Nonlocking Miniplates Research Articles

Locking Versus Non-Locking Miniplates in the Treatment of Mandibular Fractures in Above 35 Years Age Patients

Objective: To compare the frequency of short term post-operative infection of locking plates versus non-locking plate in mandibular fractures in patients above 35 years of age. Methodology: A randomized controlled study was conducted at the Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad from January 2018 to January 2019, involving a 100 patients (50 patients in each group). On the basis of history, clinical features, orthopantomogram (OPG) and intraoperative findings, the diagnosis of mandibular fractures was established. Group A patients were treated with reduction and fixation of fracture with locking miniplates and miniscrews following champy’s principle of osteosynthesis. Whereas in group B patients, fractures were reduced and fixed with non-locking miniplates and miniscrews following champy’s principle of osteosynthesis. Results: Effect modifiers such as age, gender, and type of fracture were controlled by stratification. A post-stratification chi-square test was applied. The 1 patient that had infection in group A had an age range 50- 65 years (53 years) (P value: 0.197) while the 2 patients that had infection in group B were younger in age range of 35-50 years (36 years and 38 years) (P value: 0.322). The 1 patient who had infection in group A was female (P value: 0.043) while the 2 patients of group B who had infection were also females (P value: 0.027). In group A, only 1 patient had infection at the para-symphysis of mandible according to site (P value: 0.494). In group B, 1 patient had infection at para-symphysis of mandible and 1 at the body of the mandible site (P value: 0.599). The results were not statistically significant in terms of infection by the end of 3rd week. Conclusion: The study concludes that insignificant post-operative infection rates while managing mandibular fractures either by locking plates or non-locking plates.Â

Patient-Specific 3D-Printed Miniplates for Free Flap Fixation at the Mandible: A Feasibility Study.

BackgroundThis study was conducted to evaluate the feasibility, clinical outcomes, and accuracy of patient-specific 3D-printed miniplates for mandible reconstruction with fibula free flaps.MethodsA feasibility study was conducted with 8 patients. Following virtual planning, patient-specific 1.0 mm titanium non-locking miniplates were produced via laser selective melting. 3D-printed cutting and drilling guides were used for segmental mandible resection and flap harvesting. Flap fixation was performed with two 4-hole miniplates and 2.0 mm non-locking screws (screw length 7 mm) for each intersegmental gap. Clinical follow-up was at least 6 months. Preoperative and postoperative CT/cone beam CT data were used for 3D accuracy analysis and evaluation of bone healing. Plate-related complications were monitored clinically.ResultsPatient-specific miniplate fixation of all flaps was successfully conducted (4 mono-segmental, 4 dual-segmental) with high accuracy (3.64 ± 1.18 mm) between the virtual plan and postoperative result. No technical complications were encountered intraoperatively. Osseous union occurred in all intersegmental gaps (1 partial, 18 complete) after 10 ± 2 months. No material fracture, dislocation, or plate exposure was observed.ConclusionsBased on this pilot observational study including a limited number of patients, free flap fixation for mandibular reconstruction with patient-specific 3D-printed miniplates is feasible and associated with high accuracy, bone healing, and remote soft tissue complications.

Comparative Evaluation of 3d Locking Versus Non-Locking Titanium Miniplates in the Treatment of Mandibular Fracture.

The introduction of 3-dimension systems for the treatment of mandibular fractures and continuity has offered certain advantages over other plating system. The present study was undertaken to compare 2.0mm 3D titanium locking and non-locking miniplates in the management of mandibular fractures. A prospective study was conducted on 40 patients (20 in each group) of mandibular fractures treated by open reduction and internal fixation. Group A patients underwent osteosynthesis using 2.0mm 3-D titanium locking miniplates while Group B used non-locking miniplates. Subsequent follow-up was assessed for pain, swelling, infection, paresthesia, malocclusion, mobility between fracture fragments and hardware failure in these patients. Functional occlusion was achieved postoperatively in all the patients. At 12weeks of the time intervals, significant pain was observed in group B. At 1week interval, 6 (30%) patients in both groups reported with swelling. Only one (10%) patient in each group had paresthesia which got resolved gradually over a period of 3months. Infection was observed in only 2 (10%) patient in Group B at 3months. Only 2 (10%) patient in Group B had hardware failure at 3months interval. Statistically, there was no significant difference between both the groups at any time interval (p > 0.05). 3D titanium locking miniplates are effective in the treatment of mandibular fractures with lesser overall complications as compared to non-locking miniplates.

Novel modality for management of mandibular fracture by 3D non-locking miniplate: A case report

Novel modality for management of mandibular fracture by 3D non-locking miniplate: A case report - JDS- Print ISSN No: - 2320-7302 Online ISSN No:- 2393-9834 Article DOI No:- 10.18231/j.jds.2019.032, Journal of Dental Specialities-J Dent Spec

Comparative Evaluation Between 2mm Locking and 2mm Non-Locking Miniplate System for Open Reduction and Internal Fixation of Mandibular Parasymphysis Fracture

Aims: To compare the stability, rigidity, bone healing and functional outcome of 2mm locking and 2mm non-locking miniplate system in mandibular parasymphysis fracture. Material and method: The was conducted at dept. of oral and maxillofacial surgery, GNIDSR, Kolkata, India, from May 2016, to December, 2019, 34 patients (male 30 and female 4) were randomly divided into 2 groups. The patients underwent osteosynthesis—Group A (n=17, 15 males and 2 females) with orthomax 2-mm locking titanium miniplates(LMP) and Group B (n=17, 15 males and 2 females) with orthomax 2-mm nonlocking titanium miniplates(NLMP). The age, gender, operating time, pain and swelling, mobility, occlusion, chewing efficacy, bony healing with radiological evaluation were all reviewed. The assessment of the patients was done preoperatively and postoperative days at 1 day, 3 day, 7th day, 14th day, 1st month, 2nd month, and 3rd month using the clinical parameters, observation and radiology. Results: A total of 34 parasymphysis fractures met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as operating time, pain, swelling, occlusion, chewing efficacy, mobility between the fracture segments and infection, hardware failure in postoperative period. A statistically significant difference was found in the CT scan evaluation with pre-op and post op fracture width and hounsfield unit in between two groups at preop and 3rd month postop days and it was also supported by OPG findings. Conclusion: We concluded that Locking miniplates are technically not cumbersome than non-locking one – No significant increase in operating time. Use of two locking miniplates in the parasymphysis region placed on the Champy’s line of oesteosynthesis provides a better stability and oesteosynthesis at the 3rd month postoperative period than non-locking.

Management of Mandibular Fractures Using Locking and Nonlocking Miniplates: Erratum.

Management of Mandibular Fractures Using Locking and Nonlocking Miniplates: Erratum.

Management of Mandibular Fractures Using Locking and Nonlocking Miniplates.

The study proposed to determine the superiority between locking plate and nonlocking miniplate for mandibular fractures (MFs) treatment. A comprehensive electronic search examining Medline-Ovid, Embase, and PubMed databases language without date was performed in February 2018. Inclusion criteria were studies in humans, including randomized controlled trials, controlled clinical trials, with the aim of comparing the 2 techniques. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Thirteen publications were enrolled into the analysis. The results showed that there were significant differences in overall complications (RR, 0.62; 95% CI, 0.351-1.094; P = 0.06), postoperative infection (RR, 0.503, 95% CI, 0.223-1.136) when comparing locking miniplates with nonlocking miniplates in treating mandible fractures. The incidence of malocclusion showed a statistically significant difference in the outcome favoring locking miniplates (fixed: RR, 0.503; 95% CI, 0.125-2.030; P = 0.06). In addition, the use of locking miniplates had a lower postoperative maxillomandibular fixation rate than the use of nonlocking miniplates (RR, 0.414; 95% CI, 0.196-0.872; P = 0.002). The result of meta-analysis revealed that use of locking plate is superior to the nonlocking plate in the reducing of postoperative complication rates in the management of MFs.

Three-dimensional versus standard miniplate, lag screws versus miniplates, locking plate versus non-locking miniplates: Management of mandibular fractures, a systematic review and meta-analysis

Background/purposeThe aims of the present study were to 1) evaluate the clinical outcomes between different fixation methods in the management of mandibular fractures (MFs) and 2) determine which fixation method is the best option for the treatment of mandibular fractures. Materials and methodsA systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. Inclusion criteria were studied in humans, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. In addition, the incidence of complications was evaluated. ResultsThirty-two publications were included: 20 randomized controlled trials, 4 controlled clinical trials, and 8 retrospective studies. There were statistically significant advantages for 3-dimensional miniplate and lag screws. There was no statistically significant difference between locking plates and standard miniplates (P = 0 0.2). The cumulative odds ratio was 0.64, meaning that the use of locking miniplate in the fixation of MFs decreases the risk for postoperative complications by 36% over the use of standard miniplates. ConclusionThe results of the three-Dimensional Versus Standard miniplate showed that 3-dimensional miniplate is the best option for mandibular fractures. Regarding Lag Screws Versus Miniplates results of the meta-analysis found that the use of lag screws is superior to using miniplates in reducing the incidence of postoperative complications. And in regards to locking miniplates versus non-locking miniplate, the analysis indicates that the 2.0-mm locking miniplate is a prospective fixation system in the treatment of maxillofacial fractures.

Surgical Management of Mandibular Angle Fractures.

The study proposed to determine the superiority between different fixation methods in the mandibular angle fractures (MAFs) and to evaluate best option for surgeon and patient. A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. The quality of studies was assessed, and the odds risk (OR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Subgroup analyses by different fracture regions and different miniplate sizes were performed. Publication bias was measured by a funnel plot. Twenty-one articles were enrolled in this review: 8 randomized controlled trials , 2 controlled clinical trials, and 11 retrospective studies. There were significant advantages for 3-dimensional (3D) miniplate (OR = 0.48, P = 0.003, 95% CI, 0.35-0.67) and 1 miniplate (OR 0.38, 95% CI 0.25-0.58, P < 0.00001). The cumulative OR for locking miniplate was 0.45, showing that the utilizing of locking mini-plate in management of MAFs decreases postoperative complications risk by 55% over the use of nonlocking mini-plate. The results of this review indicated that the use of 3D miniplate, locking plate, and 1 plate were more advanced to 2 miniplates technique in low incidence of postoperative complications in the treatment of MAFs.

Comparison of Conventional 2.0 mm Non-Locking and Locking Miniplates in Management of Fracture Mandible

Comparison of Conventional 2.0 mm Non-Locking and Locking Miniplates in Management of Fracture Mandible

Locking Plate System Versus Standard Plate Fixation in the Management of Mandibular Fractures: Meta-Analysis of Randomized Controlled Trials.

The aim of this meta-analysis was to evaluate the efficacy of the 2.0-mm locking miniplate system in comparison with the standard miniplate system in treatment of mandible fractures. A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and PubMed databases, eligible studies were restricted to comparative controlled trials. Inclusion criteria were based on humans randomized controlled trials, controlled clinical trials, with the aim of comparing 2 fixation techniques, namely locking miniplate and standard miniplate (nonlocking miniplate) techniques. In addition, the incidence of complications was evaluated. Nine studies with 380 patients and 551 fracture sites were enrolled into the analysis. The results showed that there were no significant differences in overall complications (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.34-1.22; P = 0.2), postoperative infection (OR, 0.53; 95% CI, 0.23-1.23, P = 0.15), and occlusion discrepancy (P > 0.05) when comparing 2.0-mm locking miniplates with 2.0-mm nonlocking miniplates in treating mandible fractures. However, the use of 2.0-mm locking miniplates had a lower postoperative maxillomandibular fixation rate than the use of 2.0-mm nonlocking miniplates (OR, 0.43; 95% CI, 0.22-0.83; P < 0.0001). Mandible fractures treated with 2.0-mm locking miniplates and standard 2.0-mm miniplates present similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using 2.0-mm locking miniplates also indicates that the 2.0-mm locking miniplate has a promising application in treatment of mandibular fractures.

Information for Contributors

The purpose of this study is to compare the efficacy of single 2 mm locking miniplates versus two 2 mm non-locking (conventional) miniplates in symphysis and parasymphysis fracture of mandible.This present study included 40 patients of maxillofacial trauma having mandibular symphysis/parasymphysis fractures in which open reduction and internal fixation is indicated. Patients were selected according to the inclusion criteria and divided into two groups, i.e. Group 1: consisted of 20 patients, requiring open reduction and internal fixation with 2 mm two non-locking titanium plate and Group 2: consisted of 20 patients, requiring open reduction and internal fixation with 2.0 mm single ultra-locking titanium plate. Fracture was then stabilized and postoperative clinical examination was carried out on 3rd day, 1st, 2nd, 4th, and 8th week.Results of this study suggested that the use of single 2.0 mm locking miniplate could be a viable option instead of using two miniplates in anterior mandibular fracture as advocated by Champy, as it provides equally good outcome along with placement of lesser implant material.Single locking miniplates give the advantage of equally good stability and early restoration of function with almost similar results as seen in osteosynthesis with two miniplates. It was also found that less precision was required in plate adaptation when using single locking miniplate. This study suggests that there is not much difference in surgical outcome with the use of either single locking miniplate or two conventional miniplates in anterior mandibular region.

Comparison of 2 mm single locking miniplates versus 2 mm two non-locking miniplates in symphysis and parasymphysis fracture of mandible

IntroductionThe purpose of this study is to compare the efficacy of single 2mm locking miniplates versus two 2mm non-locking (conventional) miniplates in symphysis and parasymphysis fracture of mandible. MethodThis present study included 40 patients of maxillofacial trauma having mandibular symphysis/parasymphysis fractures in which open reduction and internal fixation is indicated. Patients were selected according to the inclusion criteria and divided into two groups, i.e. Group 1: consisted of 20 patients, requiring open reduction and internal fixation with 2mm two non-locking titanium plate and Group 2: consisted of 20 patients, requiring open reduction and internal fixation with 2.0mm single ultra-locking titanium plate. Fracture was then stabilized and postoperative clinical examination was carried out on 3rd day, 1st, 2nd, 4th, and 8th week. ResultResults of this study suggested that the use of single 2.0mm locking miniplate could be a viable option instead of using two miniplates in anterior mandibular fracture as advocated by Champy, as it provides equally good outcome along with placement of lesser implant material. DiscussionSingle locking miniplates give the advantage of equally good stability and early restoration of function with almost similar results as seen in osteosynthesis with two miniplates. It was also found that less precision was required in plate adaptation when using single locking miniplate. This study suggests that there is not much difference in surgical outcome with the use of either single locking miniplate or two conventional miniplates in anterior mandibular region.

Bite Force Evaluation of Conventional Plating System Versus Locking Plating System for Mandibular Fracture.

To compare and evaluate the variation in recorded bite forces in patients with mandibular fractures undergoing open reduction and rigid internal fixation using standard 2.0 versus 2.0mm locking miniplates. A prospective randomized study was conducted for the treatment of mandibular fractures. Twenty adult patients with 31 mandibular fractures requiring an open reduction and internal fixation were included in the study. The sample was divided into two groups depending upon whether the patients received 2.0mm non-locking (standard) or 2.0mm locking miniplates for rigid fixation respectively. Bite force was evaluated at 1st, 3rd and 6th week after the open reduction and rigid fixation using miniplates. A statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. The results showed that amongst locking vs non-locking miniplates, the former showed a greater bite force enhancement when compared to baseline values(post-trauma).A comparison between 2nd day post-operative vs 6th week post-operative values showed a significant increase in bite force in Group 1 (non-locking) (p<0.05) whereas the values Were highly significant (p<0.001) in Group 2 (locking Plate). The findings were suggestive that the efficacy of locking miniplates plate in mandibular fracture was superior in terms of bearing the masticatory loads during osteosynthesis of the fracture. However, the clinical results were almost similar to those seen with non-locking miniplate osteosynthesis.

Three dimensional titanium miniplates in the management of mandibular fractures

Introduction: In 1992, Farmand developed three dimensional (3D) plate with quadrangular design, formed by joining two miniplates with interconnecting crossbars. 3D titanium plates and screws were then gradually developed. Here we report two cases in which 3D titanium miniplates were used in the management of mandibular fractures. Case presentation: A 21 year old male patient presented with the chief complaint of pain and swelling in the anterior region of the jaw due to road traffic accident. On further clinical and radiological evaluation, mandibular symphysis fracture was diagnosed and was posted for surgery under general anesthesia using 3D titanium miniplates through lower anterior vestibular incision. The fracture segment was reduced anatomically and fixed with 3D non-locking miniplates following which closure was done using 3-0 silk/vicryl suture and was followed for 6 months Another 24 year old male patient reported with the chief complaint of pain and inability to open the jaw due to a history of assault. Right mandibular parasymphysis fracture was diagnosed and was posted for surgery under general anesthesia using 3D titanium miniplates through intraoral approach. The healing was uneventful. Conclusion: 3D titanium miniplates are a superior method of fixation as they restore normal form and function early and lead to better approximation and stability.

Prospective Randomized Clinical Trial Comparing Bite Force in 2-mm Locking Plates Versus 2-mm Standard Plates in Treatment of Mandibular Fractures

To compare the efficacy of the 2-mm locking miniplates to 2-mm standard miniplates in the osteosynthesis of mandibular fractures on the basis of clinical parameters and bite force recording. A prospective randomized clinical trial was conducted at the Faculty of Dental Science, CSMMU (formerly King Georges Medical College), Lucknow, India, from January 1, 2007, to January 31, 2008, to treat consecutive mandible fractures. The patients were randomly divided into 2 groups. The patients underwent osteosynthesis--group 1 with Synthes 2-mm locking titanium miniplates and group 2 with Synthes 2-mm nonlocking titanium miniplates. The cause of trauma, the number of days from injury to surgery, average age, gender, and site distribution were all reviewed. The assessment of the patients was done at 1, 3, and 6 weeks and 3 months using the clinical parameters and bite force recording. A total of 20 patients with 32 fractures met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. A statistically significant difference was found between the change in bite force from the previous follow-up visit in groups 1 and 2. From 1 week to 3 months, the change in the incisor bite force was significantly greater for group 1 than for group 2. At 6 weeks and 3 months, the change in right molar bite force from the previous follow-up visit was significantly greater for group 1 than for group 2. At the 1-, 3-, 6-week and 3-month follow-up visits, the change in left molar bite force from the previous follow-up visit was significantly greater for group 1 than for group 2. These findings show that the use of locking miniplates plate in mandibular fracture was efficacious enough to bear the masticatory loads during osteosynthesis of the fracture. The locking miniplates provide the advantage of a greater bite force, with clinical results almost similar to those seen with nonlocking miniplate osteosynthesis.

Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?

Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. The present study compared results between locking plates and intramedullary K-wires. The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks' immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. Level IV continuous prospective comparative study.

A Biomechanical Evaluation of Plating Techniques Used for Reconstructing Mandibular Symphysis/Parasymphysis Fractures

The purpose of this investigation was to evaluate and compare the biomechanical behavior of 5 different methods used to repair mandibular symphysis/parasymphysis fractures. Sixty synthetic polyurethane mandible replicas (Synbone, Laudquart, Switzerland) were used in this investigation. Ten controls and 10 each of the experimental groups were tested by subjecting 5 constructs in each group to vertical loading at the incisal edge and 5 constructs to torsional loading at the molar region by an Instron 1331 (Instron, Canton, MA) servohydraulic mechanical testing unit. The 5 methods of reconstruction include: arch bars using 18-gauge stainless steel wire with an acrylic lingual splint, 2 2.4-mm lag screw technique, 2 2.0-mm 4-hole locking miniplates, 2 2.0-mm 6-hole nonlocking miniplates, and 2 2.4-mm 6-hole limited-contact dynamic-compression plates. Mechanical deformation data within a 0 to 900 N range were recorded. Yield load, displacement at yield load, and stiffness were determined. Means and standard deviations were derived and compared for statistical significance using a Fisher's protected least significant differences test with a confidence level of 95% (P < .05). Third-order polynomial best-fit curves also were created for each group to further evaluate and compare the mechanical behavior. For incisal edge loading, statistically significant differences were noted between the lag screw technique and the arch bar, limited-contact dynamic-compression plate and locking miniplate; and between the nonlocking miniplate and the arch bar, limited-contact dynamic-compression plate and locking miniplate for stiffness. Additionally, statistically significant differences were noted between the lag screw technique and arch bar; and between the nonlocking miniplate and the arch bar, dynamic-compression plate and locking miniplate for yield load. For molar loading, statistically significant differences were noted between the lag screw technique and all other groups for both yield load and stiffness; as well as the arch bar and locking miniplate for stiffness. No statistically significant differences were noted between any groups for displacement at yield, for either incisal edge or molar loading. Although statistically significant differences were noted between each of the fixation systems in their abilities to resist loads under the conditions tested, when placed in the context of functional parameters, all systems met the requirements for incisal edge loading. When molar loading was considered, the lag screw technique performed more favorably than the other systems.

Mandibulotomy fixation: a laboratory analysis

Purpose: Mandibulotomy is an access osteotomy technique associated with significant complications. Critical evaluation of available fixation systems is required to aid in the selection of the most stable fixation method. This study was designed to provide data on the stability of traditionally used plating configurations and a low-profile 2.0-mm locking plate (mandibular locking plate, Synthes MLP; Synthes Maxillofacial, Paoli, PA). Materials and methods: An in vitro red oak model was used to evaluate the stability provided by the study fixation devices. Five groups were studied as follows: group 1, two 4-hole 2.0-mm nonlocking miniplates; group 2, two 4-hole 2.0-mm mandibular locking plates; group 3, one 6-hole 2.0-mm mandibular locking plate; group 4, one 6-hole 2.4-mm nonlocking rigid plate; and group 5, control (uncut red oak blocks). Each specimen was tested with vertical loads applied over the osteotomy site. The force-versus-displacement behavior was recorded for each specimen and analyzed statistically. Results: Plate type and configuration affected the resistance to vertical peak load (kilogram/force [kgf]) and the fixation stiffness (kgf/mm). The greatest peak load (58.92 kgf) and stiffness (7.07 kgf/mm) was found with group 2 specimens. The differences in system stiffness were statistically significant ( P < .05), as were the peak loads for groups 1, 2, and 3. The control group (nonosteotomized red oak) had markedly higher values of peak load and stiffness (484 kg and 83 kg/mm, respectively). Group 2 specimens exhibited increased resistance to flexion. Conclusions: Two 2.0-mm locking plates provided the greatest resistance to vertical load.