Sutural Research Articles

Is there a sexual dimorphism in Wormian bones presence? A study on Polish and Lithuanian sample

Is there a sexual dimorphism in Wormian bones presence? A study on Polish and Lithuanian sample

Piezo1 Promotes Osteogenesis Through CaMKII Signalling in a Rat Maxillary Expansion Model.

Rapid maxillary expansion (RME) is a widely used technique to treat maxillary transverse deficiency. Piezo1 is a cation channel that is activated by mechanical force and regulates bone formation. This study aims to elucidate the role of Piezo1 in bone remodelling during the RME process. In this study, the periosteal-derived stem cells (PDSCs) were cultured and stretched by the Flexcell system. The effects of Piezo1 on osteogenesis were assessed via RNA sequencing, real-time quantitative PCR, and western blot analyses. Moreover, for invivo analyses, the rat RME model was established. The function of Piezo1 in mid-palatal suture bone remodelling was evaluated using micro-CT, haematoxylin-eosin (HE) staining, and immunohistochemistry analyses. It was revealed that under tension force, the osteogenic factors (Runt-related transcription factor 2, Osterix, and Alkaline Phosphatase) and Ca2+/calmodulin -dependent protein kinase (CaMKII) were significantly enhanced in PDSCs over time. Furthermore, these were also upregulated in the RME model with the expansion of the mid-palatal suture. However, Piezo1 inhibition by Grammostola spatulata mechanotoxin 4 downregulated the levels of these factors in the RME model. This study indicated that Piezo1 is associated with the osteogenesis of PDSCs and bone remodelling in the RME process. CaMKII might also participate in this process.

Does the distribution of Wormian bone frequencies across different world regions reflect genetic affinity between populations?

BackgroundWormian, or sutural bones, are additional, irregularly shaped bone fragments that can occur within cranial sutures. These bones may arise due to various factors, including mechanical pressure on skull bones during early ontogenetic stages, such as during artificial cranial deformations, or due to genetic and environmental influences. This study investigates the potential genetic basis of sutural bones by comparing their frequencies across diverse global regions. It analyzed 33 craniological series, encompassing 2059 crania, to assess the frequency of sutural bones in the coronal, squamous, lambdoid, and occipitomastoid sutures among skeletal populations from regions including Aboriginal Australia, Melanesia, Southeast Asia, Siberia, Europe, and Native America. Biological distances between populations were calculated using Smith’s mean measure of divergence (MMD), with results visualized through multidimensional scaling.ResultsThe analysis identified distinct clusters of Caucasian and Siberian populations. Siberian aboriginal populations are compactly grouped, consistent with mtDNA data indicating genetic roots dating back to the Neolithic inhabitants of the Lake Baikal region. Further, differentiation within these populations is linked to the founder effect and gene flow. Notably, genetically related groups like the Inuit and Chukchi of Chukotka differ from other Siberian groups. In contrast, southern Siberian populations, such as the Buryats and Mongols, are closely positioned, aligning with genetic data. The differentiation between Southeast Asian and African regions was subtler, with their clusters largely overlapping. Yet, genetic links between populations were observed in some cases. Thus, Australians, Melanesians, and Papua New Guineans were located close to each other on the multidimensional scaling map, as were two African populations.ConclusionsThe findings tentatively suggest a potential genetic component in the expression of Wormian bones, although this hypothesis requires further empirical support, particularly through genetic studies. While genetic factors may influence the expression of Wormian bones, environmental conditions and pathological processes also play significant roles. It can be suggested that Wormian bones could potentially serve as an additional tool in kinship analysis within burials; however, their utility significantly depends on the extent of their genetic influence. If future genetic studies confirm a substantial genetic component and its dominance over environmental factors, the use of these bones in anthropological and forensic analyses would receive additional validation.

Mechanically induced M2 macrophages are involved in bone remodeling of the midpalatal suture during palatal expansion

BackgroundPalatal expansion is a common way of treating maxillary transverse deficiency. Under mechanical force, the midpalatal suture is expanded, causing local immune responses. This study aimed to determine whether macrophages participate in bone remodeling of the midpalatal suture during palatal expansion and the effects on bone remodeling.MethodsPalatal expansion model and macrophage depletion model were established. Micro-CT, histological staining, and immunohistochemical staining were used to investigate the changes in the number and phenotype of macrophages during palatal expansion as well as the effects on bone remodeling of the midpalatal suture. Additionally, the effect of mechanically induced M2 macrophages on palatal osteoblasts was also elucidated in vitro.ResultsThe number of macrophages increased significantly and polarized toward M2 phenotype with the increase of the expansion time, which was consistent with the trend of bone remodeling. After macrophage depletion, the function of osteoblasts and bone formation at the midpalatal suture were impaired during palatal expansion. In vitro, conditioned medium derived from M2 macrophages facilitated osteogenic differentiation of osteoblasts and decreased the RANKL/OPG ratio.ConclusionsMacrophages through polarizing toward M2 phenotype participated in midpalatal suture bone remodeling during palatal expansion, which may provide a new idea for promoting bone remodeling from the perspective of regulating macrophage polarization.

RhoA/ROCK-TAZ Axis regulates bone formation within calvarial trans-sutural distraction osteogenesis

BackgroundCraniofacial skeletal deformities can be addressed by applying tensile force to sutures to prompt sutural bone formation. The intricate process of mechanical modulation in craniofacial sutures involves complex biomechanical signal transduction. The small GTPase Ras homolog gene family member A (RhoA) functions as a key mechanotransduction protein, orchestrating the dynamic assembly of the cytoskeleton by activating the Rho-associated coiled-coil containing protein kinase (ROCK). Transcriptional coactivator with PDZ-binding motif (TAZ) serves as a crucial mediator in the regulation of genes and the orchestration of biological functions within the mechanotransduction signaling pathway. However, the role of RhoA/ROCK-TAZ in trans-sutural distraction osteogenesis has not been reported. MethodsWe utilized pre-osteoblast-specific RhoA deletion mice to establish an in vivo calvarial trans-sutural distraction model and an in vitro mechanical stretch model for pre-osteoblasts isolated from neonatal mice. Micro-CT and histological staining were utilized to detect the formation of new bone in the sagittal suture of the skull as well as the activation of RhoA, Osterix and TAZ. The activation of ROCK-limk-cofilin and the nuclear translocation of TAZ in pre-osteoblasts under mechanical tension were detected through Western blot, qRT-PCR, and immunofluorescence. ResultsThe osteogenic differentiation of pre-osteoblasts was facilitated by mechanical tension through the activation of RhoA and Rho-associated kinase (ROCK), while ablation of RhoA impaired osteogenesis by inhibiting pre-osteoblast differentiation after suture expansion. Furthermore, inhibiting RhoA expression could block tensile-stimulated nuclear translocation of TAZ by preventing F-actin assembly through ROCK-LIM-domain kinase (LIMK)-cofilin pathway. In addition, the TAZ agonist TM-25659 could attenuate impaired osteogenesis caused by ablation of RhoA in pre-osteoblasts by increasing TAZ nuclear accumulation. ConclusionsThis study demonstrates that mechanical stretching promotes the osteogenic differentiation of pre-osteoblasts in trans-sutural distraction osteogenesis, and this process is mediated by the RhoA/ROCK-TAZ signaling axis. Overall, our results may provide an insight for potential treatment strategies for craniosynostosis patients through trans-sutural distraction osteogenesis.

Brain and the whole-body bone imaging appearances in Menkes disease: a case report and literature review

BackgroundMenkes disease (MD) is a rare, inherited, multisystemic copper metabolism disorder. Classical Menkes disease is characterized by low serum copper and ceruloplasmin concentrations, leading to multiple abnormalities in the whole-body, especially in connective tissue and central nervous system. However, serum copper and ceruloplasmin levels are not reliable diagnostic biomarkers due to the low concentrations in healthy newborns either. The featured imaging manifestations play an important role in diagnosing Menkes disease. To our knowledge, there are few reports on the systemic imaging manifestations of Menkes disease.Case presentationA 4-month-old male patient presented with recurrent seizures. He had cognitive, intellectual, growth, gross motor, precision movement, and language developmental lags. The patient’s hemoglobin and serum ceruloplasmin level were low. On MRI, increased intracranial vascular tortuosity, cerebral and cerebellar atrophy, white matter changes, and basal ganglia abnormalities were observed. Plain radiograph revealed wormian bones, rib flaring, metaphyseal spurring, and periosteal reactions in the long bones of the limbs. A pathogenic variant in ATP7A gene was identified in the patient, so he was confirmed the diagnosis of Menkes disease. His symptoms did not improve despite symptomatic and supportive treatment during his hospitalization. Unfortunately, the infant died 3 months after leaving hospital.ConclusionA comprehensive and intuitive understanding of the disease’s imaging manifestations can help clinicians to identify the disease and avoid delays in care.

Multiple Wormian Bones in the Lambdoid Suture: A Report of Rare Occurrence

Multiple Wormian Bones in the Lambdoid Suture: A Report of Rare Occurrence

Fat mass and obesity-associated protein (FTO) affects midpalatal suture bone remodeling during rapid maxillary expansion.

The fat mass and obesity-associated protein (FTO) is an RNA demethylase that contributes to several physiological processes. Nonetheless, the impact of FTO on bone remodeling in the midpalatal suture while undergoing rapid maxillary expansion (RME) remains unclear. First, to explore the expression of FTO in the midpalatal suture during RME, six rats were randomly divided into two groups: Expansion group and Sham group (springs without being activated). Then, suture mesenchymal stem cells (SuSCs) were isolated as in vitro model. The expression of FTO was knocked down by small interfering RNA to study the effect of FTO on the osteogenic differentiation of SuSCs. Finally, to evaluate the function of FTO in the process of bone remodeling in the midpalatal suture, ten rats were randomly divided into two groups: FB23-2 group (10 μM, a small molecule inhibitor of FTO) and DMSO group (control). Increased arch width and higher expression of OCN and FTO in the midpalatal area were observed in expansion group (P < .05). In the in vitro model, the mRNA expression levels of Runx2, Bmp2, Col1a1, Spp1, and Tnfrsf11b were decreased (P < .05) upon knocking down FTO. Additionally, the protein levels of RUNX2 and OPN were also decreased (P < 0.05). Adding FB23-2, a small-molecule inhibitor targeting FTO, to the medium of SuSCs caused a decrease in the mRNA expression levels of Runx2, Bmp2, Col1a1, Spp1, and Tnfrsf11b (P < 0.05). There was a statistically significant difference in evaluating the expression of OCN and OPN on the palatal suture between the FB23-2 and DMSO groups (P < .05). The molecular mechanisms by which FTO regulates SuSCs osteogenesis remain to be elucidated. The FTO conditional knock out mouse model can be established to further elucidate the role of FTO during RME. FTO contributes to the osteogenic differentiation of SuSCs and plays a promoting role in midpalatal suture bone remodeling during the RME.

Morphometric Evaluation of Sutural Patterns at the Pterion and Asterion in Dry Indian Skulls: Surgical Relevance.

The pterion and asterion serve as crucial landmarks on the skull, representing the antero-lateral and postero-lateral fontanelles in neonates, respectively. In clinical practice, these points play a pivotal role in guiding the understanding of deeper structures and their relationships to the head's surface. The thin calvarium at these junctures is susceptible to fractures, and the underlying vessels are prone to tear, often leading to extradural hematoma formation, necessitating burr hole surgery for evacuation. The study involved 40 human dry skulls in Indians (n= 27 male (10.8%), n= 13 female (5.2%)) of unknown age, evaluating morphometric characteristics of 80 pterions and asterions. Measurements were conducted using a digital caliper (SKADIOO±0.2mm/0.01") in millimeters on both sides of each skull. The investigation also included an examination of sutural patterns in Pterion and asterion. Three types of sutural patterns were identified in the pterion, the most common being the sphenoparietal variety (75% on the right, 70% on the left), followed by the epipteric variety, which was the second most common (11.3% on the right, 12.5% on the left), and then the frontotemporal type (1.3% on the right, 2.5% on the left). Two sutural patterns were observed in the asterion: type 1 (presence of sutural bone) in 17.9% of skulls and type 2 (absence of sutural bone) in 82.1%. The differences in pterion and asterion positions across various populations explored in previous studies motivated us to conduct this research in the Indian population. Our findings revealed that among Indians, the predominant pterion type is predominantly sphenoparietal, whereas type 2 is the most prevalent in asterion. Understanding the clinical significance of the pterion and asterion is crucial for healthcare professionals to ensure precise and safe surgical procedures, particularly for the effective treatment of head trauma patients.

Variation of Wormian and Inca Bones in Adult Skulls

Objective: Irregular and abnormal small additional bones called Wormian bones can be encountered between the skull bones. This study aimed to investigate the incidence, topographical distribution, morphology, and interrelationship of the Wormian and Inca bones in Central Anatolia Region dry adult skulls. Methods: In the study, 119 adult skulls were examined. The location and frequency of additional bones (Wormian) in the sutures in the cranium were determined. Skulls with Inca bones were identified. The Inca bones were typified in accordance with the literature and their dimensions in the transverse and sagittal axis were measured with a digital caliper. Results: Wormian bone was present in 33 of 119 adult skulls (27.7%). Of the 33 bones, 22 were detected in the male (66.66%) and 11 female (33.34%) skulls. The locations of the Wormian bones in the order of decreasing incidence were the lambdoid suture (16.0%, 19/119), pterion (16.0%, 19/119), lambda (7.6%, 9/119), asterion (2.5%, 3/119), and bregma (1.7%, 2/119). Nine Inca bones were found in the lambdoid region (27.3%, 9/33). Six of these bones (66.7%) were in the male skull. We found that two of these bones were incomplete lateral asymmetric, two were complete symmetric bipartite, two were incomplete asymmetric bipartite and three were incomplete median type. We found that 13 (10.9%) of the skulls in the study had metopic sutures and 0.8% had craniosynostosis. When the craniums with metopic suture were evaluated, it was found that 8 of them (61.5%) had additional bone. 50% of the Wormian bones were found in the lambdoid suture. Conclusion: It has been found that the incidence of Wormian bone increases with suture variations. It was determined that the frequency of Inca bone variation may vary depending on regional differences.

Pyknodysostosis- A Challenging Diagnosis

We report a case of a 7-year-old boy presented to us with short stature, born at full term by SVD with an immediate cry and a birth weight of 03 kg, breast-fed for 2 years. There are no apparent signs of development delay. By the age of two, the mother was concerned about physical and developmental delays.&#x0D; The patient had a male sibling with a history of repeated fractures and sensorineural hearing loss, labelled osteopetrosis.&#x0D; EXAMINATION:&#x0D; &#x0D; An active male child of 95cm and 12 kg falls below the 3rd centile.&#x0D; He had frontal bossing, mildly hypoplastic maxillae, a wide open fontanelle, and sutural diastasis.&#x0D; &#x0D; INVESTIGATIONS:&#x0D; &#x0D; Complete Blood Count, Thyroid profile, Serum Calcium, Phosphorus and Alkaline Phosphatase. All normal.&#x0D; A skeletal survey showed an increase in bone density. Sutural diastasis, multiple Wormian bones, thickening of the Calvaria, thickening of long bones with medullary sparing, and spool deformity of vertebral bodies.&#x0D; &#x0D; DIFFERENTIAL DIAGNOSIS&#x0D; &#x0D; Pyknodysostosis&#x0D; Hypothyroidism&#x0D; Osteopetrosis&#x0D; &#x0D; CONCLUSION:&#x0D; Additional X-rays, including the mandible, showed an obtuse angle, the clavicle was laterally deficient, and the hand showed acro osteolysis. The patient was diagnosed with a rare case of pyknodysostosis.

The Impact of Systemic Simvastatin on Bone Remodeling Following Rapid Maxillary Expansion: An In Vivo Study

A midpalatal suture contention after rapid maxillary expansion (RME) is a major orthodontic challenge. The objective of this study is to evaluate the effect of systemic simvastatin on suture bone remodeling after disjunction. For that, 15 Wistar rats were used. In 10, orthodontic appliances were installed and activated for 5 days for RME. These animals were randomly divided into two groups: control (CT, n = 5) and simvastatin (SVT, n = 5). Also, animals without intervention (HG, n = 5) were used. In the SVT and CT groups, 5 mg/kg of simvastatin and distilled water were administered by gavage, respectively, for 20 consecutive days. Then, the animals were euthanized and scanned in micro-computed tomography (µCT). The images were analyzed through pixel linear measurement at four different points (P1, P2, P3 and P4), in the intra-incisor distance (DI) and in the suture distance (SD). Microtomographic parameters, such as cortical bone area (Ct.Ar), cortical area fraction (Ct.Ar/Tt.Ar), and cortical thickness (Ct.Th), were obtained. Also, bone volume fraction (BV/TV) and empty space (EV) were extracted. Then, histological slides were prepared for descriptive and histomorphometric analysis. There was a statistically significant difference in the linear measurements, microtomographic parameters, and histomorphometric results between the experimental groups. In conclusion, simvastatin demonstrated an osteoinductive and antiresorptive effect in the palatine suture region after RME.

A Cross-sectional Study of Wormian Bones in the Cranium: Exploring their Clinical Significance and Diagnostic Implications

Introduction: Wormian Bones (WBs) are small, irregularly shaped ossicles often located within the cranial sutures and at the fontanelles, with the majority found in the lambdoid sutures. They result from the formation of abnormal ossification centres in the cranium that develop through an unknown mechanism. Clinically, Significant Wormian bones (SWBs) are defined as bones arranged in a general mosaic-like pattern with a size larger than 6×4 mm; for pathological significance, more than 10 such SWBs should be present. Aim: To study the incidence of WBs in various sutures of human dry skulls and to investigate the incidence of the metopic suture and Inca bone in human dry skulls. Materials and Methods: The present cross-sectional study was conducted in the Department of Anatomy, Government Doon Medical College, Dehradun, Uttarakhand, India, from January 2024 to May 2024. In the present study, 38 dried adult human skulls of unknown age and sex were examined for the presence, number and location of WBs, the metopic suture, and the Inca bone in various sutures of the skull. The data were analysed using descriptive statistics, and results were expressed in terms of incidence. Results: Wormian bones were present in 21 (55.26%) skulls, while 17 (44.74%) had no WBs. One (0.27%) skull had a metopic suture, and 1 (0.27%) skull had an Inca bone. Pathologically significant WBs were not found in any of the skulls examined. Conclusion: The overall incidence of WBs is 55.26%, while the incidences of the metopic suture and Inca bone are both 2.63%. Thus, WBs may mimic a cranial fracture, leading to misdiagnosis, which could delay or alter treatment. Additionally, some WBs may be lost during putrefaction, giving the appearance of an entry/exit gunshot wound in postmortem cases.

Topography and clinical implication of Wormian bones on dry adult human skulls in Telangana region

Introduction and Aim: Wormian bones vary in size, form and quantity and their occurrence is influenced by both genetic and environmental variables. Wormian bones are also seen in foetus ultrasounds during the antenatal period. The occurrence of much more than one sutural bone at the pterion is radiographically significant. The current study aims at the occurrence and topography of Wormian bones in the Telangana region and correlates them to other population groups. Material and Methods: This study was carried out in 160 dry adult human skulls. Presence of these Wormian bones in sagittal, coronal, and Lambdoid sutures along with bregma, lambda, asterion and pterion were noted. The quantitative data is analyzed, and the images were captured. Results: Their incidence was 45 % while in 55% skulls they were absent. Their percentage was more in lambdoid suture (16.9%) followed by asterion (12.5%). They were also observed in sutures like coronal (5.6%) and sagittal (1.9%). In pterion their occurrence was 3.12%. In bregma, none of the skull showed Wormian bones. Conclusion: In the present study, incidence of Wormian bones (Wb’s) is 45% with a greater number of Wb’s observed in Lambdoid suture (16.9%). In the event of any interventions or investigations on the skull, topography of these bones is to be considered.

Prevalence, Number and Localization of Wormian Bones in Anatolian Adult Dry Skulls

Aim: The locations of the Wormian bones (WBs) are critical knowledge for physicians, anatomists, forensic scientists, and anthropologists. The purpose of the study is to identify the number and location of WBs in the Anatolian population.&#x0D; Material and Methods: The study included 29 adult skulls from anatomy departments at two universities in Türkiye. The skulls' gender and age were unknown. The prevalence, quantity, and location of WBs were assessed. &#x0D; Results: The greatest number of WBs (mean 1.79) were found in the lambdoid suture, which was followed by the coronal suture (0.43). Among the fontanelles, the Asterion had the highest number of WBs (0.42).&#x0D; Conclusion: According to our findings, the Lambdoid suture has the highest number of WBs. There is still a great deal of mystery around the causes of the occurrence and localization of WBs. Radiologists, neurosurgeons, forensic scientists, anatomists, and anthropologists must conduct more research in this area.

Wormian Bones: Prevalence, Topography, and Implications.

Wormian bones also known as sutural bones are asymmetrical and shapeless bones occurring in cranial sutures and fontanelle of the skull. Their incidence is reported to vary in population. The exact etiology is debatable, but their formation is under the control of both genetic and environmental factors and has great anthropological and clinical implications related to the cranium. Due to high clinical relevance of Wormian bones, the study was carried out. The aim of the study is to expound the incidence and topography of Wormian bones along with clinical significance in dry adult skulls of Indian origin. The study was conducted in the Department of Anatomy using 200 complete adult dry skulls of unknown age and sex. All the sutures in the skull were inspected for the presence of Wormian bones. The Wormian bones were classified into 10 categories, and associated implications were brought out. The Wormian bones were photographed, and details were compared with the available literature. The Wormian bones were observed in 190 (380 sides) skulls with 186 on the right side and 108 on the left side. The predominance site of sutural bone was lambdoid suture followed by sagittal suture. The least common site of Wormian bone was lambda. The detailed information of precise topography, frequency, and number of Wormian bones is of utmost use for surgeons performing surgery on the skull, anthropologists for identifying races, and forensic scientists for investigating child abuse cases.

Pycnodysostosis: In the Indian Population – A Case Report with Review of the Literature

Abstract Bone disorders having different causes, such as metabolic, genetic, and environmental, are well known and each of them has a characteristic clinical and radiographic appearance. Pycnodysostosis is one such rare bone disease that manifests as generalized osteosclerosis of the skeleton because of decreased bone turnover. Some of the unique radiographic and clinical features distinguish it from other bone disorders, such as osteogenesis imperfect, osteopetrosis, and cleidocranial dysplasia. Recognition of these signs is important to make a diagnosis and prevent further complications. We report a case of a 24-year-old male, who presented with a chief complaint of dirty and malaligned teeth and was unhappy with his facial appearance. General examination features which drew attention were short stature, beaking of the nose, and frontal and parietal bossing. Radiographically, open fontanelles, wormian bones, and dental abnormalities were evident.

A Bilateral Quadricipital Tendon Rupture in a Patient with Chronic Renal Failure

Bilateral quadricipital tendon rupture is a rare lesion, especially in patients with different chronic diseases. We report the case of a bilateral rupture of the quadricipital tendon in a young patient followed for chronic renal failure on hemodialysis for 17 years. Surgical repair was successfully performed using bone sutures and reinforcement by metal framing. We present our results with a literature review.

KDM6A Mediated Regulation of Cranial Frontal Bone Suture Fusion in Mice is Sex-Dependent.

The five flat bones of developing cranial plates are bounded by fibrous sutures, which remain open during development to accommodate for the growing brain. Kdm6A is a demethylase which removes the epigenetic repressive mark, tri-methylated lysine 27 on histone 3 (H3K27me3), from the promoters of osteogenic genes, and has previously been reported to promote osteogenesis in cranial bone cells. The present study generated a mesenchyme-specific deletion of a histone demethylase, Kdm6a, to assess the effects of Kdm6a loss, in cranial plate development and suture fusion. The results showed that the loss of Kdm6a in Prx-1+ cranial cells caused increased anterior width and length in the calvaria of both male and female mice. However, the posterior length was further decreased in female mice. Moreover, loss of Kdm6a resulted in suppression of late suture development and calvarial bone formation predominantly in female mice. In vitro assessment of calvaria cultures isolated from female Kdm6a knockout mice, found significantly suppressed calvarial osteogenic differentiation potential, associated with decreased gene expression levels of Runx2 and Alkaline Phosphatase and increased levels of the suppressive mark, H3K27me3 on the respective gene promoters. Conversely, cultured calvaria bone cultures isolated from male Kdm6a knockout mice exhibited an increased osteogenic differentiation potential. Interestingly, the milder effects on cranial suture development in Kdm6a knockout male mice, were associated with an overcompensation of the Kdm6a Y-homolog, Kdm6c and increased expression levels of Kdm6b in calvarial bone cultures. Taken together, these data demonstrate a role for Kdm6a during calvarial development and patterning, predominantly in female mice, and highlights the potential role of Kdm6 family members in patients with unexplained craniofacial deformities.

FEATURES OF MANDIBULAR FRACTURES

In order to prevent some of the observed complications from the above-mentioned methods of treatment, i.e. Kirschner needle, bone sutures, during the development of medicine, titanium microscrews and miniplates are being used for modern treatment. By using microscrews and miniplates, it has been possible to achieve stable fixation of fracture fragments and treatment of mandibular fractures by non-burning method.