The 3-dimensional miniplate is more effective than the standard miniplate for the management of mandibular fractures: a meta-analysis

Liu, Yong; Wei, Bo; Li, Yuxiang; Gu, Da‐Wei; Yin, Guochao; Wang, Bo; Xu, Da; Zhang, Xuebing; Kong, Daliang

doi:10.1186/s40001-017-0244-2

Cited by 13 publications

(10 citation statements)

References 27 publications

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“…This was insignificant due the established fact that nerve affection in MAFs depended mainly on the preoperative degree of displacement of the segments (9) . This was confirmed in other studies which did not identify any difference after surgery regarding the presented paresthesia (17) .…”

Section: Discussionsupporting

confidence: 85%

Patient-specific Computer modified titanium plate in Unilateral angle fractures

Amr

Hatem

Shehab

2019

Egyptian Dental Journal

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Purpose: Various treatment modalities have been stated to avoid faulty healing of the mandibular angle fracture and the subsequent functional and esthetic disasters. In this study, we aimed to design a new patient-specific titanium plate to overcome Champy's acknowledged drawbacks and avoid splaying of the inferior border of the mandible. Patients and methods: This study included eight patients suffering from a displaced unilateral mandibular angle fracture with a mean age of 37 years. They all needed open reduction and internal fixation. Preoperative evaluation included the clinical examination through inspection of malocclusion and measurement of maximum inter-incisal mouth opening, along with the radiographic assessment through the screening panoramic view and the 3-D CT examination to determine the amount of displacement between the fractured segments. Computer mirroring of the intact side was done to virtually reduce the fractured side to design a patient-specific plate. This plate aimed to fit on the superior ventral surface of the external oblique ridge, namely; Champ's osteosynthesis line. Downward extended lingual shelf and two buccal arms were added in the plate, to only immobilize the mandible lingually along with fixing both fractured segments buccaly with screws, while fixing the segments superiorly at Champy's line with the standard plate shaft. The titanium PS-plate was processed and fixed in place using 2.0 screws through the standard intra-oral approach after Maxillo-mandibular fixation using ivy-loops. Immediate postoperative mandibular function was allowed. Postoperative clinical assessment of the occlusion and the Maximum inter-incisal opening (MIO) was performed at one week, 1 month and 3 months. Postoperative radiographic CT assessment was performed through measuring the linear inter-fragmentary gap between the fractured segments at the inferior mandibular border. Results: The surgeries in all cases were uneventful. Surgical site was normal with no signs of infection or dehiscence except in only one case, which showed primary intra-oral plate exposure. The preoperative parasthesia recorded in three patients was improved postoperatively, however without its complete disappearance. MIO was significantly improved over the follow-up period to reach a mean of 40.3 mm after 3 months. Radiographic examination, over the follow-up period,

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Section: Discussionsupporting

confidence: 85%

Patient-specific Computer modified titanium plate in Unilateral angle fractures

Amr

Hatem

Shehab

2019

Egyptian Dental Journal

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“…In regard to post-operative infection, wound dehiscence and paresthesia, both methods provided similar results [ 18 ]. Conversely, post-operative complications, such as mal-occlusion and trismus, appear to occur more frequently when fractures are fixed using conventional miniplates [ 9 , 20 ]. These findings are in agreement with Mohd et al (2019) [ 21 ], who showed a lower mobility and improved occlusion restoration for parasymphisis fractures treated with 3D miniplates.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Mandible Fractures Using a Miniplate System: A Retrospective Analysis

Bohner

Beiglböck

Schwipper

et al. 2020

JCM

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Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital Münster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate.

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“…All screws were designed as cylinders with 2 mm diameter and 6 mm in length. All mini-plates with 2 mm thickness had four screw holes [ 6 , 20 , 31 ]. And the biomechanical properties of the fractured mandible fixed with the two different fixation systems were calculated by finite element analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Currently, there are two typical treatment modalities for the mandibular angle fractures: the first one uses one mini-plate for fixation, which has been widely used during the past two decades, following the principles described in 1975 by Champy [ 6 – 8 ]; the other one uses two mini-plates [ 9 ], with a upper mini-plate fixed at the same place of previous treatment which corresponds to the tension band of the mandible, and the lower mini-plate fixed at the inferior border of the mandible which corresponds to the compression band of the mandible. However, all the mini-plates used in the clinical case are standard and straight plates, and need to be bent to bone surface before fixation, which will increase the time of the operation and may lead to mismatching between the bone surface and titanium plates [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

A customized fixation plate with novel structure designed by topological optimization for mandibular angle fracture based on finite element analysis

et al. 2017

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BackgroundThe 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).MethodsA 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.ResultsThe 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.ConclusionsThe 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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The 3-dimensional miniplate is more effective than the standard miniplate for the management of mandibular fractures: a meta-analysis

Cited by 13 publications

References 27 publications

Patient-specific Computer modified titanium plate in Unilateral angle fractures

Patient-specific Computer modified titanium plate in Unilateral angle fractures

Treatment of Mandible Fractures Using a Miniplate System: A Retrospective Analysis

A customized fixation plate with novel structure designed by topological optimization for mandibular angle fracture based on finite element analysis

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