The role of the titanium functionally dynamic bridging plate for the treatment of the atrophic mandible fractures

Hachleitner, Johannes; Enzinger, Simon; Brandtner, Christian; Gaggl, Alexander

doi:10.1016/j.jcms.2013.05.037

Cited by 11 publications

(5 citation statements)

References 27 publications

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“…Once the healing process is completed and implants are no longer functional ( Rosa et al, 2016 ), their presence might interfere with facial growth (in adolescents), increase the infection risk, or be a source of metallic ion release ( Katou et al, 1996 ; Armencea et al, 2019 ; Wang et al, 2019 ). Furthermore, when positioned in close proximity to the mental nerve, chronic pain and paraesthesia can result ( Hachleitner et al, 2014 ). These considerations lead to the general strategy of plate removal in up to 70% of all cases, including both symptomatic and asymptomatic plates ( Matthew and Frame, 1999 ; Bhatt et al, 2005 ; Van Bakelen et al, 2013 ; Sukegawa et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

In Silico Biomechanical Evaluation of WE43 Magnesium Plates for Mandibular Fracture Fixation

Orassi

Fischer

Duda

et al. 2022

Front. Bioeng. Biotechnol.

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Titanium fixation devices are the gold standard for the treatment of mandibular fractures; however, they present serious limitations, such as non-degradability and generation of imaging artifacts. As an alternative, biodegradable magnesium alloys have lately drawn attention due to their biodegradability and biocompatibility. In addition, magnesium alloys offer a relatively high modulus of elasticity in comparison to biodegradable polymers, being a potential option to substitute titanium in highly loaded anatomical areas, such as the mandible. This study aimed to evaluate the biomechanical competence of magnesium alloy WE43 plates for mandibular fracture fixation in comparison to the clinical standard or even softer polymer solutions. A 3D finite element model of the human mandible was developed, and four different fracture scenarios were simulated, together with physiological post-operative loading and boundary conditions. In a systematic comparison, the material properties of titanium alloy Ti-6Al-4V, magnesium alloy WE43, and polylactic acid (PLA) were assigned to the fixation devices, and two different plate thicknesses were tested. No failure was predicted in the fixation devices for any of the tested materials. Moreover, the magnesium and titanium fixation devices induced a similar amount of strain within the healing regions. On the other hand, the PLA devices led to higher mechanical strains within the healing region. Plate thickness only slightly influenced the primary fixation stability. Therefore, magnesium alloy WE43 fixation devices seem to provide a suitable biomechanical environment to support mandibular fracture healing in the early stages of bone healing. Magnesium WE43 showed a biomechanical performance similar to clinically used titanium devices with the added advantages of biodegradability and radiopacity, and at the same time it showed a remarkably higher primary stability compared to PLA fixation devices, which appear to be too unstable, especially in the posterior and more loaded mandibular fracture cases.

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Section: Introductionmentioning

confidence: 99%

In Silico Biomechanical Evaluation of WE43 Magnesium Plates for Mandibular Fracture Fixation

Orassi

Fischer

Duda

et al. 2022

Front. Bioeng. Biotechnol.

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“…Thus, despite the inconsistencies in the literature, the authors sought to define and differentiate between ORIF modular systems in each study. With this data, a meta-analysis could not be properly performed because of the presence of heterogeneity in data reporting of articles that met the inclusion criteria, specifically with regard to predictor and outcome variables 18–25 …”

Section: Discussionmentioning

confidence: 99%

Comparing Load-Sharing Miniplate and Load-Bearing Plate Fixation in Atrophic Edentulous Mandibular Fractures: A Systematic Review and Meta-Analysis

Seu

Jazayeri

Lopez

et al. 2021

Journal of Craniofacial Surgery

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Purpose: To critically examine reported data to compare patient outcomes between load-sharing and load-bearing plate fixation for edentulous mandibular fractures. Materials and Methods: A systematic review and meta-analysis were designed to test the null hypothesis of no difference in postoperative outcomes between load-sharing and load-bearing plate fixation in atrophic, edentulous mandibular fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried up until July 2016. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation method. Results: A total of 1212 studies were screened for inclusion of which we included 1 high-quality Cochrane review, 6 narrative reviews, and 21 publications of case reports and case series. Overall, the quality of evidence was low. No difference was found between load-bearing and load-sharing fixation in functional recovery, nonunion, or infection. An uncontrolled case series portrayed complete functional and morphological restoration in 96.9% of patients (83.2-99.5; 95% confidence interval) in load-bearing osteosynthesis while another demonstrated the same outcome in only 40.0% of patients (17.5-65.0; 95% confidence interval). Conclusions: The authors did not find a statistically significant difference between load-bearing and load-sharing plate fixation in edentulous atrophic mandibular fracture patients; although this finding may be influenced by type 2 statistical error. Surgeons should continue to use their best clinical judgment in deciding on treatment approach for these challenging fractures. Future studies with higher level evidence are necessary to guide optimal fracture management.

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“…The extraoral approach during the surgical approach avoids the complete periosteal removal of the mandible, thus reducing risks related to infection or exposure of plates (Hachleitner et al, 2014;Brucoli et al, 2020). Still, in Luhr class III, the inferior alveolar nerve is found in the most superior part of the alveolar crest, hindering an intraoral approach (Brucoli et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Atrophic mandibular fracture treatment: prototyping as a tool in surgical planning

Silva¹,

Pereira²,

Silva³

et al. 2020

RSD

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Introduction: Atrophic mandibular fractures are injuries found in old age due to facial trauma. Its treatment is a challenge, even for experienced surgeons, due to the different approaches that can be taken from clinical decisions. Taking into consideration the limitations that the age presented by most of the affected patients brigs, there are devices that stand out by seeking benefits in terms of predictability and time gain in the intraoperative period. The additive manufacturing is a valuable resource in the surgical planning and rehabilitation of these patients. Objective: To expose a clinical case that demonstrates the success in the use of surgical planning through a prototype printed in 3D technology. Clinical case: Elderly woman, 75 years old, victim of a fall from her own height who had a bilateral atrophic mandible fracture due to facial trauma. The surgical procedure was planned using a prototype printed in 3D technology providing predictability and reduced surgical time. The patient evolved in the postoperative period without complaints, with function immediately restores and without signs of infection or plate exposure. Conclusions: Atrophic mandible fractures are still related to a challenging treatment, therefore, adequate surgical planning and the use of auxiliary strategies such as 3D prototyping provide greater predictability of results, as well as time gain during the intraoperative.

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The role of the titanium functionally dynamic bridging plate for the treatment of the atrophic mandible fractures

Cited by 11 publications

References 27 publications

In Silico Biomechanical Evaluation of WE43 Magnesium Plates for Mandibular Fracture Fixation

In Silico Biomechanical Evaluation of WE43 Magnesium Plates for Mandibular Fracture Fixation

Comparing Load-Sharing Miniplate and Load-Bearing Plate Fixation in Atrophic Edentulous Mandibular Fractures: A Systematic Review and Meta-Analysis

Atrophic mandibular fracture treatment: prototyping as a tool in surgical planning

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