Mental Foramen Region Research Articles

AI-Powered Identification of Osteoporosis in Dental Panoramic Radiographs: Addressing Methodological Flaws in Current Research.

Background: Osteoporosis, a systemic skeletal disorder, is expected to affect 60% of women over 50. While dual-energy X-ray absorptiometry (DXA) scans are the current gold standard for diagnosis, they are typically used only after fractures occur, highlighting the need for early detection tools. Initial studies have shown panoramic radiographs (PRs) to be a potential medium, but these have methodological flaws. This study aims to address these shortcomings by developing a robust AI application for accurate osteoporosis identification in PRs. Methods: A total of 348 PRs were used for development, 58 PRs for validation, and 51 PRs for hold-out testing. Initially, the YOLOv8 object detection model was employed to predict the regions of interest. Subsequently, the predicted regions of interest were extracted from the PRs and processed by the EfficientNet classification model. Results: The model for osteoporosis detection on a PR achieved an overall sensitivity of 0.83 and an F1-score of 0.53. The area under the curve (AUC) was 0.76. The lowest detection sensitivity was for the cropped angulus region (0.66), while the highest sensitivity was for the cropped mental foramen region (0.80). Conclusion: This research presents a proof-of-concept algorithm showing the potential of deep learning to identify osteoporosis in dental radiographs. Furthermore, our thorough evaluation of existing algorithms revealed that many optimistic outcomes lack credibility when subjected to rigorous methodological scrutiny.

Enhanced Osteoporosis Detection Using Artificial Intelligence: A Deep Learning Approach to Panoramic Radiographs with an Emphasis on the Mental Foramen.

Osteoporosis, a skeletal disorder, is expected to affect 60% of women aged over 50 years. Dual-energy X-ray absorptiometry (DXA) scans, the current gold standard, are typically used post-fracture, highlighting the need for early detection tools. Panoramic radiographs (PRs), common in annual dental evaluations, have been explored for osteoporosis detection using deep learning, but methodological flaws have cast doubt on otherwise optimistic results. This study aims to develop a robust artificial intelligence (AI) application for accurate osteoporosis identification in PRs, contributing to early and reliable diagnostics. A total of 250 PRs from three groups (A: osteoporosis group, B: non-osteoporosis group matching A in age and gender, C: non-osteoporosis group differing from A in age and gender) were cropped to the mental foramen region. A pretrained convolutional neural network (CNN) classifier was used for training, testing, and validation with a random split of the dataset into subsets (A vs. B, A vs. C). Detection accuracy and area under the curve (AUC) were calculated. The method achieved an F1 score of 0.74 and an AUC of 0.8401 (A vs. B). For young patients (A vs. C), it performed with 98% accuracy and an AUC of 0.9812. This study presents a proof-of-concept algorithm, demonstrating the potential of deep learning to identify osteoporosis in dental radiographs. It also highlights the importance of methodological rigor, as not all optimistic results are credible.

Are different screw lengths associated with osteosynthesis quality in the region of the mental foramen?

AbstractIntroductionThe use of two monocortical malleable 04‐hole miniplates, placed above and below the mental foramen, has been indicated to prevent the adverse effects of tension and torsion forces on fracture healing. To obtain good fixation in the mandible's outer cortex screws, 5–8 mm long have been recommended. However, studies have shown thicknesses in the mental foramen region of up to 3 mm, meaning the length of the screw could be a risk to nerve or tooth root damage. The purpose of this study is to identify the influence of screw length on osteosynthesis quality in the region of the mental foramen.Materials and Methods10 synthetic polyurethane human lower jaw replicas were subjected to a linear loading test to evaluate fixation techniques with 5 and 10 mm of displacement. In the photoelastic analysis, 02 lower jaw models were made of photoelastic resin and subjected to linear loading in the fixation technique with 10 mm of displacement. Two 04‐hole miniplates in the region of the mental foramen either fixed completely with 4 mm screws (group 1) or with 5 mm screws in the tension zone and 8 mm screws in the compression zone (group 2). The variables were registered for peak load and peak displacement, and final load and final displacement. One‐way analysis of variance (ANOVA) was applied, followed by the Tukey test, with a significance of 5% (p = 0.05) for the comparisons between the means.ResultsConsidering 95% confidence intervals, the mechanical test showed no statistical differences in peak load between the fixations groups. In the photoelastic analysis, the fringes were concentrated on the distal segment of the fracture in both groups.ConclusionDue to the lack of statistical difference in the biomechanical and photoelastic tests, considering the methodologic limitation, our study indicates a tendency of advantage toward the treatment of fractures with two 04‐hole plates, fixed with 4 mm screws, to minimize complications like tooth or nerve damage. In vivo studies are needed to verify the convergence of the results of in vitro studies to evaluate the resistance and stability in real masticatory forces.

The Value of Mandibular Indices on Cone Beam Computed Tomography in Secondary Causes of Low Bone Mass.

Background: As implant treatment cases increase, many cases of failure/side effects also occur. Generally, dental clinics determine the density of the jawbone using cone beam CT (CBCT). Considering the known potential role of this tool for bone assessment in primary osteoporosis, this study evaluated patients with secondary endocrine causes of low bone mass. Methods: The study included 83 patients with endocrine causes of osteoporosis who were evaluated by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and mental foramen (MF) region CBCT. The following CBCT indices were measured: anterior (A)-thickness of inferior mandibular cortex 10 mm anterior from MF; molar (M)-thickness of inferior mandibular cortex 10 mm posterior from MF; posterior (P)-thickness of inferior mandibular cortex 25 mm posterior from MF; symphysis (S)-thickness of inferior mandibular cortex equidistant from the centers of right and left MF. Results: The highest correlation coefficient in the secondary causes group was between the A index and the lumbar BMD (r = 0.375, p = 0.001) and the P index and the femoral neck BMD (r = 0.38, p = 0.001). Hypercortisolism seems to be the most predictable cause of secondary osteoporosis using the A, M, and P indices. The A, M, and P indices showed predictive values of the bone micro-architecture that was evaluated using TBS score, and were statistically significant. The symphysis index does not significantly predict osteoporosis or impaired bone micro-architecture. Conclusions: These findings support the potential usefulness of A, M, and P CBCT-derived radiomorphometric mandibular indices in secondary osteoporosis, underlining the well-known effects of these pathologies on bone micro-architecture rather than bone quantity.

Cone Beam Computed Tomography Panoramic Mandibular Indices in the Screening of Postmenopausal Women with Low Bone Mass: Correlations with Bone Quantity and Quality.

This study examined the potential use of computed tomography panoramic mandibular indices on cone beam CT (CBCT) for assessing bone density in postmenopausal women with low bone mass. The study enrolled 104 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen region CBCT alongside the NewTom VGi EVO Cone Beam 3D system. We assessed the relationship between the following DXA parameters: lumbar, femoral neck, and total hip T score, bone mineral density (BMD), and lumbar trabecular bone score (TBS). The following panoramic mandibular indices were also considered: the computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)), and computed tomography mental index (CTMI). The study revealed moderate correlations between CBCT indices and BMD/TBS scores: CTMI showed the highest correlation with the femoral neck T-score (r = 0.551, p < 0.0001). TBS scores were also moderately correlated with CBCT indices: CTMI showed a moderate positive correlation with TBS (r = 0.431, p < 0.0001); CTI(S) had a similar moderate positive correlation with TBS (r = 0.421, p < 0.0001). AUC values ranged from 0.697 to 0.733 for osteoporosis versus the osteopenia/normal group and from 0.734 to 0.744 for low versus normal bone quality groups, p < 0.0001. The comparison of the values of the studied indices between low versus normal bone quality (quantified with TBS) groups showed high sensitivity but low specificity. CBCT-measured indices CTI(S), CTI(I), and CTMI are useful in assessing patients with low bone mass to improve, by specific treatment, the prognosis of dental implants.

The Utility of Radiomorphometric Mandibular Indices on Cone Beam Computer Tomography in the Assessment of Bone Mass in Postmenopausal Women: A Cross-Sectional Study.

The present study examined the potential use of computed tomography radiomorphometric mandibular indices on cone beam CT (CBCT) for the assessment of bone density in postmenopausal women with low bone mass. We included 104 postmenopausal women who received dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen (MF) region CBCT using a NewTom VGi EVO Cone Beam 3D system. We assessed the relationships between the following DXA parameters: lumbar, femoral neck, and total hip T-scores, bone mineral density (BMD), lumbar trabecular bone score (TBS), and mandibular inferior cortical bone thickness at 4 sites. The cross-sectional images were obtained, as follows: anterior (A)-10 mm anterior from the MF; molar (M)-10 mm posterior from the MF; posterior (P)-25 mm posterior from the MF; symphysis (S)-equidistant from the centers of the right and left MF. We found that A and M indices showed statistically significant moderate positive correlations with lumbar spine, femoral neck, and total hip BMD, as well as TBS. The P index demonstrated moderate positive correlations with these measurements, while the S index did not show significant correlations with BMD or TBS in postmenopausal women. These findings support the potential usefulness of CBCT-derived radiomorphometric mandibular indices for non-invasive bone health assessment in clinical practice.

Morphological Assessment of the Anterior Loop in the Region of Mental Foramen Using Cone Beam Computed Tomography

Morphological Assessment of the Anterior Loop in the Region of Mental Foramen Using Cone Beam Computed Tomography

Comparison of quantitative radiomorphometric predictors of healthy and MRONJ-affected bone using panoramic radiography and cone-beam CT.

To determine the most distinctive quantitative radiomorphometric parameter(s) for the detection of MRONJ-affected bone changes in panoramic radiography (PR) and cone-beam CT (CBCT). PR and sagittal CBCT slices of 24 MRONJ patients and 22 healthy controls were used for the measurements of mandibular cortical thickness (MCT), fractal dimension (FD), lacunarity, mean gray value (MGV), bone area fraction (BA/TA), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N). MCT was measured in the mental foramen region. While FD and lacunarity were measured on mandibular trabecular and cortical regions-of-interest (ROIs), the remaining parameters were measured on trabecular ROIs. The independent samples t-test was used to compare the measurements between the MRONJ and control groups for both imaging modalities (P = .05). MCT was the only parameter that differentiated MRONJ-affected bone in both PR and CBCT (P < .05). None of the remaining parameters revealed any difference for MRONJ-affected bone in CBCT (P > .05). FD, lacunarity, MGV, BA/TA, and Tb.Sp could distinguish MRONJ-affected trabecular bone in PR (P < .05). The correspondent ROI for both imaging methods that was reliable for detecting MRONJ-affected bone was the trabecular bone distal to the mental foramen above the inferior alveolar canal (ROI-3). MCT is a reliable parameter for the discrimination of MRONJ-affected bone in both PR and CBCT images. PR may be used to detect MRONJ-affected trabecular bone using FD, lacunarity, MGV, BA/TA, and Tb.Sp measurements as well.

Prevalence, length, and patterns of Anterior Loop among the South Indian population: A comparative study between Panoramic Radiography and Cone Beam Computed Tomography.

To assess the prevalence, length, and patterns of the anterior loop of the inferior alveolar nerve by panoramic radiography and cone beam computed tomography (CBCT). A prospective study was conducted on 300 mental foramen regions by exposing them to panoramic radiography and CBCT scan. Two individual observers evaluated the images to assess the presence of an anterior loop, the mean length of the loop, and the most frequent pattern of the loop in our population. The prevalence of the anterior loop for male patients and female patients by panoramic radiography was 34% and 32% on the right side and 30% and 36% on left side, respectively. By CBCT, the corresponding values were 69% and 72% on the right and left side, respectively, for male patients, and 73% and 81% on the right and left side, for female patients, respectively. The results from our study strongly emphasize the need for CBCT imaging before planning for procedures in the mental foramen region because the prevalence, length, and pattern of loop significantly varies with respect to age, sex, and population.

Measurement and Analysis of Anatomical Structures Associated with the Implantation of Anterior Mental Foramen Based on CBCT

To evaluate the occurrence and morphological characteristics of related anatomical structures in the anterior mental foramen region and to verify the measurement consistency by cone beam CT (CBCT) and specimen measurement. Thirty-two mandibular specimens were selected to measure the relevant anatomical structures and to take CBCT images of the specimens for 3D reconstruction using NNT-Viewer. The studies included the occurrence and diameter of the mental foramen, accessory foramen, median lingual foramen, the distance from the lower margin of the foramen to the lower margin of the mandible, and the distance from the upper margin of the foramen to the crest of the alveolar ridge. Thirty-two specimens including a total of 59 central lingual foramens, with a 100% probability of occurrence. Four specimens were found to have an accessory mental foramen, of which 1 had bilateral accessory mental foramens. Compared with direct observation, there were differences in the number of central lingual foramens in 3 specimens. The mean distance between the upper mental foramen edge and the alveolus crest was 13.7 mm. There were statistically significant differences between the two methods in measuring the distance (mm) between the central lingual aperture and the alveolar crest (P<0.05). Except for the distance between the central lingual aperture and the alveolar crest (ICC=0.658), the ICC of the other study variables was above 0.85. The measurement results of the two methods showed a high degree of consistency. The measurement results of CBCT in this study showed a high degree of consistency with the measurement results from specimens, and the relevant anatomical structures of jaw bones could be analyzed using CBCT before the operation in the intermental foramen region.

Versatility of various 3D non locking miniplates in treatment of mandibular fractures

Context: The optimal management of mandibular fractures continues to evolve. Fractures of mandible predispose the patients to structural, functional and aesthetic compromise if not treated. The current understanding of the biomechanics and fracture healing of the mandible has influenced the modern approach to the open reduction and internal fixation of these fractures. These help us to evaluate shortcomings of compression plates and 2D miniplates leading to development of 3D plates. Aims: To evaluate the versatility and efficacy and complication of 3 different varieties of 3D non locking plates–2x2 and 2x3 and delta plates in the treatment of mandibular fractures at different sites.Materials and Methods: A total of 86 patients of mandibular fractures were managed by open reduction and internal fixation utilizing total 114 three dimensional plates (109 non locking 3D plates (2X2,3X2) and 5 delta plates) were used for fractures of the mandible including symphysis, parasymphysis, body, angle, ramus and condyle over a period of 3 years.Results: The use of 3D plates provided semi-rigid fixation of fractured fragments with no immediate post-operative mobility. Immediate and subsequent postoperative clinical and radiographic evaluation was carried out at 15 days, 1 month, 3 months and 6 months. Post-operative complications observed were post-operative neurosensory deficit in 3 patients, occlusal discrepancy in 3 patients, wound dehiscence in 2 patient, plate exposure in 1 patient and parotid fistula in 1 patient which accounted for 8.6% of total patients. None of the patient suffered from Infection, segmental mobility, paraesthesia. Malunion, non-union. All these were treated successfully with definitive measures.Conclusion: The 3D mini-plate system is a versatile and efficient method for fixation of mandibular fractures. Delta plates are efficient method for reduction and fixation of subcondylar fracture. The only contraindication for 3D plates is their use in mental foramen region (where distance between mental foramen and inferior border is less than 1.5cm).

Measurement analysis of the mandible body using CBCT images in the mental foramen region to determine sexual dimorphism

The purpose of this study was to assess the distance between the mandibular canal and the base of the mandible in the mental foramen region, in order to determine sexual dimorphism in the Brazilian population. The assessment of this distance is also important to prevent injuries to the inferior alveolar neurovascular bundle and to avoid clinical complications during surgical procedures. Using the simplified Kalabalik and Aytuğarn method for studies in Forensic Dentistry or Anatomy, this study assessed 100 cone-beam computed tomography images of male and female patients. The distance between the inferior border of the mandibular canal and the base of the mandible in the mental foramen region was evaluated bilaterally. No significant statistical differences were found between the right and left sides of the mandible. However, statistically significant difference between the genders was found (p=0.038). The lower distance (D2) measure can be applied to determine sexual dimorphism in the Brazilian population. Further studies presenting larger samples are needed to confirm these initial findings.

Assessment of anterior loop of mandibular canal and its implication in implant therapy.

Context:Precise identification of anatomic structures is imperative for presurgical planning for implant installation to ensure effectiveness of procedures, especially in the region of mental foramen, and to prevent iatrogenic complications.Aims:This study aimed to assess the presence of anterior loop of mandibular canal and its approximation to the alveolar crest using cone-beam computed tomography (CBCT).Materials and Methods:CBCT scans of the patients scheduled for implant therapy in the region of mental foramen were retrospectively analyzed for the presence of anterior loop of mandibular canal. Findings were compared based upon gender and side of the mandible. Distance between the most prominent part of anterior loop of mandibular canal and the alveolar crest was measured.Results:Anterior loop of the mandibular canal was identified 66.8% of hemimandibles analyzed with the highest prevalence in the fourth decade of life. Males and females exhibited predilection toward the right and left side, respectively. The presence of anterior loop of mandibular canal is associated with reduced distance between the neurovascular bundle and alveolar crest jeopardizing the placement of standard length dental implant.Conclusion:The current study emphasizes an increased need for precise identification and preservation of anterior loop of mandibular canal in the third and fourth decades of life, especially in females.

A NEW METHOD FOR ASSESSMENT OF MENTAL FORAMEN RELATED LANDMARKS USING COMPUTED TOMOGRAPHY SCAN

Background: Mental foramen is the opening of mandibular canal in the mandibular body, and its place shows contra-versus. As mental foramen is an essential anatomical landmark required for implant surgery, the determination of the exact place for the mental foramen to detect exact amount of local anesthesia solution and to decrease dismissed injuries during the prosthetic surgical treatments. The determination of the situation of mental foramen according to its site in horizontal and vertical direction of mental foramen according to the adjacent premolars and molars on the skull, diagnostic radiographs, and CBCT. Objectives: Assessment of MF related landmarks using computed tomography scan by a new computerized method. Materials and Methods: Twelve patients ranging from 45-60 years old came to the department of prosthodontics, Alexandria University, Alexandria, Egypt. The anatomical structural landmarks such as mandibular canal, mental foramen according to its site relative to the lower border of the mandible of the mandible were evaluated by radiographic CT and scores were assessed. All the measurements done by Image J computed program which was not used in the previous studies. Results: Anatomical landmark structures in the mandible (mandibular canal, mandibular foramen, mental foramen, and incisive canal) were detected and measurements in millimeter were recorded by using CT images. Conclusion: An essential anatomical landmark for the dentist is the place of mental foramen so, the dentists must have attention about this anatomical landmark before any surgical procedure including mental foramen region. Computed tomography (CT) is highly essential measure to avoid any expected complication.

Relict root left in the mandible after extraction of the teeth 35 as a causative agent of the inflammation process in the region of mental foramen of the mandible

We present a case of iatrogenic complication after extraction of the teeth 35 in 63-years old women. There was a root of the teeth left in the bone. It was a causative agent of pain sensations and inflammation of the surrounding tissues. Due to the close distance between the root, mandible canal and mental foramen of mandible the removal of relict root was burden with high risk of parasthesis.

Proton pump inhibitors and mandibular bone quality: A preliminary study.

Proton pump inhibitors (PPI) provide a long-lasting anti-acidic effect by inhibiting the proton pump, and they are one of the most commonly prescribed drugs worldwide. PPIs adversely affect the bone structure via deficiency of vitamins and minerals. The aim of this study was to investigate the possible PPI-induced bone changes in the mandible on panoramic radiographs with the methods of fractal analysis and panoramic morphometric indices. Panoramic radiographs of 402 patients were used (201 PPI users, 201 control group). Fractal analysis was performed on 4 regions of interests (ROI): 1- upper part of the ramus, 2- angulus, 3- anterior of the mental foramen, 4- distal of the middle ramus. Also, the panoramic mandibular index (PMI), mandibular cortical width (MCW), and Klemetti index (KI) were performed on radiographs. There were significant differences in terms of ROI3, MCW, and KI between the control and study groups (p < 0.05) while there was no significant difference for ROI1, ROI2, ROI4, and PMI (p > 0.05). Males were severely affected than females. Osteoporotic changes were detected in the trabecular and cortical bone in the mental foramen region in PPI users with fractal analysis and morphometric indices, while there were no differences for mandibular ramus and angulus regions according to fractal analysis.

Identification of anterior loop in different populations to avoid nerve injury during surgical procedures-a systematic review and meta-analysis.

Exact recognition of the anterior loop is very important to avert any injury to the neurovascular bundle during surgical procedures. The purpose of this review was to evaluate the prevalence and length of the anterior loop in different populations. A comprehensive search of Medline/Pubmed and Cochrane database was done. The focused question was the presence of anterior loop (including loop length) of the inferior alveolar nerve in mental foramen region in CBCT images of the various subjects. Articles related to the presence of anterior loop (including loop length) were only included. Initial literature search resulted in 3024 papers, after removing duplicate articles, 2821 articles were left. Two thousand seven hundred eighty-four articles were further excluded by the reviewers after screening the abstracts which resulted in 37 studies. Hand searching resulted in 2 additional papers. Seven full-text articles were excluded for not fulfilling the inclusion criteria. Finally, 32 articles were included in the review. Two thousand five hundred three subjects with anterior loop were found, which approximates 38% with 48.4% bilateral, 27.8% right side, and 23.8% left side. The loop distribution in males and females was also found to be different. There was highly significant (P < 0.001; I2= 98.81%) heterogeneity found in the included studies. Variations were found in the prevalence, length, gender, and side distribution of anterior loop in various populations. This systematic review highly recommends not relying on any average values and the clinician should compulsorily make use of imaging modalities available in each and every case, wherever surgical procedure is to be performed near mental foramen region.

MORPHOMETRIC BONE EVALUATION OF MEN AND WOMEN OF DIFFERENT AGES BY CONE BEAM COMPUTED TOMOGRAPHY

Osteoporosis is a worldwide public health problem, defined as a systemic skeletal disease with decreased bone mass, and consequently bone fragility and risk of fractures. Our objective was to evaluate bone morphometry and correlate the morphometric indices between the men and women groups and women of different age groups. The sample was divided into groups: (A) men aged 65 to 75 years, (B1) women aged 45 to 55 years, (B2) women aged 55 to 65 years, and (B3) women aged 65 to 75 years. Morphometric indices were analyzed in the region of the mental foramen in a coronal section and panoramic reconstructions of cone beam computed tomography (CBCT) through OnDemand3-D software. Computed Tomography Canine Index (CTCI), Computed Tomography Mentual Index (CTMI), Superior Computed Tomography Index (SCTI), and Inferior Computed Tomography Index (ICTI) were used. There were significant differences between the different groups in the IMTC, ITC(i), and ITC(s) and high correlation between indices. There was no difference in the qualitative index ICTC when used in isolation. There are differences in the bone structure of men and women and among women of different age groups, and the quantitative and qualitative indices may be a useful tool in the detection of patients with low bone mineral density when used together for subsequent referral to bone densitometry and specialized medical treatment.

Edentulous mandible with four splinted interforaminal implants exposed to three different situations of trauma: A preliminary three-dimensional finite element analysis.

An increasing number of elderly patients with implant-prosthodontic rehabilitation of the edentulous mandible frequently show increased life activity, and consequently, a greater number of aged patients is at risk for maxillofacial trauma. The aim of this 3-dimensional (3D) finite element analysis (FEA) was to evaluate the biomechanical effects of the edentulous mandible (EM) with and without four splinted interforaminal implants exposed to three different trauma applications including assessment of different mandibular fracture risk areas. In a 3D-FEA study design, EM with and without four splinted interforaminal implants were exposed to the application of 1000N at the symphyseal, parasymphyseal, and mandibular angle region. On four pre-defined superficial cortical mandibular areas (symphysis region, mental foramen region, angle of mandible, and mandibular neck) representing regions of interest (ROI), the von Mises stresses were measured for the three trauma applications. For all ROIs, stress values were evaluated and compared for the different force application sites as well as between EM models with and without interforaminal implants. For EM with and without four splinted interformaninal implants, all traumatic loads generated the highest stress levels at the mandibular neck region. However, in the EM with four splinted interforaminal implants, an anterior symphyseal force application generated significantly (P<.01) increased stress values in the parasymphyseal (mental foramen) region than in EM without implants. For force applications at the parasymphaseal region (mental foramen) and at the angle of the mandible elevated, von Mises stress values were noted directly at the application sites without difference between edentulous mandibles with and without four interforaminal implants. In an edentulous mandible model with four splinted interforaminal implants, the condylar neck and the mental foramen represent the predilectional risk areas for mandibular fracture for both anterior symphyseal and lateral parasymphyseal force application.

Comparison Between Conventional Titanium Miniplates and Indigenous Detachable Custom made 3D Titanium Plates (VAS 3D Bone Plate) for Fixation of Mandibular Fracture in Mental Foramen Region: A Randomized Clinical Trial and Finite Element Analysis.

To overcome limitation of 3D plate for fracture fixation in mental foramen region, by designing an indigenous custom made detachable 3D titanium plate (VAS 3D bone plate) and comparing it with two miniplate fixations for fractures of aforementioned region. Finite element analysis (FEA) of VAS plate and randomised clinical trial was performed and compared with miniplates. Twenty fractures in 19 patients with fracture in mental foramen region were divided randomly into two groups (Group I-fixation by miniplates and Group II with VAS plate) and evaluated for ease of fixation, neurosensory deficit, bite forces, occlusion and adequacy of fracture fixation. FEA of VAS plate revealed better performance for stress distribution, deformation and rigidity. A total of 20 mental foramen region fractures in 19 patients (18 male and 1 female) were treated. Group II had better results for bite forces and lingual control. Except for two patients with screw exposure in Group II and transient neurosensory deficit (resolved by 6months), no other complications were observed. Ease of fixation was significantly better in miniplate group. VAS plate was successful in providing satisfactory fixation and was observed to be better in terms of lingual control and masticatory efficiency.