordings and other clinical parameters. Methods A prospective randomized double-blinded clinical trial was carried out for the treatment of anterior mandibular fractures. In total, 20 patients were randomly divided into two groups of 2-mm 3D and standard titanium miniplates. The assessment of patients was done at weekly intervals for 6 weeks using bite force recordings and other clinical parameters. Results A statistically significant difference was found in the duration of surgery which was less in group A as compared to group B (p = 0.03). No significant difference was found in other clinical parameters. Interpretation and Conclusion The clinical outcome of both the 3D and standard miniplate systems in the present study was similar; however, the following advantages with the use of 3D miniplates can be highlighted:Relatively lesser operating time.Three-dimensional stability of the fracture site and simultaneous stabilization at superior and inferior borders in the fixation of mandibular fractures.
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Affiliation(s)
- Manoj Kumar Jain
- 1Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka 573201 India
- Nuface/Sumukha Clinic, Benaka Complex 1st Floor, Sankar Matt Road 5th Cross, KR Puram, Hassan, Karnataka 573201 India
| | - Priyadarshini Kerur
- Department of Oral and Maxillofacial Surgery, Inderprastha Dental College and Hospital, Sahibabad, Ghaziabad, Uttar Pradesh 201010 India
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3-D Miniplates Versus Conventional Miniplates in Treatment of Mandible Fractures. J Maxillofac Oral Surg 2017; 18:65-72. [PMID: 30728695 DOI: 10.1007/s12663-017-1068-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022] Open
Abstract
Aim To study whether the use of 3-D miniplate, when compared with conventional miniplate, gives better clinical outcomes with fewer complications in patients with fracture mandible. Materials and Methods A prospective study was conducted in the Department of Oral and Maxillofacial Surgery, Trauma Care Centre, on 40 patients. They were randomly divided into Group-I and Group-II with 20 patients in each group. In Group-I, 3-D miniplate was used and in Group-II, conventional miniplate was used. Parameters such as fracture stability, occlusal status, mouth opening, nerve paresthesia, infection, pain, swelling, and complications were evaluated on 1st, 7th postoperative day, 1st month and 3rd month. Results Fracture stability and occlusion were clinically better in Group-I than in Group-II on each follow-up; however, it was not statistically significant. Infection rate was lesser in Group-I than in Group-II (p = 0.003). Mouth opening was more in Group-II than in Group-I on immediate (p = 0.001) and 7th post-op day (p = 0.002). Overall complications were lesser in Group-I than in Group-II (p > 0.005). Conclusion There is no major difference observed in clinical outcomes between 3-D miniplate and conventional miniplate. Either method of fixation can be used successfully in treatment of mandible fractures with comparable rates of complications.
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de Oliveira JCS, Moura LB, de Menezes JDS, Gabrielli MAC, Pereira Filho VA, Hochuli-Vieira E. Three-dimensional strut plate for the treatment of mandibular fractures: a systematic review. Int J Oral Maxillofac Surg 2017; 47:330-338. [PMID: 28928010 DOI: 10.1016/j.ijom.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/12/2017] [Accepted: 08/30/2017] [Indexed: 11/25/2022]
Abstract
The treatment of mandibular fractures by open reduction and internal fixation is very variable. Thus, there are many controversies about the best fixation system in terms of stability, functional recovery, and postoperative complications. This systematic review sought scientific evidence regarding the best indication for the use of three-dimensional (3D) plates in the treatment of mandibular fractures. A systematic search of the PubMed/MEDLINE, Elsevier/Scopus, and Cochrane Library databases was conducted to include articles published up until November 2016. Following the application of the inclusion criteria, 25 scientific articles were selected for detailed analysis. These studies included a total of 1036 patients (mean age 29 years), with a higher prevalence of males. The anatomical location most involved was the mandibular angle. The success rate of 3D plates was high at this location compared to other methods of fixation. In conclusion, the use of 3D plates for the treatment of mandibular fractures is recommended, since they result in little or no displacement between bone fragments.
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Affiliation(s)
- J C S de Oliveira
- Oral and Maxillofacial Surgery Residency Program, Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil.
| | - L B Moura
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - J D S de Menezes
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - M A C Gabrielli
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - V A Pereira Filho
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
| | - E Hochuli-Vieira
- Department of Diagnosis and Surgery, Dental School at Araraquara, UNESP - Universidade Estadual Paulista, Araraquara, São Paulo, Brazil
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Silajiding K, Wusiman P, Yusufu B, Moming A. Three dimensional versus standard miniplate fixation in the management of mandibular fractures: A meta-analysis of randomized controlled trials. Kaohsiung J Med Sci 2017; 33:464-472. [PMID: 28865605 DOI: 10.1016/j.kjms.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 11/28/2022] Open
Abstract
The aim of this meta-analysis is to evaluate the efficacy of the 3-dimensional miniplate system in comparison with the standard miniplate system for the treatment of mandibular fractures (MFs). A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and PubMed databases. The primary search objective was to identify all papers reporting the results of randomized control trials (RCTs) for the treatment of adults with mandibular fractures, with the aim of comparing the different techniques. The incidence of complications was evaluated; nine studies including 283 patients with different fracture sites were enrolled in the analysis. The results showed no significant differences in overall complications (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.552-1.542; P = 0.81), postoperative infections (OR, 0.99; 95% CI, 0.40-2.48; P = 0.89), wound dehiscence (OR, 0.96; 95% CI, 0.13-7.37; P = 0.96), paresthesia (OR, 0.47; 95% CI, 0.20-1.07; P = 0.11), or malocclusion (OR, 1.8; 95% CI, 0.39-8.32; P = 0.47) between standard miniplates and 3-dimensional miniplates for treating mandibular fractures. Mandibular fractures treated with 3-dimensional miniplates and standard miniplates presented similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using standard miniplates also indicated that the standard miniplate has a promising application in the treatment of mandibular fractures.
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Affiliation(s)
- Kubila Silajiding
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Patiguli Wusiman
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Bilikezi Yusufu
- Department of Oral and Maxillofacial Surgery, The First People's Hospital in Kashgar Region, Kashgar, Xinjiang, People's Republic of China
| | - Adili Moming
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.
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Locking Plate System Versus Standard Plate Fixation in the Management of Mandibular Fractures. J Craniofac Surg 2017; 28:1456-1461. [DOI: 10.1097/scs.0000000000003857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Aggarwal S, Singh M, Modi P, Walia E, Aggarwal R. Comparison of 3D plate and locking plate in treatment of mandibular fracture-a clinical study. Oral Maxillofac Surg 2017; 21:383-390. [PMID: 28785906 DOI: 10.1007/s10006-017-0642-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/27/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study was performed to evaluate the efficacy and post-operative complication of 3-dimensional (3D) titanium miniplate and locking plate in mandibular fractures (parasymphysis, symphysis, body, and angle). MATERIALS AND METHODS Forty patients, with non-comminuted mandibular fractures treated with open reduction and internal fixation using 3D titanium miniplate system or locking plate system through an intra-oral approach, were included in this study. All patients were systematically monitored up to 2 months post-operatively. Parameters recorded were infection, occlusal discrepancies, hardware failure, wound dehiscence, sensory disturbance of the inferior alveolar nerve, and stability of fractured segments. RESULTS Forty patients with mandibular fracture were divided into two groups randomly without any bias. The fractures of all 40 patients were found to be adequately fixed when checked intra-operatively after fixation. One patient (2.5%) of the 3D plate group developed an infection on the first and second post-operative visit and was treated by antibiotic coverage. One patient in the locking plate group (2.5%) reported wound dehiscence after the first week follow-up. CONCLUSION Both 3D titanium miniplates and locking plate are effective in the treatment of mandibular fractures, and overall complication rates are lesser. However, the 3D plating system uses less hardware in cases of parasymphysis and symphysis fractures and more hardware in cases of body and angle fractures.
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Affiliation(s)
- Sakshi Aggarwal
- , House no. 2940, Sector 15, Panchkula, Haryana, 134113, India.
| | - Manpreet Singh
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, India
| | | | - Esha Walia
- Department of Oral Pathology, Kothiwal Dental College and Research Centre, Moradabad, India
| | - Rachit Aggarwal
- Department of Pedodontics, Guru Nanak Dev Dental College and Research Institute, Sonam, Punjab, India
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Rastogi S, Paul S, Kukreja S, Aggarwal K, Choudhury R, Bhugra A, Indra B NP, Jawaid M. Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation Is Required? Craniomaxillofac Trauma Reconstr 2017; 10:188-196. [PMID: 28751942 DOI: 10.1055/s-0037-1600904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/27/2016] [Indexed: 10/19/2022] Open
Abstract
The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0-5), swelling (visual analog scale: 0-5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments. A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week. 3D plating system is an easy to use alternative to conventional miniplates to treat mandibular angle fractures that uses lesser foreign material, thus reducing the operative time and overall cost of the treatment. Better fracture stability and occlusion was also achieved using the 3D plating system.
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Affiliation(s)
- Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, TMDCRC, Moradabad, Uttar Pradesh, India
| | - Sam Paul
- Department Orthodontics and Dentofacial Orthopaedics, Educare Institute of Dental Sciences, Chattiparamba, Malappuram, Kerala, India
| | - Sumedha Kukreja
- Department of Oral and Maxillofacial Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Karun Aggarwal
- Department of Oral and Maxillofacial Surgery, Jodhpur Dental College and Research Center, Jodhpur, Rajasthan, India
| | - Rupshikha Choudhury
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India
| | - Amit Bhugra
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Niranjana Prasad Indra B
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Moazzam Jawaid
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
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Liu Y, Wei B, Li Y, Gu D, Yin G, Wang B, Xu D, Zhang X, Kong D. The 3-dimensional miniplate is more effective than the standard miniplate for the management of mandibular fractures: a meta-analysis. Eur J Med Res 2017; 22:5. [PMID: 28196543 PMCID: PMC5322783 DOI: 10.1186/s40001-017-0244-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/02/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The study aimed to determine the superiority between 3-dimensional (3D) miniplate and standard miniplate for mandibular fractures (MFs) treatment. BACKGROUND Controversial results on the use of standard miniplate and 3D miniplate have remained for management of MFs. METHODS Several electronic databases were retrieved up to September 2014 to identify eligible studies. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Subgroup analyses by different fracture regions and different 3D miniplate sizes were performed. Publication bias was measured by a funnel plot. RESULTS There were 13 studies included for the meta-analysis, consisting of 593 participants. The 3D miniplate achieved significant lower incidences of malocclusion (RR 0.43, 95% CI 0.24-0.77, P = 0.004) and hardware failure (RR 0.31, 95% CI 0.13-0.74, P = 0.008) than the standard miniplate. There were no significant differences between the two miniplates on the incidence of the remaining outcomes: wound dehiscence, infection, paresthesia, and nonunion/malunion. Subgroup analyses indicated that 3D miniplate caused a lower hardware failure than standard with the size of 8 or 10 holes (RR 0.23, 95% CI 0.08-0.66, P = 0.006). Besides, publication bias was not detected. CONCLUSION The 3D miniplate is superior to the standard miniplate on the reduction of postoperative complication rates for the management of MFs. More holes in the 3D miniplate might contribute to a successful treatment.
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Affiliation(s)
- Yong Liu
- Departments of Orthopaedics, Jilin Oilfield General Hospital, Songyuan, 131200, China
| | - Bo Wei
- Departments of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Yuxiang Li
- Departments of Orthopaedics, Jilin Oilfield General Hospital, Songyuan, 131200, China
| | - Dawei Gu
- Departments of Orthopaedics, Jilin Oilfield General Hospital, Songyuan, 131200, China
| | - Guochao Yin
- Departments of Orthopaedics, Jilin Oilfield General Hospital, Songyuan, 131200, China
| | - Bo Wang
- Departments of Orthopaedics, Jilin Oilfield General Hospital, Songyuan, 131200, China
| | - Dehui Xu
- Departments of Orthopaedics, Jilin Oilfield General Hospital, Songyuan, 131200, China
| | - Xuebing Zhang
- Departments of Orthopaedics, Jilin Oilfield General Hospital, Songyuan, 131200, China
| | - Daliang Kong
- Departments of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China.
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Yamaji MAK, Oliveira Neto PJD, Ribeiro MDC, Pereira LC, Morais MD, Sverzut CE, Trivellato AE. Evaluation of in vitro resistance of different 2.0-mm titanium plates on the mandibular angle sectioning. Oral Maxillofac Surg 2016; 19:65-70. [PMID: 25015878 DOI: 10.1007/s10006-014-0456-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to compare, by mechanical in vitro testing, a regular 5-hole plate and a long 4-hole plate with a regular 4-hole plate, applied to stabilize a simulated mandibular angle fracture. STUDY DESIGN The plates from the 2.0-mm titanium-based system were adapted and stabilized passively in the same site in both groups using four screws, 6 mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side, first molar at the contralateral side, and between the central incisors. RESULTS The regular 5-hole plates and longer 4-hole plates were superior to the regular 4-hole plates. Furthermore, no statistically significant difference was found between the regular 5-hole plates and long 4-hole plate. CONCLUSIONS The length and shape of plates did not interfere with the effectiveness to stabilize the fragments. OBJECTIVE The purpose of this study was to compare, by mechanical in vitro testing, a regular 5-hole plate and a long 4-hole plate with a regular 4-hole plate, applied to stabilize a simulated mandibular angle fracture.Study design The plates from the 2.0-mm titanium-based system were adapted and stabilized passively in the same site in both groups using four screws, 6 mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side, first molar at the contralateral side, and between the central incisors. RESULTS The regular 5-hole plates and longer 4-hole plates were superior to the regular 4-hole plates. Furthermore, no statistically significant difference was found between the regular 5-hole plates and long 4-hole plate.Conclusions The length and shape of plates did not interfere with the effectiveness to stabilize the fragments.
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Monnazzi MS, Gabrielli MAC, Gabrielli MFR, Trivellato AE. Mandibular angle fractures: a comparative study between one- and two-plate fixation. Dent Traumatol 2016; 33:121-125. [PMID: 27900824 DOI: 10.1111/edt.12312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM The mandibular angle fracture is a challenging fracture to manage. Over time, the literature has shown many types of treatment modalities and different kinds of internal fixation. The aim of this study was to evaluate the outcomes and complications of mandibular angle fractures managed by Champy's technique and two-plate fixation, over a period of 20 years. MATERIAL AND METHODS The files of 149 patients with 155 angle fractures fulfilled the inclusion criteria and were chosen for this study. Data were collected regarding gender, age, race, date of trauma, addictions, etiology, signs and symptoms, fracture management, and complications. RESULTS Prevalence was higher in males (82%), Caucasians (62%), and during the third decade of life (62%). Mean age was 26.5 years. The main cause was interpersonal violence, and the mean follow-up period was 232 days. The main signs and symptoms were pain, edema, and mouth-opening restriction. The most often associated fracture involved the mandibular condyle, and the most common complication was infection. CONCLUSION There was no difference between the two modalities of treatment. However, the one-plate fixation technique had fewer complications.
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Affiliation(s)
- Marcelo Silva Monnazzi
- Dental School of Araraquara, UNESP, Araraquara, Brazil.,Periodontology and Maxillofacial Surgery Department, Dental School of Ribeirão Preto, USP, Ribeirão Preto, Brazil
| | | | | | - Alexandre Elias Trivellato
- Periodontology and Maxillofacial Surgery Department, Dental School of Ribeirão Preto, USP, Ribeirão Preto, Brazil
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Beza SA, Attia S, Ellis E, Omara L. A Comparative Study of Transbuccal and Extraoral Approaches in the Management of Mandibular Angle Fractures: A Systematic Review. Open Access Maced J Med Sci 2016; 4:482-488. [PMID: 27703579 PMCID: PMC5042639 DOI: 10.3889/oamjms.2016.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of the present study was to compare the extraoral and transbuccal approaches for the treatment of mandibular angle fractures with regard to postoperative complications. PATIENTS AND METHODS An electronic search for relevant articles without language and date restrictions was performed in July 2016. Inclusion criteria were studies in humans including randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective studies (PS), and retrospective studies (RS). In total, 107 patients were included from four studies (transbuccal = 48, extraoral = 59). The follow-up period varied from 3 months to 24 months. RESULTS In extraoral group the average of unsightly scar, facial nerve weakness, infection, malocclusion, plate removal were found to be 55% (range, 10% -100%), 26.5% (range, 0%-53%), 11.7% (range, 0% - 20%), 22.5% (range, 0% -50%), 6.7% (range, 3.3% - 10%) respectively while these parameters in the transbuccal approach were found to be no obvious unsightly scar, 6.6 % (range, 0%-13.3%), 8.1% (range, 0% - 20%), 4.8% (range, 0% - 12.5%), 0%. The incidence of postoperative trismus and nonunion/malunion were 0% in both groups. CONCLUSION The results of this study suggest that transbuccal approach shows fewer complications than extraoral approach when used for the treatment of mandibular angle fractures.
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Affiliation(s)
- Sabah Ali Beza
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Sayed Attia
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery University of Texas Health Science Center at San Antonio, TX, USA
| | - Layla Omara
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
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Wusiman P, Yarbag A, Wurouzi G, Mijiti A, Moming A. Three dimensional versus standard miniplate fixation in management of mandibular fractures: A systematic review and meta-analysis. J Craniomaxillofac Surg 2016; 44:1646-1654. [PMID: 27618717 DOI: 10.1016/j.jcms.2016.07.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The aims of the present study were to 1) evaluate clinical outcomes between standard and three-dimensional (3D) miniplate fixation in the management of mandibular fractures and 2) determine which fixation method is the best option for the treatment of mandibular fractures. MATERIALS AND METHODS A comprehensive electronic search language without date was performed in July 2015. Inclusion criteria were studies in humans, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. In addition, the incidence of complications was evaluated. RESULTS Seventeen publications were included: nine randomized controlled trials, three controlled clinical trials, and five retrospective studies. The meta-analyses showed statistically significant differences for the incidence of hardware failure, malocclusion, and postoperative trismus. There were no significant differences in the incidence of postoperative infection, wound dehiscence, non-union/malunion, and paresthesia. The cumulative odds ratio was 0.48, meaning that the use of 3D miniplates in the fixation of mandibular fractures decreases the risk of the event (postoperative complication) by 52%. CONCLUSION The results of this meta-analysis showed that the use of 3D miniplates was superior to the two-miniplate technique in reducing the incidence of postoperative complications in the management of mandibular fractures.
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Affiliation(s)
- Patiguli Wusiman
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Moming), The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, People's Republic of China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang 830054, People's Republic of China
| | | | - Guli Wurouzi
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Moming), The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, People's Republic of China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang 830054, People's Republic of China
| | - Ainiwaer Mijiti
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Moming), The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, People's Republic of China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang 830054, People's Republic of China
| | - Adili Moming
- Department of Oral and Maxillofacial Surgery (Head: Prof. A. Moming), The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, People's Republic of China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang 830054, People's Republic of China.
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The use of three-dimensional strut plates for the management of mandibular angle fractures: a retrospective analysis of 222 patients. Int J Oral Maxillofac Surg 2016; 45:1410-1417. [PMID: 27328630 DOI: 10.1016/j.ijom.2016.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 11/22/2022]
Abstract
This study was performed to evaluate the use of three-dimensional (3D) strut plates for the surgical management of mandibular angle fractures and to determine the subsequent postoperative complication rate. Two hundred and twenty-two patients met the inclusion criteria for mandible angle fracture at the university hospital in Miami between 2009 and 2013 and were included in this study. The treatment protocol for mandibular angle fractures included open reduction and internal fixation with the utilization of a 3D strut plate. Patients were not placed in postoperative intermaxillary fixation. An evaluation of the cases revealed a complication rate of 15.3%, of which 6.8% were considered major complications requiring a surgical intervention. The 3D strut plate has been found to have many advantages over single miniplate techniques with respect to the stability of the fracture and the rate of complications. Based on the current data, 3D strut plates provide a predictable result in the treatment of mandibular angle fractures.
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Kanubaddy SR, Devireddy SK, Rayadurgam KK, Gali R, Dasari MR, Pampana S. Management of Mandibular Angle Fractures: Single Stainless Steel Linear Miniplate Versus Rectangular Grid Plate-A Prospective Randomised Study. J Maxillofac Oral Surg 2016; 15:535-541. [PMID: 27833349 DOI: 10.1007/s12663-016-0892-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/18/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This prospective study was conducted to evaluate the efficacy of stainless steel single linear miniplate with rectangular grid plate in the treatment of mandibular angle fractures. METHODS This study included 30 patients who were allocated randomly into two groups of each. Group 1 patients were treated with single 2 mm × 4 hole linear stainless steel miniplate and group 2 patients with 2 mm × 4 hole rectangular grid plate. Patients were evaluated for fracture stability, occlusion, mouth opening, and complications at 1st week, 1 and 3 months post operatively. RESULTS There were no significant differences between the two groups with respective variables statistically. In group 1 20 % (n = 3) had mild occlussal derangement 6.66 % (n = 1) patient had deranged occlusion at 1 week post operatively and 13.3 % (n = 2) had mild derangement at 1 month post operatively. In group 2 6.66 % (n = 1) had mild derangement at 1 week postoperatively. 20 % (n = 3) had limited mouth opening at 1 week in group 1 and 13.3 % (n = 2) in group 2. All patients in both groups achieved adequate mouth opening by the end of 3 month. None of the patients in both groups had plate fracture, screw loosening, non union or mal-union. CONCLUSION Within the limits of the study, use of rectangular grid plates for fixation of mandibular angle fractures was reliable with low complication rates, easy adaptation and an effective alternative to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.
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Affiliation(s)
- Sridhar Reddy Kanubaddy
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Sathya Kumar Devireddy
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Kishore Kumar Rayadurgam
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Rajsekhar Gali
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Mallikarjun Rao Dasari
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Sivaganesh Pampana
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
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Finite-Element Analysis of a New Designed Miniplate which is Used via Intraoral Approach to the Mandible Angle Fracture: Comparison of the Different Fixation Techniques. J Craniofac Surg 2016; 26:e445-8. [PMID: 26091053 DOI: 10.1097/scs.0000000000001890] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The mandible is the largest facial bone as well as the most commonly fractured bone in the maxillofacial region. Despite numerous studies conducted to identify optimal treatment modalities and plates configurations for intraoral and transoral approaches, no definitive conclusion has been reached. This study used finite element analysis (FEA) to assess 4 scenarios for treatment of an angle fracture (6-hole noncompression miniplate; 6-hole single plate/Champy's technique, 3D strut plate; 2 parallel 4-hole noncompression miniplates). Analysis included segmental displacement and Von Mises Stress evaluations of a 3D reconstruction of a human mandible. Von Mises Stress values for plates did not vary significantly among treatment groups. Moreover, no significant differences were observed in cumulative displacement of segments subjected to vertical and horizontal loads, with all treatment configurations demonstrating clinical acceptability.
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Pandey V, Bhutia O, Nagori SA, Seith A, Roychoudhury A. Management of mandibular angle fractures using a 1.7 mm 3-dimensional strut plate. J Oral Biol Craniofac Res 2016; 6:35-40. [PMID: 26937367 DOI: 10.1016/j.jobcr.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022] Open
Abstract
AIM We report our experience with the use of 1.7 mm 3-dimentional (3D) strut plate for the management of mandibular angle fractures. METHODS This prospective study enrolled 15 patients in whom mandibular angle fractures were treated with 1.7 mm 3D plate using trans-buccal trochar. Patients were evaluated at 72 h, 2 weeks, 6 weeks and 12 weeks for fracture stability, occlusion, soft-tissue swelling, infection and post-operative inferior alveolar nerve damage. Other complications like wound dehiscence, non-union, mal-union and hardware failure were also assessed. RESULTS In the immediate post-operative period, fracture instability was seen in 1 (6.7%) patient which resolved by 2 weeks. Mild occlusal discrepancy was also noted in 1 (6.7%) patient. Wound dehiscence was seen in 5 (33.3%) patients and all resolved by local measures. 1 (6.7%) patient developed post-operative nerve paraesthesia. Immediate post-operative radiographic evaluation demonstrated optimal reduction in all cases with no inferior border gaping. No case of infection, hardware failure, non-union and mal-union was noted. CONCLUSION Within the limitations of the study, 1.7 mm 3D strut plate was found to be effective for management of non-communited mandibular angle fractures.
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Affiliation(s)
- Varnika Pandey
- Ex-Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shakil Ahmed Nagori
- Ex-Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith
- Professor, Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Professor and Head, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Mittal Y, Varghese KG, Mohan S, Jayakumar N, Chhag S. A Comparative Study of 3-Dimensional Titanium Versus 2-Dimensional Titanium Miniplates for Open Reduction and Fixation of Mandibular Parasymphysis Fracture. J Maxillofac Oral Surg 2016; 15:93-8. [PMID: 26929559 DOI: 10.1007/s12663-015-0780-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 03/05/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Three dimensional titanium plating system was developed by Farmand in 1995 to meet the requirements of semi rigid fixation with lesser complication. The purpose of this in vivo prospective study was to evaluate and compare the clinical effectiveness of three dimensional and two dimensional Titanium miniplates for open reduction and fixation of mandibular parasymphysis fracture. MATERIALS AND METHODS Thirty patients with non-comminuted mandibular parasymphysis fractures were divided randomly into two equal groups and were treated with 2 mm 3D and 2D miniplate system respectively. All patients were systematically monitored at 1st, 2nd, 3rd, 6th week, 3rd and 6th month postoperatively. The outcome parameters recorded were severity of pain, infection, mobility, occlusion derangement, paresthesia and implant failure. The data so collected was analyzed using independent t test and Chi square test (α = .05). RESULTS The results showed that one patient in each group had post-operative infection, occlusion derangement and mobility (p > .05). In Group A, one patient had paresthesia while in Group B, two patients had paresthesia (p > .05). None of the patients in both the groups had implant failure. There was no statistically significant difference between 3D and 2D miniplate system in all the recorded parameters at all the follow-ups (p > .05). CONCLUSION 3D miniplates were found to be better than 2D miniplates in terms of cost, ease of surgery and operative time. However, 3D miniplates were unfavorable for cases where fracture line was oblique and in close proximity to mental foramen, where they were difficult to adapt and more chances for tooth-root damage and inadvertent injury to the mental nerve due to traction.
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Affiliation(s)
- Yogesh Mittal
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Jodhpur, 342005 Rajasthan India
| | - K George Varghese
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, 686008 Kerala India
| | - S Mohan
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, 686008 Kerala India
| | - N Jayakumar
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, 686008 Kerala India
| | - Somil Chhag
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, 686008 Kerala India
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Singh A, Arunkumar KV. Standard 3D Titanium Miniplate Versus Locking 3D Miniplate in Fracture of Mandible: A Prospective Comparative Study. J Maxillofac Oral Surg 2015; 15:164-72. [PMID: 27298539 DOI: 10.1007/s12663-015-0817-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/07/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The purpose/aim of the study conducted was to compare the efficiency between two principles of plating system, 3D non locking mini plates versus 3D locking mini plates. MATERIALS AND METHODS A total of 20 adult patients were selected according to the inclusion criteria and divided into two groups of locking plates/screws and non-locking plates/screws of ten each. All patients were treated with 2.0 mm 3D locking and non locking mini plates and screw system. Comparison of ease of use, functional stability, operator's comfort were tabulated. RESULTS A total of 27 fractures in 20 patients were treated. Each group contained ten patients. Fracture reduction was good in all the cases. At the follow up of 3 months, all fractures had healed, only one patient had a occlusal discrepancy. CONCLUSION There was no difference in the stability in both the groups. Intra operatively locking group consumed more time in fixation as it demands precision in making a hole exactly in the centre of plate necessitating the use of drill guide. Clinical and radiographic healing was good in both the groups.
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Affiliation(s)
- Arjun Singh
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, NH-58, Subhartipuram, Meerut, U.P. India
| | - K V Arunkumar
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, NH-58, Subhartipuram, Meerut, U.P. India
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Tay ABG, Lai JB, Lye KW, Wong WY, Nadkarni NV, Li W, Bautista D. Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures. J Oral Maxillofac Surg 2015; 73:1328-40. [DOI: 10.1016/j.joms.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
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Singh M, Agrawal A, Chaudhary M, Kaur G, Harjani B, Yadav A. Use of Three-dimensional Plates in Mid-face Fracture: A Prospective Study. J Contemp Dent Pract 2015; 16:571-577. [PMID: 26329413 DOI: 10.5005/jp-journals-10024-1724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of our study was to evaluate the advantages and disadvantages of three-dimensional (3D) plating system in the treatment of mid-face fractures. PATIENTS AND METHODS Thirty mid-face fractures in 18 patients at various anatomic locations were treated by open reduction and internal fixation using 3D plates. All patients were followed at regular intervals of 4th, 8th and 12th weeks respectively. Patients were assessed postoperatively for postoperative complication and occlusal stability. The incidence of neurosensory deficit, infection, masticatory difficulty, nonunion and malunion was also assessed. RESULTS A significant reduction in fracture (72.2%) and occlusal stability (72.2%) was seen. The overall complication rate was (16.6%) which included two patients who developed postoperative 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 nonunion and malunion was noted. CONCLUSION Single 3D titanium plates with 1.7 mm diameter holes and 1.7 mm screws were reliable and an effective treatment modality for mid-face fracture. CLINICAL SIGNIFICANCE Because of unique biogeometrical design owing to lesser amount of hardware material (fixation device) resulting into increased stability, the fixation in mid-face fractures is better in comparison to conventional 1.5 mm miniplate fixation.
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Affiliation(s)
- Manpreet Singh
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Amiya Agrawal
- Reader, Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow Uttar Pradesh, India, e-mail:
| | - Manoj Chaudhary
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Gagandeep Kaur
- Department of Conservative Dentistry and Endodontics Kothiwal Dental College and Research Centre, Moradabad Uttar Pradesh, India
| | - Bhupendra Harjani
- Department of Oral and Maxillofacial Surgery, KD Dental College, Mathura, Uttar Pradesh, India
| | - Arvind Yadav
- Department of Dentistry, Government Medical College, Banda Uttar Pradesh, India
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Comparison of three-dimensional plate versus double miniplate osteosynthesis for treatment of unfavorable mandibular angle fractures. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.tdj.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Muñante-Cardenas JL, Passeri LA. Biomechanical comparison of four mandibular angle fracture fixation techniques. Craniomaxillofac Trauma Reconstr 2015; 8:123-8. [PMID: 26000083 DOI: 10.1055/s-0034-1393737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/21/2014] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested.
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Affiliation(s)
| | - Luis Augusto Passeri
- Department of Surgery, School of Medical Sciences, State University of Campinas, Sao Paulo, Brazil
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Al-Moraissi E, Mounair R, El-Sharkawy T, El-Ghareeb T. Comparison between three-dimensional and standard miniplates in the management of mandibular angle fractures: a prospective, randomized, double-blind, controlled clinical study. Int J Oral Maxillofac Surg 2015; 44:316-21. [DOI: 10.1016/j.ijom.2014.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 10/12/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
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Surgical Management of Anterior Mandibular Fractures: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2014; 72:2507.e1-11. [DOI: 10.1016/j.joms.2014.07.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/19/2014] [Accepted: 07/30/2014] [Indexed: 11/18/2022]
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