Bite Force Assessment of Mandibular Interforaminal Fractures Treated with Combination of Microplate and Miniplate—A Randomized Control Study

Abstract

Trauma to the facial skeleton frequently results in injuries to the soft tissues, teeth, and major skeletal component of the face, including mandible, maxilla, zygoma, naso-orbito-ethmoid complex, and supra orbital fractures. 1Proper anatomical reduction, restoration of the premorbid occlusion, and proper fixation until stable osseointegration are considered as the basic principles in treating mandibular fractures. Miniplates and reconstruction plates are commonly used to treat simple and comminuted fractures of mandible. However, thick fixation plates are bulky and palpable through the thin skin and the gingiva. A large miniplate placement in the interforaminal region in upper half of the mandible can result in complications such as infection, wound healing problems, tooth-root injuries, or mass-effect problems due to limited space available. 2In the mandible, because of thick compact bone, the difficulty in identifying the course of the dental roots leads to the probability of injury to the teeth which is three times higher than in the maxilla. It is desirable to minimize the size and amount of osteosynthesis material used, as there are Keywords ► bite force ► mandible fracture ► microplate ► miniplate ► open reduction and internal fixation AbstractThe purpose of this study was to compare the mechanical behavior of combination of microplate and miniplate with two standard miniplates for fixation of mandibular fractures in the interforaminal region on the basis of bite force and other clinical parameters. A prospective randomized study was conducted on 20 patients with mandibular fracture requiring open reduction and internal fixation (ORIF) who were randomly categorized into Group A and Group B with 10 patients in each group. Ten healthy persons whose age and gender matched with study groups were included in control Group C. Pre-and postoperative bite force was measured at specified intervals in both the study groups and was compared with the control group. The bite force values were comparatively less in Group A than Group B, although there was no statistically significant difference. Also, bite force values were less in both the study groups when compared with the control group. No statistically significant difference was found in other clinical parameters such as infection, fracture mobility, and hardware failure. The results were suggestive that the use of microplate and miniplate combination in management of minimally displaced mandibular fractures in the interforaminal region provides stable fixation comparable to two miniplate combination.

Efficacy of microplates versus miniplates in the management of maxillofacial fractures

“…Sadove and Eppley,[ 41 ] Gupta et al .,[ 42 ] Xie et al .,[ 43 ] Huston and Stassen (2016)[ 44 ] Anand et al ., Abdullah (2009), Ozkan and Cil, Anand et al . [ 45 ] found no significant difference among their study groups for fractures treated with microplates in terms of infection and plate exposure. Burm et al .…”

Comparative evaluation of bite force in patients treated for unilateral mandibular condylar fractures by open and closed methods

“…However, the forces achieved at the end of 3 months at the incisor, premolar and molar regions were not completely normal, considering that the average bite forces are 22-50 kgs at the molars, 15-40 kgs at the premolars and 3-27 kgs at the incisors in healthy individuals without a fracture. 7,9,17 Throckmorton and Ellis 18 found that surgical correction of unilateral condylar fractures has relatively little effect on the duration and excursion of masticatory function. In the current study, by the end of 3 months, those patients treated with ORIF had significantly higher bite forces than those managed with the closed method, and they also had relatively fewer occlusal discrepancies.…”

“…Similar results were observed in the current study with a significant increase in the bite forces from the pre‐operative to 1 week, 1 week to 1 month and 1 month to 3 months post‐operative periods. However, the forces achieved at the end of 3 months at the incisor, premolar and molar regions were not completely normal, considering that the average bite forces are 22–50 kgs at the molars, 15–40 kgs at the premolars and 3–27 kgs at the incisors in healthy individuals without a fracture 7,9,17 …”

“…This reduces the occlusal forces at the ipsilateral affected joint and as a result, the masseter activity decreases on the affected side and increases on the unaffected site. 7 Although occlusion can be restored by surgery, it is not clearly known to what extent the patient can produce occlusal loads due to the changes in the hard and soft tissue components of the masticatory apparatus either due to the fracture or by the surgical treatment. 8 The aim of this study was to compare the re-establishment of bite forces following two different treatment methods for unilateral condylar fractures.…”

The Reliability of a New Device for Measuring the Maximum Bite Force

“…The OSMF patients were graded according to the previous classification. The patients were divided into four groups on the basis of interincisal mouth opening, i.e., group I (mouth opening, 35 mm), group II (mouth opening between 30 and 35 mm), group III (mouth opening between 20 and 30 mm), and group IV (mouth opening, 20 mm) [ 14 ]. The inclusion criteria considered in the selection of the participant are as follows: angle class I molar relationship without an anterior or posterior crossbite or open bite; class 1 facial profile and normal facial height and no history of orthodontic therapy; no missing teeth in the molar region; no pain related to the molars; no heavily restored teeth in the molar region; no gingival inflammation, no periodontal pathology, and absence of mobility of the teeth; and no reported systemic disease (chronic arthritis) or apparent facial asymmetry that could influence the registration of bite force.…”