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Daqiq O, Roossien CC, Wubs FW, van Minnen B. Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing. Sci Rep 2024; 14:11795. [PMID: 38782942 PMCID: PMC11116419 DOI: 10.1038/s41598-024-62011-4] [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] [Received: 01/26/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
The clinical finite element analysis (FEA) application in maxillofacial surgery for mandibular fracture is limited due to the lack of a validated FEA model. Therefore, this study aims to develop a validated FEA model for mandibular fracture treatment, by assessing non-comminuted mandibular fracture fixation. FEA models were created for mandibles with single simple symphysis, parasymphysis, and angle fractures; fixated with 2.0 mm 4-hole titanium miniplates located at three different configurations with clinically known differences in stability, namely: superior border, inferior border, and two plate combinations. The FEA models were validated with series of Synbone polymeric mandible mechanical testing (PMMT) using a mechanical test bench with an identical test set-up. The first outcome was that the current understanding of stable simple mandibular fracture fixation was reproducible in both the FEA and PMMT. Optimal fracture stability was achieved with the two plate combination, followed by superior border, and then inferior border plating. Second, the FEA and the PMMT findings were consistent and comparable (a total displacement difference of 1.13 mm). In conclusion, the FEA and the PMMT outcomes were similar, and hence suitable for simple mandibular fracture treatment analyses. The FEA model can possibly be applied for non-routine complex mandibular fracture management.
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Affiliation(s)
- Omid Daqiq
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Charlotte Christina Roossien
- Engineering and Technology Institute Groningen, Department of Bio-Inspired MEMS and Biomedical Devices, University of Groningen, Nijenborgh 4, 9747 AG, Groningen, The Netherlands
| | - Frederik Wilhelm Wubs
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Nijenborgh 9, 9747 AG, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Jain M, Krishnan V, Panneerselvam E, Raja VBK. Management of Lingual Cortex Fracture of Mandible Using Lingual Arch Bar: A Finite Element Analysis of Reduction with a Pilot Clinical Trial. J Maxillofac Oral Surg 2023; 22:979-986. [PMID: 38105814 PMCID: PMC10719211 DOI: 10.1007/s12663-023-02031-1] [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: 04/04/2023] [Accepted: 10/03/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Fractures of lingual cortex are frequently left untreated leading to poor resolution of patient's symptoms and function. Positioning an implant on same side of fracture would provide better reduction. The study aims at improving stability offered by Erich arch bar placed on lingual surface, by Finite element analysis (FEA) along with a pilot clinical trial. Methods Two FEA models were generated from CT scan of an individual having lingual cortex fracture: control model with labial arch bar and study model with lingual arch bar. Parameters assessed: Stress distribution (Mpa) along lines of osteosynthesis; Separation of fracture fragments (mm) across fracture line. Associated, was a clinical trial of 5 patients, managed by placing lingual arch bar. Feasibility of arch bar, post-operative pain, radiographic inter-fragmentary gap and complications were assessed clinically. Results Lingual positioning of arch bar demonstrated less displacement (mm) of fracture fragments compared to labial placement (0.123 vs. 0.677) upon application of masticatory load. Insignificant lingual splay and lesser degree of stress distribution (Mpa) was observed (83.1 vs. 99.3) favoring placement of arch bar on lingual side. Clinical trial correlated with outcomes of FEA, resulting in improvement of patient's symptoms. Conclusion FEA and supporting clinical trial provided an effective method of reduction for lingual cortical fracture.
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Affiliation(s)
- Meghana Jain
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - Velavan Krishnan
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - V. B. Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
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Guerra RC, de Fátima Borim Pulino B, Salomão Júnior VF, Dos Santos Pereira R, Thieringer FM, Sacco R, Sader R, Vieira EH. Finite element analysis of low-profile reconstruction plates for atrophic mandibles: a comparison of novel 3D grid and conventional plate designs. Oral Maxillofac Surg 2023:10.1007/s10006-023-01173-3. [PMID: 37516667 DOI: 10.1007/s10006-023-01173-3] [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: 01/05/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES This study aimed to compare the reconstruction with type 2.4 and three-dimensional (3D) grid plates relating the areas of weakness to anatomical regions of force incidence in atrophic mandibles with and without segmentation using finite element analysis (FEA). MATERIALS AND METHODS Strength and force quality in the mandible were also determined. The atrophic mandible models with and without segmentation were divided into four groups, and the behavior of each plate was analyzed using finite element analysis. In the atrophic mandible without segmentation using the type 2.4 reconstruction plate, the highest stress concentration in the plate was observed in the posterior region of the mandibular body and in the grid type 3D reconstruction plate was observed in the mandibular angle. RESULTS In the segmented atrophic mandible with the 2.4 reconstruction plate, higher stress concentration was observed in the mandibular segment defect. Analysis of the 3D grid-like reconstruction plate revealed that the geometry of the plate conferred greater stiffness to the assembly, as the most significant stress concentration was observed at the mandibular angle. CONCLUSION The width of the plate design may influence the strength, not the thickness.
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Affiliation(s)
- Raphael Capelli Guerra
- Research and Education Institute - Hospital Sírio Libanes, DASA/Leforte Group, São Paulo State University Araraquara - UNESP, São Paulo Metodista University, São Paulo, Brazil
| | - Bianca de Fátima Borim Pulino
- Research and Education Institute, Hospital Sírio Libanes; São Paulo State University Araçatuba; DASA/Leforte Group, São Paulo Metodista University, Praça Francisco Manuel, 72, São Paulo, 01541-020, Brazil.
| | | | | | | | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, London, UK
| | - Robert Sader
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt Am Main, Frankfurt, Hessen, Germany
| | - Eduardo Hochuli Vieira
- DASA/Leforte Group, Research and Education Institute, Hospital Sírio Libanes; São Paulo State University - UNESP, Araraquara, Brazil
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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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Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances. Polymers (Basel) 2022; 14:polym14142782. [PMID: 35890557 PMCID: PMC9316877 DOI: 10.3390/polym14142782] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 02/06/2023] Open
Abstract
Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.
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Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery. Sci Rep 2020; 10:18143. [PMID: 33097757 PMCID: PMC7584639 DOI: 10.1038/s41598-020-75299-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022] Open
Abstract
To guide the selection of osteosynthesis systems, this study compared the mechanical properties of biodegradable and titanium osteosynthesis systems. SonicPins Rx and xG were subjected to pull-out tests. Additionally, 15 biodegradable (Inion CPS 2.0 and 2.5 mm; LactoSorb 2.0 mm; Macropore 2.0 mm; Polymax 2.0 mm; BioSorb FX 2.0 mm; ResorbX 2.1 mm; Osteotrans-MX 2.0 mm with plate thicknesses 1.0 and 1.4 mm; SonicWeld Rxplate/Rxpins, xGplate/Rxpins and xGplate/xGpins 2.1 mm without and with tapping the burr hole) and six titanium (CrossDrive (2006), CrossDrive (2018), MaxDrive; all 1.5 and 2.0 mm) straight, four-hole osteosynthesis systems were evaluated. All systems were subjected to tensile, bending and torsion tests. Pull-out loads of the SonicPins were comparable (P = 0.423). Titanium systems’ tensile loads were higher than biodegradable systems (P < 0.001). CrossDrive (2018) and MaxDrive systems’ tensile and torsional stiffness were lower, accompanied with higher ductility, than corresponding CrossDrive (2006) systems (P < 0.001). Bending stiffness of 1.5 mm titanium systems was comparable to, and of the 2.0 mm systems higher than, all biodegradable systems (P < 0.001). Regarding biodegradable systems, Inion CPS 2.5 mm had highest tensile load and torsional stiffness, SonicWeld 2.1 mm highest tensile stiffness, and BioSorbFX 2.0 mm highest bending stiffness (P < 0.001). On the basis of the results of this study, the CrossDrive (2018) and MaxDrive 1.5 mm titanium systems are recommended for midface fractures (e.g., zygomatic or maxillary fractures) and osteotomies (e.g., Le Fort I osteotomy), and the CrossDrive (2018) and MaxDrive 2.0 mm titanium systems for mandibular fractures and osteotomies when a titanium osteosynthesis system is used. When there is an indication for a biodegradable osteosynthesis system, the SonicWeld 2.1 mm or BioSorbFX 2.0 mm are recommended for midface fractures and osteotomies, and the Inion CPS 2.5 mm biodegradable system for mandibular osteotomies and non-load bearing mandibular fractures, especially when high torsional forces are expected (e.g., mandibular symphysis fractures).
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The Influence of the Gonial Angle on the Initial Biomechanical Stability of the Plate Osteosynthesis in Polyurethane Mandibles With Angle Fractures. J Craniofac Surg 2020; 31:871-875. [PMID: 31895842 DOI: 10.1097/scs.0000000000006099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to examine the biomechanical stability of the mandibular angle fractures (MAF) fixated with standard titanium miniplates in polyurethane models with different gonial angles (GA). Three custom molds were prepared for 3-dimensional printed mandibles with low, normal and high GA. Twenty polyurethane replicas were cast per group and standard MAFs were created on each sample. Fractures were stabilized with 1 4-hole standard titanium miniplate inserted over the superior alveolar border. Half of the samples were subjected to molar loading and the other half to the incisal loading up until 150 N force magnitude. The load-displacement curves and the horizontal moment arms were recorded and analyzed. The samples with high GA demonstrated greater displacement than those with normal and low GA during molar loading (P < 0.05 for both). After correcting for the effects of the moment arm, the incisal loading also resulted in higher mean displacement in the high GA group than the others (P < 0.05 for both) and the normal GA samples showed higher displacement after 100 N level compared to those in low GA (P < 0.05). Within the limits of this in vitro study, it can be concluded that the MAFs of the polyurethane mandibles with high GA fixated with 1 standard monocortical plate are more likely to demonstrate higher displacement values under the effects of the molar and incisal loadings than do the mandibles with normal and low GA.
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Assessment of Lingual Stability in Mandible Fracture: Monocortical Versus Bicortical Fixation Using FEM Analysis. J Maxillofac Oral Surg 2018; 17:514-519. [PMID: 30344395 DOI: 10.1007/s12663-017-1073-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022] Open
Abstract
Aim of the study The present study compares lingual stability of monocortical miniplate fixation with that of bicortical miniplate fixation in parasymphysis fracture using FEM analysis. Materials and methods Using multislice CT scanner, 3D FEM of patient's mandible was created. Fracture was simulated at parasymphysis region and fixed with 2-mm titanium miniplates and screws of length 8, 10, 12 mm, respectively. Loading force of 120 N applied at molar region and 62.8 N at incisor region. These three models were imported into ANSYS Workbench FEM software. Result There is no significant difference in results between bicortical fixation and monocortical fixation. Conclusion It was concluded that use of monocortical fixation provides sufficient lingual stability. This suggests monocortical fixation system is as reliable as bicortical fixation.
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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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Liu YF, Fan YY, Jiang XF, Baur DA. A customized fixation plate with novel structure designed by topological optimization for mandibular angle fracture based on finite element analysis. Biomed Eng Online 2017; 16:131. [PMID: 29141673 PMCID: PMC5688740 DOI: 10.1186/s12938-017-0422-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/10/2017] [Indexed: 12/26/2022] Open
Abstract
Background The purpose of this study was to design a customized fixation plate for mandibular angle fracture using topological optimization based on the biomechanical properties of the two conventional fixation systems, and compare the results of stress, strain and displacement distributions calculated by finite element analysis (FEA). Methods A three-dimensional (3D) virtual mandible was reconstructed from CT images with a mimic angle fracture and a 1 mm gap between two bone segments, and then a FEA model, including volume mesh with inhomogeneous bone material properties, three loading conditions and constraints (muscles and condyles), was created to design a customized plate using topological optimization method, then the shape of the plate was referenced from the stress concentrated area on an initial part created from thickened bone surface for optimal calculation, and then the plate was formulated as “V” pattern according to dimensions of standard mini-plate finally. To compare the biomechanical behavior of the “V” plate and other conventional mini-plates for angle fracture fixation, two conventional fixation systems were used: type A, one standard mini-plate, and type B, two standard mini-plates, and the stress, strain and displacement distributions within the three fixation systems were compared and discussed. Results The stress, strain and displacement distributions to the angle fractured mandible with three different fixation modalities were collected, respectively, and the maximum stress for each model emerged at the mandibular ramus or screw holes. Under the same loading conditions, the maximum stress on the customized fixation system decreased 74.3, 75.6 and 70.6% compared to type A, and 34.9, 34.1, and 39.6% compared to type B. All maximum von Mises stresses of mandible were well below the allowable stress of human bone, as well as maximum principal strain. And the displacement diagram of bony segments indicated the effect of treatment with different fixation systems. Conclusions The customized fixation system with topological optimized structure has good biomechanical behavior for mandibular angle fracture because the stress, strain and displacement within the plate could be reduced significantly comparing to conventional “one mini-plate” or “two mini-plates” systems. The design methodology for customized fixation system could be used for other fractures in mandible or other bones to acquire better mechanical behavior of the system and improve stable environment for bone healing. And together with SLM, the customized plate with optimal structure could be designed and fabricated rapidly to satisfy the urgent time requirements for treatment.
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Affiliation(s)
- Yun-Feng Liu
- Key Laboratory of E &M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou, 310014, Zhejiang, China.
| | - Ying-Ying Fan
- Key Laboratory of E &M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou, 310014, Zhejiang, China
| | - Xian-Feng Jiang
- Key Laboratory of E &M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou, 310014, Zhejiang, China
| | - Dale A Baur
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
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Simple Percutaneous Transbuccal Approach for Management of Mandibular Angular Fracture. J Craniofac Surg 2017; 28:1035-1037. [DOI: 10.1097/scs.0000000000003539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Osteosynthesis using cannulated headless Herbert screws in mandibular angle fracture treatment: A new approach? J Craniomaxillofac Surg 2017; 45:526-539. [PMID: 28256384 DOI: 10.1016/j.jcms.2017.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/18/2016] [Accepted: 01/20/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Fractures of the mandibular angle are a common type of facial skull fracture. Although operative treatment includes a wide range of fixation techniques, a definite gold standard method has yet to be established. Headless, cannulated Herbert screws, often used in many forms of minimally invasive trauma surgery, provide functional and stable fracture fixation. MATERIALS AND METHODS In a prospective, double-randomised, controlled, parallel-group - designed, in vitro trial, the biomechanical behaviour of the Herbert bone screw system was compared to that of a conventional locking plate system in 40 mandibular angle fractures of human mandible cadaver phantoms. RESULTS The mean stress values were 250 (±68.0) N in the plate subgroup and 200 (±61.0) N in the screw subgroup. The respective mean strain values were 7.90 (±2.7) mm and 6.90 (±2.2) mm, and the respective mean stiffness were values 1.10 (±0.61) N/m and 0.78 (±0.40) N/m. The differences in the results obtained using the two treatments were not significant (p = 0.55). CONCLUSIONS The biomechanical behaviour of the two fixation systems within the tested loads did not significantly differ with respect to postoperative parameters clinically relevant in osteosynthesis. Both systems met the mandibular angle assessment criterion, which is considered to be sufficient for clinical use. The results indicate the potential clinical utility of these two systems, and recommend further testing.
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Raut R, Keerthi R, Vaibhav N, Ghosh A, Kamath Kateel S. Single Miniplate Fixation for Mandibular Symphysis and Parasymphysis Fracture as a Viable Alternative to Conventional Plating Based on Champy's Principles: A Prospective Comparative Clinical Study. J Maxillofac Oral Surg 2017; 16:113-117. [PMID: 28286395 PMCID: PMC5328869 DOI: 10.1007/s12663-016-0919-1] [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: 09/15/2015] [Accepted: 05/17/2016] [Indexed: 10/21/2022] Open
Abstract
To compare long term and short term outcomes of fixing mandibular symphysis and parasymphysis fractures with single mini plate and conventional fixation using two mini plates. STUDY DESIGN in this prospective clinical comparative study, 30 patients with fracture in study region were randomly divided into two groups. Group A patients received single 2.5 mm titanium miniplate and Group B patients received two 2 mm titanium miniplates as per Champy's lines of osteosynthesis. Patients were followed up at intervals of 1, 12 and 24 weeks. Parameters assessed were: duration of surgery, fracture stabilization, paresthesia, occlusion and wound dehiscence. Statistically significant difference was observed in mean duration of surgery and wound dehiscence (P < 0.05). No significant difference was observed with respect to other parameters. Single 2.5 mm miniplate for mandibular symphysis and parasymphysis fractures is a time saving and cost effective technique with post-operative outcomes similar to conventional 2 plate fixation.
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Affiliation(s)
- Rohan Raut
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, VV Puram, Bangalore, 560004 India
| | - R. Keerthi
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, VV Puram, Bangalore, 560004 India
| | - N. Vaibhav
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, VV Puram, Bangalore, 560004 India
| | - Abhishek Ghosh
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, VV Puram, Bangalore, 560004 India
| | - Shashidhara Kamath Kateel
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, VV Puram, Bangalore, 560004 India
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Kim SS, Kwak KH, Ko CC, Park SB, Son WS, Kim YI. Comparison of postoperative changes in the distal and proximal segments between conventional and sliding mini-plate fixation following mandibular setback. Korean J Orthod 2016; 46:372-378. [PMID: 27896211 PMCID: PMC5118216 DOI: 10.4041/kjod.2016.46.6.372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/10/2016] [Accepted: 05/07/2016] [Indexed: 11/10/2022] Open
Abstract
Objective The purpose of the present study was to evaluate the postoperative three-dimensional (3D) changes in the proximal segments after mandibular setback sagittal split ramus osteotomy and to compare the changes between the conventional mini-plate fixation and semi-rigid sliding plate fixation. Methods Cone-beam computed tomography (CBCT) images were used to evaluate the postoperative 3D changes in the proximal segments during the healing process. CBCT images were superimposed using the symphysis and the lower anterior mandible as references. Results There were no statistically significant differences between the conventional mini-plate and semi-rigid sliding plate groups (p > 0.05). With respect to the distribution of changes greater than 2 mm in the landmarks, the right condylion, right coronoid process, and left condylion showed ratios of 55.6%, 50.0%, and 44.4%, respectively, in the semi-rigid sliding plate group; however, none of the landmarks showed ratios greater than 30% in the conventional mini-plate group. Conclusions There were no statistically significant differences in postoperative changes in the segments between the conventional mini-plate and semi-rigid sliding plate groups. Nevertheless, while selecting the type of fixation technique, clinicians should consider that landmarks with greater than 2 mm changes were higher in the semi-rigid sliding plate group than in the conventional mini-plate group.
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Affiliation(s)
- Seong-Sik Kim
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Kyoung-Ho Kwak
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Ching-Chang Ko
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Soo-Byung Park
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Woo-Sung Son
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Yong-Il Kim
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea.; Department of Orthodontics, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.; Institute of Translational Dental Sciences, Pusan National University, Busan, Korea
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Wang R, Liu Y, Wang JH, Baur DA. Effect of interfragmentary gap on the mechanical behavior of mandibular angle fracture with three fixation designs: A finite element analysis. J Plast Reconstr Aesthet Surg 2016; 70:360-369. [PMID: 27939907 DOI: 10.1016/j.bjps.2016.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/04/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to simulate stress and strain distribution numerically on a normal mandible under physiological occlusal loadings. The results were compared with those of mandibles that had an angle fracture stabilized with different fixation designs under the same loadings. The amount of displacement at two interfragmentary gaps was also studied. MATERIALS AND METHODS A three-dimensional (3D) virtual mandible was reconstructed with an angle fracture that had a fracture gap of either 0.1 or 1 mm. Three types of plate fixation designs were used: Type I, a miniplate was placed across the fracture line following the Champy technique; Type II, two miniplates were used; and Type III, a reconstruction plate was used on the inferior border of the mandible. Loads of 100 and 500 N were applied to the models. The maximum von Mises stress, strain, and displacement were computed using finite element analysis. The results from the control and experimental groups were analyzed and compared. RESULTS The results demonstrated that high stresses and strains were distributed to the condylar and angular areas regardless of the loading position. The ratio of the plate/bone average stress ranged from 215% (Type II design) to 848% (Type I design) irrespective of the interfragmentary gap size. With a 1-mm fracture gap, the ratio of the plate/bone stress ranged from 204% (Type II design) to 1130% (Type I design). All strains were well below critical bone strain thresholds. Displacement on the cross-sectional mapping at fracture interface indicated that uneven movement occurred in x, y, and z directions. CONCLUSIONS Interfragmentary gaps between 0.1 and 1 mm did not have a substantial effect on the average stress distribution to the fractured bony segments; however, they had a greater effect on the stress distribution to the plates and screws. Type II fixation was the best mechanical design under bite loads. Type I design was the least stable system and had the highest stress distribution and the largest displacement at the fracture site.
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Affiliation(s)
- Russell Wang
- Department of Comprehensive Care, Case Western Reserve University, School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4905, USA.
| | - Yunfeng Liu
- Department of Mechanical Engineering, Key Laboratory of E&M, Zhejiang University of Technology, 18 Tsao Wong Road, Hangzhou, Zhejiang 310014, China
| | - Joanne Helen Wang
- Department of Orthopedic Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44016, USA
| | - Dale Allen Baur
- Department of Oral and Maxillofacial Surgery, Case Western Reserve University, School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4905, USA
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Chen S, Zhang Y, An JG, He Y. Width-Controlling Fixation of Symphyseal/Parasymphyseal Fractures Associated With Bilateral Condylar Fractures With 2 2.0-mm Miniplates: A Retrospective Investigation of 45 Cases. J Oral Maxillofac Surg 2016; 74:315-27. [DOI: 10.1016/j.joms.2015.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/27/2015] [Accepted: 09/27/2015] [Indexed: 11/25/2022]
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de Medeiros RC, Sigua EA, Navarro P, Olate S, Albergaria Barbosa JR. In Vitro Mechanical Analysis of Different Techniques of Internal Fixation of Combined Mandibular Angle and Body Fractures. J Oral Maxillofac Surg 2015; 74:778-85. [PMID: 26701138 DOI: 10.1016/j.joms.2015.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate in vitro resistance of 5 techniques of internal fixation of bilateral fractures involving the mandibular angle and body. MATERIALS AND METHODS Twenty-five polyurethane mandibles were used as substrates, fixed with a 2-mm fixation system, and divided into 5 groups: I, 1 4-hole plate, without intermediate space, in the neutral zone of the mandibular body and another similar plate in the external oblique ridge of the contralateral mandibular angle; II, 1 6-hole plate, with intermediate space, in the neutral zone of the mandibular body and a similar plate in the external oblique ridge of the left mandibular angle; III, 1 4-hole locking plate, with intermediate space, in the right neutral zone and another similar plate in the left external oblique ridge; IV, 2 4-hole plates, with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body, and 1 4-hole plate, with intermediate space, in the external oblique ridge of the contralateral mandibular angle; V, 2 4-hole plates with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body and similarly in the buccal side of the left mandibular angle. Mandibles were subjected to vertical linear load tests by a mechanical testing machine (Instron 4411, Instron Corp, Norwood, MA) to record peak load and load for displacements of 3, 5, and 7 mm. RESULTS Group I had the least mechanical resistance of all groups, regardless of displacement, and group IV had the greatest mechanical resistance. Among groups II, III, and V, there was no statistically meaningful difference. CONCLUSION Fixation of bilateral mandibular fractures involving the mandibular angle and body using 2 plates in the region of the body and 1 plate in the tension zone in the region of the mandibular angle was the technique that presented the best mechanical resistance.
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Affiliation(s)
- Raquel Correia de Medeiros
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil.
| | - Eder Alberto Sigua
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Pablo Navarro
- Assistant Professor, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile
| | - Sergio Olate
- Assistant Professor and Head, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco; Associated Research, Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
| | - Jose Ricardo Albergaria Barbosa
- Adjunct Professor, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
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Kumar S, Gattumeedhi SR, Sankhla B, Garg A, Ingle E, Dagli N. Comparative evaluation of bite forces in patients after treatment of mandibular fractures with miniplate osteosynthesis and internal locking miniplate osteosynthesis. J Int Soc Prev Community Dent 2014; 4:S26-31. [PMID: 25452924 PMCID: PMC4247547 DOI: 10.4103/2231-0762.144575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aims and Objectives: The aim of present study was to compare the stability of fractured mandibular fragments under functional load, when fixed with conventional miniplate and internal locking miniplate. Materials and Methods: Bite force (in kg) recorded in twenty mandible fractured patients and fifty normal healthy individuals. Bite force was measured at incisor and molar regions. Comparative evaluation of bite force generated was performed between 10 cases treated with conventional miniplates and 10 cases treated with internal locking miniplates. Bite force generated by patients in mandibular fracture between symphysis and the angle of mandible was recorded in incisor and molar regions preoperatively. The fracture fragments were fixed using the above fixation techniques. Then same recording was undertaken on the 7th, 14th, 21st, 28th, and 90th days postoperatively. Results: Bite force generated by patients treated with locking plates at the 7th, 14th, 21st, 28th, and 90th postoperative days was significantly higher as compared to those in patients treated with miniplates. Conclusion: It was observed in our study that the locking plate/screw system offers significant advantages over the conventional plating system. There are no intraoperative difficulties associated with placement of the plate.
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Affiliation(s)
- Saurab Kumar
- Department of Oral and Maxillofacial Surgery, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Shashank Reddy Gattumeedhi
- General Dental Practitioner, Vokkaligara Sangha Dental College and Hospital, Bangalore, Karnataka, India
| | - Bharat Sankhla
- Department Oral Pathology, Government Dental College and Hospital, Jaipur, India
| | - Akshay Garg
- Department of Endodontics, Jaipur Dental College and Hospital, Jaipur, Rajasthan, India
| | - Ekta Ingle
- Department of Oral Medicine and Radiology, Vasantdada Dental College, Sangli, Maharashtra, India
| | - Namrata Dagli
- Editor in chief, Journal of Health Research and Review, Ahmedabad, Gujarat, India
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Joshi U, Kurakar M. Comparison of Stability of Fracture Segments in Mandible Fracture Treated with Different Designs of Mini-Plates Using FEM Analysis. J Maxillofac Oral Surg 2014; 13:310-9. [PMID: 25018606 PMCID: PMC4082558 DOI: 10.1007/s12663-013-0510-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/22/2013] [Indexed: 10/27/2022] Open
Abstract
AIM To compare the displacement gap of mandible fracture segments treated with different designs of mini-plates under various loading conditions. MATERIALS AND METHODS Fracture in the body of mandible was bridged with 15 different designs and configuration of titanium mini-plates. Bite forces were applied at 3 locations, ipsilateral fractured side, contra lateral side and incisor site. 3D finite element methods (FEM) model of mandible was generated using 10 nodal tetrahedral elements. A commercial FE solver was used to solve bone inter fragmentary displacement during loading. RESULTS Superior position of mini-plates produced better stability than inferior position. Positive bending moments can be reduced by larger plate in lower border in 2 plate system. Results of X mini-plate are comparable to 2 plate configuration. If length of middle portion of plate increased, stability decreased. Number of screws did not affect fracture stability. CONCLUSION Finite element methods analysis is used to determine the gap between mandible fragments which is otherwise impossible to measure clinically. The results obtained from this study offered us a choice of mini-plate design and configuration for clinical application.
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Affiliation(s)
- Udupikrishna Joshi
- Department of Oral and Maxillofacial Surgery, S. Nijalingappa Institute of Dental Sciences, Sedam Road, Gulbarga, 585105 Karnataka India
| | - Manju Kurakar
- Department of Oral and Maxillofacial Surgery, S. Nijalingappa Institute of Dental Sciences, Sedam Road, Gulbarga, 585105 Karnataka India
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Trivellato P, Pepato A, Ribeiro M, Sverzut C, Trivellato A. In vitro evaluation of the resistance of a 2.0-mm titanium fixation system in the sectioned angle without continuity of the inferior border of the mandible. Int J Oral Maxillofac Surg 2014; 43:559-63. [DOI: 10.1016/j.ijom.2013.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/17/2022]
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21
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Falci SGM, Rodrigues DC, Marchiori EC, Brancher G, Makyama A, Fernandes Moreira RW. Assessment of the fixation of mandibular symphysis fractures using conical cannulated screws: mechanical and photoelastic tests. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:174-80. [PMID: 24906943 DOI: 10.1016/j.oooo.2014.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with other fixation methods in mandibular symphysis fractures. STUDY DESIGN Ten polyurethane mandibles were allocated to each group and fixed as follows: group PRP, 2 perpendicular miniplates; group PLL, 1 miniplate and 1 plate, parallel; and group CS, 2 cannulated screws. Vertical linear loading tests were performed. The differences between mean values were analyzed with the Tukey test. The photoelastic test was carried out using a polariscope. RESULTS The results revealed differences between the CS and PRP groups at 1, 3, 5, and 10 millimeters of displacement. The photoelastic test confirmed higher stress concentration in all groups close to the mandibular base, whereas the CS group showed it throughout the region assessed. CONCLUSIONS Conical cannulated screws performed well in mechanical and photoelastic tests.
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Affiliation(s)
- Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Surgery Section, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Danillo Costa Rodrigues
- Oral and Maxillofacial Surgery Section, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Giulia Brancher
- Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Andréia Makyama
- Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Roger William Fernandes Moreira
- Oral and Maxillofacial Surgery Section, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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22
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Saluja H, Dehane V, Kini Y, Mahindra U, Gaikwad P. Use of miniplates in parasymphysis fractures : a survey conducted among oral and maxillofacial surgeons of India. J Maxillofac Oral Surg 2014; 12:312-4. [PMID: 24431858 DOI: 10.1007/s12663-012-0426-y] [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: 03/14/2012] [Accepted: 07/15/2012] [Indexed: 10/27/2022] Open
Abstract
Aim of the study was to find out the number of miniplates used by Indian Oral and Maxillofacial Surgeons for parasymphysis fractures. A survey was done among Oral and Maxillofacial Surgeons of India at the 34th annual meeting of Association of Oral and Maxillofacial Surgeons of India. Four questions were given to each individual to find out their opinion regarding use of miniplates in parasymphysis fractures. Eighty-eight per cent of Indian surgeons were in favour of using intra-operative or post-operative intermaxillary fixation. Thirty-eight per cent responded in favour of using single miniplate for parasymphysis fracture instead of using two miniplates. Fifty-four per cent maxillofacial surgeons use various modifications depending on different conditions. Forty-two per cent of maxillofacial surgeons accepted that lower arch bar can be used as a tension band. Use of miniplates for the treatment of parasymphysis fracture varies from centre to centre and from surgeon to surgeon. Though miniplates are best used following Champy's principle, still many surgeons use single miniplate. Arch bars placed for intermaxillary fixation can be used as a tension band, again eliminating the need for upper plate.
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Affiliation(s)
- Harish Saluja
- Department of Oral & Maxillofacial Surgery, Rural Dental College, Tal. Rahata, Ahmednagar, Loni, 413736 Maharashtra India
| | - Vipin Dehane
- Department of Oral & Maxillofacial Surgery, Rural Dental College, Tal. Rahata, Ahmednagar, Loni, 413736 Maharashtra India
| | - Yogesh Kini
- Department of Oral & Maxillofacial Surgery, Rural Dental College, Tal. Rahata, Ahmednagar, Loni, 413736 Maharashtra India
| | - Uma Mahindra
- Department of Oral & Maxillofacial Surgery, Rural Dental College, Tal. Rahata, Ahmednagar, Loni, 413736 Maharashtra India
| | - Prafful Gaikwad
- Department of Oral & Maxillofacial Surgery, Rural Dental College, Tal. Rahata, Ahmednagar, Loni, 413736 Maharashtra India
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23
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de Oliveira KP, de Moraes PH, da Silva JSP, de Queiroz WF, Germano AR. In vitro mechanical assessment of 2.0-mm system three-dimensional miniplates in anterior mandibular fractures. Int J Oral Maxillofac Surg 2013; 43:564-71. [PMID: 24239141 DOI: 10.1016/j.ijom.2013.10.008] [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: 04/04/2013] [Revised: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
Abstract
This study constituted a comparative assessment of the mechanical resistance of square and rectangular 2.0-mm system three-dimensional miniplates as compared to the standard configuration using two straight miniplates. 90 polyurethane replica mandibles were used for the mechanical trials. Groups 1, 2, and 3 simulated complete symphyseal fractures characterized by linear separation of the central incisors; groups 4, 5, and 6 simulated parasymphyseal fractures with an oblique configuration. Groups 1 and 4 represented the standard method with two straight miniplates set parallel to one another. Square miniplates were used in groups 2 and 5, and rectangular miniplates in groups 3 and 6. A universal testing machine set to a velocity of 10mm/min and delivering a vertical linear load to the first left molar was used to test each group. Maximum load values and load values with pre-established dislocation of 5mm were obtained and submitted to statistical analysis using a calculated reliability interval of 95%. The mechanical performances of the devices were similar, except in the case of rectangular plates used in the parasymphyseal fractures. The innovative fixation methods used showed significantly better results in the case of symphyseal fractures.
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Affiliation(s)
- K P de Oliveira
- Department of Oral and Maxillofacial Surgery, Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - P H de Moraes
- Department of Oral and Maxillofacial Surgery, Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - J S P da Silva
- Department of Oral and Maxillofacial Surgery, Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - W F de Queiroz
- Department of Oral and Maxillofacial Surgery, Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - A R Germano
- Department of Oral and Maxillofacial Surgery, Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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Xue AS, Koshy JC, Wolfswinkel EM, Weathers WM, Marsack KP, Hollier LH. A Prospective Study of Strut versus Miniplate for Fractures of Mandibular Angle. Craniomaxillofac Trauma Reconstr 2013; 6:191-6. [PMID: 24436758 DOI: 10.1055/s-0033-1349213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 01/27/2013] [Indexed: 10/26/2022] Open
Abstract
This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures. The patients were randomly assigned to receive the strut plate or Champy miniplate for angle fracture fixation. Patient demographics, fracture characteristics, operative and postoperative outcomes were collected prospectively. Statistical analysis was performed to evaluate the significance of the outcome. A total of 18 patients were included in this study and randomly assigned to receive either the strut plate or Champy miniplate. Out of which five patients were excluded postoperatively due to complex fracture resulting in postoperative maxillomandibular fixation. The final enrollment was 13 patients, N = 6 (strut) and N = 7 (Champy). There was no statistically significant difference in the pretreatment variables. Nine of these patients had other associated facial fractures, including parasymphyseal and subcondylar fractures. Most of the (11) patients had sufficient follow-up after surgery. Both groups exhibited successful clinical unions of the mandibular angle fractures. The complications associated with the mandibular angle were 20% in the strut plate group and 16.7% in the Champy group. One patient in the strut plate group had a parasymphyseal infection, requiring hardware removal. The strut plate demonstrated comparable surgical outcome as the Champy miniplate. It is a safe and effective alternative for management of mandibular angle fracture.
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Affiliation(s)
- Amy S Xue
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - John C Koshy
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Larry H Hollier
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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25
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Khiabani KS, Mehmandoost MK. Transoral Miniplate Fixation of Mandibular Angle Fracture with and without 2 Weeks of Maxillomandibular Fixation: A Clinical Trial Study. Craniomaxillofac Trauma Reconstr 2013; 6:107-14. [PMID: 24436745 DOI: 10.1055/s-0033-1333878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/20/2012] [Indexed: 10/27/2022] Open
Abstract
Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region provides sufficient strength to stabilize the fracture but others imply a second plate is required. Such controversies exist in the use of maxillomandibular fixation (MMF). The intention of the present study was to compare efficiency and complications of using one miniplate with and without MMF in mandibular angle fractures. Methods and Materials Forty patients with facial trauma with mandibular angle fractures including displaced and unfavorable fractures were categorized into two groups of 20 persons. In all patients, one miniplate was placed on the external oblique ridge. In the first group, patients had light maxillomandibular elastic bands just after surgery but no rigid MMF. In the second group, patients had rigid MMF for 2 weeks after surgery. Patients were followed to evaluate complications and treatment efficiency. Conclusions Our study showed that use of a single miniplate in the external oblique ridge is a functionally stable treatment for all types of angle fractures (including displaced and unfavorable fractures) except comminuted and long oblique fractures, which were not included in our study. Use of postoperative MMF did not improve the results.
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Affiliation(s)
- Kazem S Khiabani
- Oral and Maxillofacial Surgery, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
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Lee T, Sawhney R, Ducic Y. Miniplate Fixation of Fractures of the Symphyseal and Parasymphyseal Regions of the Mandible. JAMA FACIAL PLAST SU 2013; 15:121-5. [DOI: 10.1001/jamafacial.2013.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas Lee
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas (Drs Lee, Sawhney, and Ducic), and Departments of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville (Dr Sawhney), and University of Texas Southwestern Medical Center, Dallas (Dr Ducic)
| | - Raja Sawhney
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas (Drs Lee, Sawhney, and Ducic), and Departments of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville (Dr Sawhney), and University of Texas Southwestern Medical Center, Dallas (Dr Ducic)
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas (Drs Lee, Sawhney, and Ducic), and Departments of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville (Dr Sawhney), and University of Texas Southwestern Medical Center, Dallas (Dr Ducic)
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27
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A comparative evaluation of different treatment modalities for parasymphysis fractures: a pilot study. Int J Oral Maxillofac Surg 2012; 41:906-11. [DOI: 10.1016/j.ijom.2012.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 02/09/2012] [Accepted: 05/08/2012] [Indexed: 11/22/2022]
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Comparative Evaluation of Different Miniplates for Internal Fixation of Mandible Fractures Using Finite Element Analysis. J Oral Maxillofac Surg 2008; 66:1225-32. [PMID: 18486788 DOI: 10.1016/j.joms.2005.11.092] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Revised: 07/23/2005] [Accepted: 11/11/2005] [Indexed: 11/21/2022]
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Korkmaz HH. Evaluation of different miniplates in fixation of fractured human mandible with the finite element method. ACTA ACUST UNITED AC 2007; 103:e1-13. [PMID: 17468022 DOI: 10.1016/j.tripleo.2006.12.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 11/21/2006] [Accepted: 12/15/2006] [Indexed: 11/30/2022]
Abstract
The objective of this study was to develop a 3-dimensional finite element model (FEM) to formulate biomechanical justification of the positioning of different plates to achieve stable fixation of a fractured mandible. Miniplate systems that give acceptable levels of rigidity were investigated, and recommendations about miniplate location, orientation, and type selection are made. A fracture near the body region was bridged with a variety of commonly used plate configurations. Number, positioning and type of the plate system parameters. The results of this fracture model support the advantage of 2-plate systems. Using a longer plate in the superior position and a shorter one in the inferior position produced a more stable condition. Number of screws or length of the miniplate had no significant effect on the stability of fractured segments. The results obtained from this study offer the choice of a particular plate size, thickness, design, or configuration for application and thus provide information for clinical use.
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Affiliation(s)
- Hasan Husnu Korkmaz
- Civil Engineering Department, Engineering and Architecture Faculty, Selcuk University, Konya, Turkey.
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Kim Y, Smith J, Sercarz JA, Head C, Abemayor E, Blackwell KE. Fixation of mandibular osteotomies: Comparison of locking and nonlocking hardware. Head Neck 2007; 29:453-7. [PMID: 17252590 DOI: 10.1002/hed.20541] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND : The outcome of patients undergoing rigid plate fixation of symphyseal mandibular osteotomies for exposure, resection, and reconstruction of tumors in the oral cavity or oropharynx was analyzed to determine the impact of hardware selection on complications. METHODS : Forty-five patients underwent titanium plate rigid internal fixation of mandibular osteotomies during cancer resection and free flap reconstruction at an academic medical center. The incidence of hardware-related complications and mandibular nonunion was compared in patients receiving either locking hardware or nonlocking hardware. RESULTS : The incidence of osteotomy-related complications in patients with an inferior border nonlocking mandibular fracture plate was 21%. In the patients with locking hardware or an inferior border nonlocking mandibular fracture plate combined with a tension band, there were no hardware-related complications and no mandibular nonunions. This difference was statistically significant (chi(2) = 6.01, p < .05). CONCLUSIONS : Locking mandibular reconstruction plates are associated with fewer complications than inferior border nonlocking mandibular fracture plates for rigid fixation of mandibular osteotomies in patients undergoing resection of head and neck cancer.
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Affiliation(s)
- Young Kim
- Division of Head and Neck Surgery, Department of Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
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31
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Trivellato AE, Passeri LA. Evaluation of osteotomy fixation changing the number, the extension and the location of the plates. Br J Oral Maxillofac Surg 2006; 44:377-81. [PMID: 16263196 DOI: 10.1016/j.bjoms.2005.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 08/25/2005] [Indexed: 11/30/2022]
Abstract
We used a two-dimensional model that simulated a fractured human mandible to study the extent of load resistance of different plates. We studied 49 bovine ribs in seven groups using varying number (1 or 2), lengths of plates (4 or 6-holes), and location (near the lower or upper border). The number and location of plates had a greater effect on resistance to load than length of plates. The best mean resistance values were achieved by a combination of two parallel plates secured near the lower and upper borders, followed by single plates secured near the upper border. The lowest values were with single plates secured close to the lower border.
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Affiliation(s)
- Alexandre Elias Trivellato
- Oral and Maxillofacial Area, Piracicaba Dental School, State University of Campinas, Unicamp, São Paulo, Brazil.
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Agir H, Moore MH, David DJ, McLean NR, Cooter R. Fracture Patterns and Bone Healing in Recurrent Mandibular Fractures: A Clinical Study of 13 Patients. Plast Reconstr Surg 2005; 116:427-36; discussion 437-9. [PMID: 16079669 DOI: 10.1097/01.prs.0000172690.55146.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recurrent fractures of the previously treated fractured mandible are rare. METHODS In this retrospective study, 13 cases of repeated mandibular fractures were evaluated according to age, sex, cause, fracture localizations and patterns, treatment modalities, and complications. RESULTS All of the patients were men, with a mean age of 27.5 years and 32 years for the first and the subsequent fractures, respectively. The mean time interval between fractures was 4.3 years. In 10 cases, the cause for the second fracture was an assault, with 90 percent related to alcohol intake. Angle, body, and parasymphysis region of the mandible were the most common sites to be involved in the first occasion. In 10 cases, an internal rigid fixation procedure was performed for the treatment. In the recurrent injuries, none of the fractures occurred at exactly the same anatomical site. Fractures were either in the neighboring side or the contralateral side of the previously healed area of mandible. On the second occasion, angle fractures were common and body and subcondylar fracture rates increased. At second presentation, the complication rate increased from 23.1 percent to 53.8 percent and most commonly involving malocclusion. CONCLUSIONS This study showed that assault is the major etiologic factor for recurrent mandible fractures and that these fractures occur in different locations from the original injury. They necessitate a cautious approach for the prevention of unfavorable outcomes. Further retrospective clinical and experimental studies are necessary to elucidate the fracture patterns and bone-healing quality of these recurrent mandible fractures.
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Affiliation(s)
- Hakan Agir
- Department of Plastic and Reconstructive Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
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Feledy J, Caterson EJ, Steger S, Stal S, Hollier L. Treatment of mandibular angle fractures with a matrix miniplate: a preliminary report. Plast Reconstr Surg 2005; 114:1711-6; discussion 1717-8. [PMID: 15577338 DOI: 10.1097/01.prs.0000142477.77232.f7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mandibular angle fractures are technically challenging, and a spectrum of techniques for treatment of these fractures has been proposed in the literature. Currently, fixation with one or two miniplates has become a widely accepted method of providing internal fixation and eliminating the need for postoperative maxillomandibular fixation. In this study, the utility of a single 2.0-mm matrix miniplate for mandibular angle fracture management was examined. In a laboratory biomechanical analysis, the overall stability of the single 2.0-mm matrix miniplate compared favorably with two 2.0-mm miniplates in a simulated fracture setting. The matrix miniplate demonstrated an overall better intrinsic stability, more resistance to out-of-plane fracture movement, and a higher load tolerance when motion out-of-plane was challenged. Clinically, the matrix miniplate performed well. In a series of 22 consecutive patients, there were no cases of nonunion, malunion, or plate failure. Two patients developed infection that was managed in both cases by drainage with maintenance of the miniplate. Both went on to full union. These results compare very favorably to previously published series using one or two miniplates.
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Affiliation(s)
- Jules Feledy
- Division of Plastic and Reconstructive Surgery, Baylor College of MedicineHouston, Texas, USA
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Gear AJL, Apasova E, Schmitz JP, Schubert W. Treatment modalities for mandibular angle fractures. J Oral Maxillofac Surg 2005; 63:655-63. [PMID: 15883941 DOI: 10.1016/j.joms.2004.02.016] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Management of mandibular angle fractures is often challenging and results in the highest complication rate among fractures of the mandible. Optimal treatment for angle fractures remains controversial. Historically, treatment of mandible fractures included intraoperative maxillomandibular fixation (MMF) along with rigid internal fixation. More recently, noncompression plates miniplates, which produce only relative stability, have gained popularity. The absolute necessity of intraoperative MMF as an adjunct to internal fixation has also become controversial. The current trends in the management of simple, noncomminuted mandibular angle fractures are examined. MATERIALS AND METHODS A survey was submitted to North American and European AO ASIF (Arbeits-gemeinschaft fur Osteosynthesefragen Association for the Study of Internal Fixation) faculty in July 2001. Statistical analysis of results included both Fisher's exact and chi-square tests. Results were considered significant if P <.05. RESULTS One hundred ten of 127 potential responses were received (87%). Among 104 surgeons who treat mandible fractures, 86 (83%) treat more than 10 mandibular fractures per year. Preferred techniques for simple, noncomminuted mandibular angle fractures in this group were: single miniplate on the superior border (Champy technique) with or without arch bars (44 surgeons, 51%); tension band plate on the superior border and nonlocking, bicortical screw plate on the inferior border (11 surgeons, 13%); dual miniplates (9 surgeons, 10%); a locking screw plate on the inferior border only (6 surgeons, 7%), and 3-dimensional plates (5 surgeons, 6%). Eleven surgeons (13%) gave multiple answers. Although only 13% of surgeons surveyed primarily use the combination of tension band and nonlocking, bicortical screw plates, many surgeons (73%) continue to use this technique in certain circumstances. Within this group, 32 (51%) place screws in a neutral position, while 31 (49%) place screws in an eccentric position, resulting in compression. For simple noncomminuted angle fractures, the number of surgeons performing internal fixation without MMF were: 14 often (16%); 20 occasionally (23%); 17 seldom (20%); and 35 never (41%). Surgeons treating more than 10 versus those who treat less than 10 fractures per year, International versus North American faculty, and Oral and Maxillofacial surgeons (OMS) versus non-OMS surgeons were compared. Surgeons who treat more than 10 fractures per year favor the Champy technique over the tension band and bicortical plate combination (44 [51%] vs 11 [13%]), while those surgeons who treat less than 10 per year favor the tension band and bicortical plate combination over the Champy technique (9 [50%] vs 3 [17%]; P < .01, Fisher exact test). International faculty are less likely to use intraoperative MMF than North American faculty (29 [81%] vs 31 [43%]; P < .01, Fisher exact test). OMS surgeons are less likely to use the tension band and bicortical plate combination than non-OMS surgeons (22 [56%] vs 42 [90%]; P < .017, Fisher exact test). CONCLUSION This survey suggests an evolution in the management of mandibular angle fractures. A single miniplate plate on the superior border of the mandible has become the preferred method of treatment among AO faculty. When using large, inferiorly based plates more surgeons are now favoring neutral rather than eccentric screw placement. Intraoperative MMF is not considered mandatory by some surgeons in certain circumstances.
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Affiliation(s)
- Andrew J L Gear
- University of Minnesota and Regions Hospital, Department of Plastic and Hand Surgery, Saint Paul, MN 55101, USA
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Meyer C, Kahn JL, Boutemi P, Wilk A. Photoelastic analysis of bone deformation in the region of the mandibular condyle during mastication. J Craniomaxillofac Surg 2002; 30:160-9. [PMID: 12220995 DOI: 10.1054/jcms.2002.0297] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The purpose of this experimental study was to demonstrate the stress patterns arising in the region of the mandibular condyle during mastication. MATERIAL AND METHOD Stress analysis was performed using reflection photoelasticity to demonstrate deformation occurring on the surface of the mandible. The rami of three fresh dentate human mandibles were coated with a shell of photoelastic resin. Using a novel loading device, these mandibles were then subjected to external forces (muscular traction, resultant mandibular forces and intra-articular reaction force) reproducing a unilateral biting task between the first right molars. Deformations were measured from the working side. RESULTS The trace of isostatic lines from the isoclinic fringes revealed major differences in stress distributions between the three mandibles. These differences were attributed to differences in shape between the three mandibles. Conversely, we consistently found compressive stress patterns along the posterior border of the ramus and tensile stress patterns along the anterior border of the ramus and in the zone situated below the siqmoid notch. CONCLUSION These findings suggest that during this particular task, the mandible is subjected to sagittal forces which tend to straighten the mandibular angle. This implies that new concepts are needed for the positioning of osteosynthesis plates in the condylar region, close to the tensile strain lines, as has been recommended also for other parts of the mandible when applying semi-rigid internal fixation.
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Affiliation(s)
- Christophe Meyer
- Department of Maxillofacial Surgery, University Hospital of Strasbourg, France.
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Tams J, Van Loon JP, Otten B, Bos RR. A computer study of biodegradable plates for internal fixation of mandibular angle fractures. J Oral Maxillofac Surg 2001; 59:404-7; discussion 407-8. [PMID: 11289171 DOI: 10.1053/joms.2001.21877] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This computer-based study was performed to determine the suitability of small biodegradable plate systems for mandibular angle fractures. MATERIALS AND METHODS In a 3-dimensional computer model of the mandible, fracture mobility and plate strain were calculated for bite forces applied on 13 bite points on the dental arch. The angle fracture was fixed with 2 polylactide (PLA) midiplates or with 2 PLA maxiplates. The first plate was positioned buccally on the external oblique ridge. Two positions of the second plate were studied: halfway up the height of the mandible or on the lower border. Maximum fracture mobility was set at a limit of 150 microm to enable undisturbed fracture healing. Maximum plate strain was set at the yield strain of PLA. RESULTS Fixation with the PLA maxiplates, with the second plate positioned halfway up the height of the mandible, resulted in fracture mobility below the set limit for all bite points. For the other PLA fixation strategies, fracture mobility exceeded the set limit. Fixation with the second plate positioned halfway up the height of the mandible generally resulted in less fracture mobility than with the plate positioned on the lower border. The yield strain of PLA was not exceeded in any of the fixation strategies. CONCLUSIONS Based on the computer model, 2 PLA maxiplates are suitable for fixation of mandibular angle fractures. One plate should be positioned buccally on the external oblique ridge, and the other should be positioned halfway up the height of the mandible.
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Affiliation(s)
- J Tams
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands.
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Meyer C, Kahn JL, Lambert A, Boutemy P, Wilk A. Development of a static simulator of the mandible. J Craniomaxillofac Surg 2000; 28:278-86. [PMID: 11467391 DOI: 10.1054/jcms.2000.0149] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Our aim was to build and assess a static mandibular simulator capable of reproducing various masticatory exercises as closely as possible to physiological situations. Unlike existing devices that reproduce a small number of exercises and of muscular bundles, our simulator is able to reproduce all types of effort in the sagittal plane and integrates eleven muscular groups considered by the majority of authors as being the most important in mastication. The value of our simulator arises from its ability to replicate the external forces (including muscular traction, intra-articular reaction and resultant forces applied to the mandible) as determined in vivo during previous studies. The importance of such a versatile simulator, in addition to enabling study of the mechanical behaviour of the mandible, is that it greatly enhances evaluation of a possible mathematical model by means of finite element analysis. Stages of the development and evaluation of this device are described.
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Affiliation(s)
- C Meyer
- Department of Maxillofacial Surgery, Strasbourg University Hospital, France
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Meechan JG. The effect of mandibular third molar presence and position on the risk of an angle fracture. J Oral Maxillofac Surg 2000. [DOI: 10.1016/s0278-2391(00)90922-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tams J, Otten B, van Loon JP, Bos RR. A computer study of fracture mobility and strain on biodegradable plates used for fixation of mandibular fractures. J Oral Maxillofac Surg 1999; 57:973-81; discussion 981-2. [PMID: 10437725 DOI: 10.1016/s0278-2391(99)90020-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This computer-based study was done to determine whether a small biodegradable plate system was suitable for internal fixation of mandibular fractures. MATERIALS AND METHODS In a three-dimensional computer model of the mandible, fracture mobility and plate strain were calculated for bite forces applied on 13 bite points on the dental arch. Simulated solitary angle, body, and symphysis fractures were fixed with one titanium miniplate, one polylactide (PLA) midiplate, one PLA maxiplate, or two PLA midiplates. Fractures with and without interfragmentary bone contact were studied. In the case of fractures with bone contact, the loads were transmitted through the fracture surfaces and the plate; when there was no contact, the loads were transmitted only through the plate. Maximum fracture mobility was set at 150 microm. Maximum plate strain was set at the yield strain of PLA and titanium. RESULTS For fractures without interfragmentary bone contact, all plate fixations resulted in a fracture mobility and plate strain higher than the limits set, except for the symphysis fracture fixed with two PLA midiplates. Interfragmentary bone contact significantly reduced fracture mobility and plate strain. For the angle fracture with bone contact, all PLA plate fixations resulted in a fracture mobility above the limit, whereas the titanium miniplate fixation had a fracture mobility below the limit. For the body and symphysis fracture with bone contact, only double PLA midiplate fixation resulted in a fracture mobility below the limit. CONCLUSIONS From a mechanical point of view, based on the computer model, small PLA plates are only suitable for symphysis fractures with and without interfragmentary bone contact and for body fractures with interfragmentary contact. However, fixation with two PLA plates is always necessary to provide sufficient reduction of fracture mobility and plate strain.
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Affiliation(s)
- J Tams
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands.
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