Abstract
Mandibular fracture repair is complicated by limited availability of bone as well as the presence of the neurovascular bundle and an abundance of tooth roots. Fractures at the location of the mandibular first molar teeth are common and it can be particularly challenging to apply stable fixation. Non-invasive fracture repair techniques utilize intraoral placement of fixation devices typically involving polymerized composites and/or interdental wiring. A novel calcium phosphate-phosphoserine–based mineral–organic adhesive was tested ex vivo to determine its effects on augmenting strength of different non-invasive fracture fixation techniques. This study both tested the use of mineral–organic adhesive for the purpose of stabilizing currently used non-invasive fracture repair constructs (intraoral composite splinting ± interdental wiring) and evaluated adhesive alone or with subperiosteally placed plates on buccal cortical bone surface. Aside from controls, not receiving an osteotomy along the mesial root of the mandibular first molar tooth, six treatment groups were tested to evaluate ultimate strength, stiffness, angular displacement, bending moment, and application time. All forms of fixation were found to be significantly weaker than control (p < 0.001). Only the control (p < 0.001) and mineral–organic adhesive and composite (P = 0.002) groups were found to be significantly stronger than wire and composite. No difference was noted in stiffness between any groups with control or wire and composite. Application times varied from the mineral–organic adhesive group (mean = 206 s) to mineral–organic adhesive and composite (mean = 1,281 s). Twenty-three fixation devices exhibited adhesive failure, 20 demonstrated cohesive failure, and 5 failed by cohesive and adhesive failure. When evaluating the ultimate strength of the fixation device groups, mineral–organic adhesive, and composite was shown to be the strongest construct. The use of resorbable bone adhesive and composite may provide a stronger fixation construct over interdental wire and composite for mandibular fracture repair in dogs.
Highlights
Mandibular fractures are the most commonly occurring maxillofacial fractures in small animal veterinary patients [1,2,3,4]
Mandibular fracture repair can be challenging in the caudal mandible of dogs
This study aims to determine whether the use of resorbable bone adhesive by itself, or in combination with other non-invasive fracture repair techniques, provides biomechanical advantage over interdental wiring and composite splinting
Summary
Mandibular fractures are the most commonly occurring maxillofacial fractures in small animal veterinary patients [1,2,3,4]. In a study characterizing mandibular first molar root volumes compared with mandibular volume, relative root volume increased as patient body weight decreased [5] This predisposition for fracture helps explain the propensity for fracture occurrence at this location in small breed dogs. Non-invasive fracture repair techniques minimize surgical exposure of the fracture site and minimize risk of damaging or disrupting anatomic structures such as tooth roots and neurovascular structures These non-invasive techniques have gained in popularity, due to extensive experience with clinical application of dental composites in veterinary medicine [7,8,9,10,11,12,13,14,15]. Using the tension band principle, placement of non-invasive fracture repair constructs along the oral surface of the mandible capitalizes on the creation of a natural compressive force along the ventral surface of the mandible, stabilizing mandibular body fractures [15]
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