Biomechanical Comparison of a New Technique of Mandibular Angle Fractures

Turgut, Gürsel; Kayali, Mahmut Ulvi; Soydan, Ali Tufan; Gündüz, Oğuzhan; Salman, Serdar; Oktar, Faik N.; Baş, Lütfü

doi:10.1097/scs.0b013e318165807b

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…Apesar da publicação de estudos in vitro a respeito de fraturas de ângulo mandibular e comportamento biomecânico (Alkan et al 2007;Bregagnolo et al 2011;Esen et al 2012;Haug et al 2002b;Haug et al 2001b;Shetty et al 1995b;Turgut et al 2008), muitos destes chegam a conclusões baseados em parâmetros que excedem aos encontrados in vivo, e embora pertinentes do ponto de vista da engenharia, são irrelevantes do ponto de vista clínico. Além disso, os estudos que comparam situações clínicas relevantes utilizam muitas vezes, um grupo limitado de possibilidades de tratamento (Haug et al 2001b).…”

Section: Discussionunclassified

“…Diversas formas de tratamento para fraturas de ângulo mandibular têm sido utilizadas e comparadas, porém a diversidade das características das fraturas associada à individualidade do paciente não permitem o estabelecimento de um único protocolo de tratamento Ellis 1999;Michelet et al 1973). As investigações experimentais in vitro avaliam as modalidades de tratamento para os diversos tipos de fraturas, com objetivo de compreender a biomecânica da interação entre a fratura e o sistema de fixação, além de desenvolver novos sistemas e técnicas de redução e fixação Turgut et al 2008).…”

Section: Introductionunclassified

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Development of plate of osteosynthes for mandibular angle fracture with boné loss

Goulart¹

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Despite the developments concerning the treatment of mandibular angle fractures, knowledge becomes limited when it comes to multiple fractures lines or loss of bone due to the lack of specific investigation in this field. Thus, the aim of this work is developing and evaluating a new design of internal fixation plate for the treatment of the complex mandibular fractures by the finite element method and mechanical testing. A three dimensional model of the fractured mandible was generated in Rhinocerus 4.0 software, and also was performed the modeling of the 2.0 mm system plates. The models have been exported to ANSYS ®, in which it was performed a static application of a force to generate displacement of 3 mm in the first molar region ipsilateral to the fracture. Three groups were evaluated according to the method of internal fixation: two plates of the 2.0 mm non-locking system, two plates of 2.0 mm locking system, and a plate with new design 2.0mm locking system. The computational model was transferred to an in vitro experiment with polyurethane mandibles with the same fixation groups and fracture pattern. Each group with five mandibles was subjected to linear loading test in a universal testing machine Instron Model 4411 to the displacement of 5 mm. A more balanced distribution of stress in the new plate design was observed. In addition, the new plate modified the mechanical behavior of the fractured region with a tendency to keep the approximate segments. However, the superiority of the reaction force of the group with two 2.0mm locking plates was observed (651.67 N). In the mechanical test the group with two locking plates showed greater resistance to the 3 mm displacement with statistically significant difference than the new plate group ( one-way ANOVA , F = 4.92 , p = 013) . A new plate for the treatment of mandibular angle fracture was developed, which, in the finite element analysis, showed a more balanced distribution of the stresses, however the group with two locking plates showed higher mechanical resistence. The new plate can replace two conventional plates without loss of mechanical resistence and with advantages of having the tendency to keep the fractured viii segments close when subjected to displacement and this use less material of internal fixation.

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Section: Discussionunclassified

Section: Introductionunclassified

Development of plate of osteosynthes for mandibular angle fracture with boné loss

Goulart¹

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Fixation of mandibular angle fractures: in vitro biomechanical assessments and computer-based studies

Chrcanovic

2012

Oral Maxillofac Surg

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The osteosynthesis positions as well as the plating technique play important roles in the stability of MAF repair. The only in vitro study evaluating the use of wire osteosynthesis concluded that wires placed through the lower border approach would provide greater stability than those at the upper border. Many studies indicate that the use of two miniplates avoids (or decreases) lateral displacement of the lower mandibular border and opening of the inferior fracture gap. Some studies even suggest that the use of two miniplates may be considered a more "rigid" fixation technique for MAFs than the use of a reconstruction plate. When using two miniplates, the biplanar plate orientation provides greater biomechanical stability than the monoplanar one. However, despite its greater biomechanical stability, the two-miniplate technique has some disadvantages that should also be taken into account. Studies with biodegradable plates suggest the use of at least two plates for each MAF. There are few studies with compression plates, and they have not yet reached a consensus. The solitary lag screw proved to withstand the functional loading of the mandible; however, only few biomechanical assessments were performed. In vitro studies have shown good biomechanical stability with the use of 3-D grid plates. The use of malleable miniplates alone is not sufficient to withstand the early postoperative bite force. Some studies suggest that the segment of the tension band miniplate located at the distal fragment of the MAF should be fixed with three screws. The studies also showed some limitations. None considered the stabilization of the fracture site afforded by the masseter-pterygoid muscle pouch. Most of the studies did not evaluate plating system strength in the long term and therefore did not observe the effect of resorption on the strength of the different biodegradable plating systems. Another limitation of many studies is the absence of a control group. A confounding factor that could not be tested in in vitro investigations is the additional resistance to displacement of jagged fracture margins present in the human fracture.

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Study of fixation of a mandibular plate for favourable fractures of the mandibular angle: numerical predictions

Ramos

Semedo

Mesnard

2020

British Journal of Oral and Maxillofacial Surgery

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Biomechanical Comparison of a New Technique of Mandibular Angle Fractures

Cited by 5 publications

References 16 publications

Development of plate of osteosynthes for mandibular angle fracture with boné loss

Development of plate of osteosynthes for mandibular angle fracture with boné loss

Fixation of mandibular angle fractures: in vitro biomechanical assessments and computer-based studies

Study of fixation of a mandibular plate for favourable fractures of the mandibular angle: numerical predictions

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