Three-dimensional Miniplates Research Articles

Usability testing of a novel interlocking three-dimensional miniplate for mandibular angle fractures.

We developed a novel interlocking three-dimensional (3D) miniplate design with an adjustable configuration. As this device is new, surgeons must become familiar with its application. This study evaluated the usability and learning curves associated with the novel interlocking 3D miniplate for mandibular fracture fixation. The study participants, nine plastic surgeons, were asked to apply an interlocking 3D miniplate and a standard miniplate to polyurethane mandible models. The participants had completed the Basic Craniomaxillofacial Osteosynthesis course during residency and had operated on craniomaxillofacial fractures within the past 5 years. They were instructed to place the interlocking 3D miniplate three times and the standard miniplate once. We assessed the time required for implant placement, the comfort level of the surgeons, and the biomechanical stability of the plates. Biomechanical testing was conducted by subjecting the mandible to forces ranging from 10 to 90 N and the displacement was measured. The results indicate increasing comfort with each attempt at placing the interlocking 3D miniplate, with a significant difference between the first and third attempts. Additionally, a reduction in application time was noted with repeated attempts, suggesting improved efficiency. Biomechanical tests showed comparable stability between the tested plates. Multiple attempts at applying the interlocking 3D miniplate resulted in increased comfort and reduced application time. These findings indicate that, despite its novelty, the interlocking 3D miniplate is relatively straightforward to apply and has a short learning curve. However, surgeons must have specific qualifications to ensure proper training and minimize errors during placement.

Comparative Evaluation of Clinical Outcome Including Neurosensory Deficit and Pain Score Variables Using Rigid Internal Fixation with Three-Dimensional Miniplate Internal Fixation in Simultaneous Angle and Contralateral Body/Parasymphysis Fractures of the Mandible: A Prospective, Randomized Controlled Study.

Purpose There have been numerous advancements in the strategies used for treating mandibular fractures in the present times, while open reduction and internal fixation is still accepted as the most preferred treatment option for such fractures despite numerous drawbacks. The aim of the present prospective, randomized controlled study was to evaluate the clinical outcome including neurosensory deficit and pain score variables in mandibular fractures that were treated using rigid internal fixation with three-dimensional (3D) miniplate internal fixation. Materials and Methods For the present study, a total of 20 patients of either sex in an age range of 18 to 55 years with simultaneous angle and contralateral body/parasymphysis fractures of the mandible were included, while the clinical outcome was compared in relation to the two groups wherein different treatment options were used including using rigid internal fixation in one as against 3D miniplate internal fixation in the other. Results Pairwise comparison of pain scores in Group I and Group II patients by the Mann-Whitney U-test at different time zones revealed the results to be statistically significant for all pairs except when the findings were compared between 1 month and 3 months after the procedure in Group II patients. Also, significant recovery was observed in both Group I and II patients during healing when assessed preoperatively to 1 month and then 3 months after the procedure with the results being statistically highly significant in case of the variations observed in relation to the neurosensory deficit observed at different time zones for both Group I and II patients ( p = 0.0001). Conclusion Based on the results obtained, it can be concluded that 3D miniplate-led osteosynthesis was found comparable to the osteosynthesis accomplished using reconstruction plates during fixation of unfavorable body/parasymphysis fractures of mandible in study, providing optimal stability, while satisfactorily meeting the biomechanical requirements for occlusal loading, and an early return to normal function.

Three-dimensional Miniplate as a Viable Alternative Fixation Device for Isolated Maxillary Sinus Fracture Management: A Technical Note

Isolated fractures of the anterior wall of the maxillary sinus are rare. Literature reveals that these fractures can be managed surgically through numerous ways but none have shown superior results over the other clinically. We put forth that three-dimensional miniplates can serve as a viable alternative fixation device for isolated maxillary sinus fracture management.

Comparative Assessment of Clinical and Quality of Life Outcomes in Mandibular Angle Fractures Treated with Standard and Three-Dimensional Mini-Plates.

To undertake a multidimensional comparative assessment of the standard and three dimensional (3D) mini-plates in managing isolated mandibular angle fractures (MAFs). Thirty-six subjects were divided equally into two groups. Group A underwent fixation with a standard 2mm miniplate, while group B with 2mm 3D mini-plates. Evaluations were done preoperatively (T0), postoperatively at one week (T1), one month (T2) and three months (T3). Maximal inter-incisal mouth opening (MIO) and mean bite force (MBF) at the central incisors, right and left molars were calculated. Postoperative complications and Quality of life (QoL) outcomes were evaluated using the short form Oral Health Impact Profile (OHIP-14). Mean operative time was almost similar for both groups. Although mean MIO improved significantly from T1 to T3 in both groups, intergroup comparison of MIO was not significant. The MBF values were significantly higher in group B on the right and left molars at T2 and T3. Although significant improvement in OHIP-14 scores was seen from T2 to T3 in both the groups, intergroup comparison of OHIP was not significant. 3D plates demonstrated similar clinical and QoL outcomes compared to the standard mini-plates.

Comparative Evaluation of Conventional Miniplates, Three-Dimensional Miniplates and Lag Screws for Internal Fixation of Parasymphysis Fracture of Mandible-A Double-Blind Randomized Clinical Study.

The aim of this study is to clinically and radiographically evaluate the stability of parasymphysis fracture managed with lag screws, miniplates and 3D miniplates. Ninety- eight patients diagnosed with parasymphysis fracture were treated using lag screws in group 1, two 4-hole miniplates in group 2 and 3D miniplates in group 3. Intraoperative stability and duration of fixation was assessed. Postoperative clinical evaluation was done at 1week, 1month, 3rd month, 6th month and 1year for complications and oral function. Radiological evaluation was done at 3rd and 6th month. Only 92 patients were considered for statistical analysis since 6 patients were lost during follow-up. Road traffic accident (65.3%) was the primary cause of mandibular fractures. Postoperative pain score showed a statistically significant difference after 1week and 1month duration (P value < 0.001). ANOVA test showed VAS was significantly higher at pre-op followed by 1st day and 1week, but no significant difference after 3months in all groups. Radiographic analysis did not show significant difference in approximation of fracture segment among 3 groups after 6months (P-value = 0.117). Chewing efficiency at 6months and occlusion by surgeon evaluation at 3months showed a significant difference (P value < 0.001). Lag screw fixation was technique-sensitive, relatively inexpensive and was less time consuming method when compared to miniplates and 3D plates. Lag screws and 3D plates are superior in reducing the incidence of complications and better in oblique or sagitally displaced mandibular fractures. The online version contains supplementary material available at 10.1007/s12663-021-01647-5.

Finite element analysis of different titanium miniplates: Evaluation of three-dimensional designs applied on condylar neck fractures

IntroductionThe fixation of condylar neck fractures is raising difficulties and for this reason, many plate designs have been developed. The current study compares the performance of four miniplates used in the condylar neck. Material and MethodsA virtual condylar neck fracture in a mandible obtained from a CT scan was fixed with four miniplates (two straight miniplates, lambda, strut, and trapezoidal). Using finite element analysis, we examined the fragments' displacements and stress distribution in the titanium material and bone. The models were analyzed under two loading conditions: a reduced bite force of 135 N and a force of 500 N. ResultsNo risk of material failure was observed. For a load of 135 N, all four plates offer an adequate fixation. For 500 N of applied loading, the lambda and strut plates showed the best rigidity and lowest bone strains. The two parallel plates showed the lowest rigidity and the trapezoidal plate the highest bone strains around all screws. DiscussionThese findings imply that three-dimensional miniplates (lambda, strut) perform better when higher loads are applied. On the other hand, the trapezoidal plate has an increased risk of screw loosening and the two straight plates higher mobility of the fragments.

An In Vitro Evaluation of a Novel Design Z Plate for Fixation of Mandibular Symphysis and Parasymphysis Fractures-A Finite Element Analysis.

Surgical management of mandibular symphysis and parasymphysis fractures has evolved from rigid fixation to semi-rigid fixation with miniplate osteosynthesis. Various miniplate systems have been developed in recent years including three-dimensional miniplate, microplates and bioresorbable plate, and their advantages and disadvantages have been compared and studied. To overcome the shortcomings of 3D plating system such as difficulty in adaptation and fixation in fractures involving the mental nerve, a novel Z plate has been designed by our institute. An in vitro study was performed to evaluate the biomechanical behaviour of the newly designed Z plate with 3D plate and two-miniplate system using finite element analysis. Our study showed total structural deformation of 0.17mm and 0.31mm of newly designed Z plate after canine loading and molar loading, respectively. The equivalent von Mises force for plate after canine loading had shown the following results-Z plate showed values of 121.3MPa and 58.40MPa after molar loading. Our study concluded that the Z plate produces lowest stresses, lesser total structural deformation, superior stability and support in comparison with the 3D plate and two-miniplate system.

The Use of 3D Titanium Miniplates in Surgical Treatment of Patients with Condylar Fractures.

The aim of this study was to evaluate the effectiveness of open treatment of mandibular condyle fractures using 3D miniplates. A group of 113 patients has been chosen for evaluation, including 100 men and 13 women. After hospitalization, each patient underwent a 6-month postoperative follow-up. The material chosen for the analysis consisted of data collected during the patient’s stay in the hospital as well as the postoperative outpatient care. A single 4-hole Delta Condyle Compression Plate (4-DCCP) was used in 90 out of 113 (79.6%) cases. In 16 out of 113 (14.2%) patients, the Trapezoid Condyle Plate (4-TCP or 9-TCP) was used. The remaining cases required more than one miniplate. No 3D miniplate fractures were found in the study subjects during the analyzed observation period. Loosening of one or more osteosynthesis screws was observed in 4 out of 113 (3.5%) patients. Screw loosening was a complication that did not affect bone healing in any of the patient cases. The conducted research confirms that titanium 3D mini-plates are easy to adjust and take up little space, therefore they can easily be used in cases of mandibular condyle base and lower condyle neck fractures. The stability of the three-dimensional miniplates for osteosynthesis gives very good reliability for the rigid fixation of the fractured mandibular condyle.

Management of mandibular angle fractures using 3- dimensional or standard miniplates: A systematic review and meta-analysis

PurposeThis study proposed to compare clinical outcomes between three-dimensional (3D) plate and standard miniplate fixation systems for the management of mandibular angle fractures (MAFs). MethodsA systematic review search of several databases, including MEDLINE-Ovid, Embase, Springer Link, and PubMed, for relevant articles in English and without date restrictions was performed in February 2018. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure postoperative complications. ResultsEleven publications were enrolled in the analysis. The results showed that there were significant differences in overall complications (RR, 0.453; 95% CI, 0.311–0.660; P = 0.007). The incidence of hardware failure showed a statistically significant difference in the outcome, favoring 3D miniplates (fixed: RR 0.156; 95% CI, 0.042–0.581; P = 0.0006). Subgroup analyses indicated that the 3D miniplate caused a lower incidence rate of malunion and hardware failure than the standard miniplate with 8 or 10 holes (P = 0.006, P = 0.03, respectively). In addition, the use of standard miniplates had a shorter operation time than the use of 3D miniplates (P = 0.002). ConclusionThe present study demonstrates that the three-dimensional miniplate was a better fixation system than the standard miniplate technique in reducing postoperative complications in the management of mandibular angle fracture (P = 0.007).

Three-Dimensional Miniplate: For the Management of Mandibular Parasymphysis Fractures.

Background:Recently, oral and maxillofacial surgeons are favoring three-dimensional (3D) miniplates to treat mandibular fractures.Aims:The aim of the study is to evaluate the efficacy of 3D-miniplates over standard miniplates in the management of mandibular parasymphysis fracture.Materials and Methods:Forty patients with mandibular parasymphysis fractures were divided into two groups of 20 patients each. Group I patients underwent osteosynthesis of mandibular fracture by noncompression, unicortical, and stainless steel 3D miniplates, and Group II patients underwent osteosynthesis by noncompression, unicortical, and stainless steel Champy's miniplates. All the patients were followed up 6 months’ postoperatively, evaluating occlusion, mobility of fracture segment, pain, wound dehiscence, neurological deficit, and infection.Statistical Analysis Used:The data were analyzed by SPSS for windows (version 17) statistical package (SPSS Inc., Chicago, IL, USA). Chi-square test was carried out to determine the statistical difference between the groups.Results:Mobility of the fractured site was evaluated postoperatively after 2 weeks, and it was found that mobility was absent in all the cases of Group I and 36 (80%) cases in Group II. There was significant difference in the mean visual analog scale scores among the Group I and II when compared from preoperative to 4-week follow-up. In Group II, two patients showed wound dehiscence. After 2 weeks, infection was seen in two patients of Group II.Conclusion:3D plates in mandibular parasymphysis fractures give dimensional stability and carry low morbidity and infection rates.

MANDIBULAR SYMPHYSIS FRACTURES

Introduction: Mandible is one of the most commonly fractured bones inmaxillofacial trauma. Mandibular symphysis is a common site of mandibular fractures. Compareto conventional miniplates, three dimentional plates were found more effective in terms of postoperative occlusion, post operative mobility of reduced fractured segments and the degree ofanatomic reduction. Objectives: Compare the conventional 2.0mm mini plates versus 3D miniplates in the fixation of isolated mandibular symphysis fractures. Study Design: Interventionalstudy. Setting: Oral &amp; Maxillofacial Surgery Department, Abbasi Shaheed Hospital Karachi.Period: Two years from 1st January 2013 to 2nd January 2015. Material &amp; Methods: Onehundred and fifty four patients were randomly selected and allocated into two groups. Group‘I’in which patients were treated with conventional mini plates and group‘II’ where patients weretreated with 3D mini plates. Results: Mean (+SD) age of patients was 29.53 (±7.88) years.Among 154 patients in this study, majority (75.3%) of cases had age 20 - 35 years. Majority,124 (81.2)were males and 29 (18.8%) were females. In Group I, anatomic reduction at 3 monthpost-operative was observed in 30 (39%). In Group II (3D Plates) at 3 months post-operatively,ideal molar relationship was higher (89.6% Vs. 98.7%; p-value = 0.016), fracture mobility waslower (14.3% Vs. 2.6%; p-value = 0.009) and higher anatomic reduction. Conclusion: Threedimensional miniplates are more effective compared to conventional miniplates.

A comparative evaluation of bite force as a parameter for the stability in conventional and three-dimensional mini plates

Introduction: Maxillofacial skeleton fractures can be treated by open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized either with intermaxillary fixation or external or internal devices (i.e. plates and screws) to allow bone healing. Aim: The study was primarily aimed at investigating the comparison between three-dimensional (3D) mini plates versus conventional mini plates in mandibular fractures under functional load. Methodology: This study was carried out in twenty patients for treatment of mandibular fractures. Bite force readings were made using indigenous bite force recorder in kilograms. Bite forces were recorded at the operated site and contralateral site of the same region. Bite force recordings were done preoperatively before fixing Erich arch bar and postoperatively at each follow-up (7th, 14th, 21st, 28th, and 90th day). Observations: Data show postoperatively in operated sites of the molar that patients in Group A generate more biting force on day 28 and day 90 when compared to Group B. The difference in mean bite force over control group on fractured sites of molars and incisors when comparison was done between postoperative days interval was significant. Conclusion: It was concluded that the 3D mini plates in mandibular fractures are efficacious enough to bear masticatory loads during the osteosynthesis of fracture. It gives the advantage of reduced implant material and 3D stability with almost similar results as seen in two conventional mini plates osteosynthesis.

Three-dimensional titanium miniplates for fixation of subcondylar mandibular fractures: Comparison of five designs using patient-specific finite element analysis

PurposeThe purpose of the current study is to compare the performance of five designs of three-dimensional titanium miniplates (lambda, strut, delta, rhombic and trapezoid) for fixation of subcondylar mandibular fracture. Materials and methodsThree-dimensional models were constructed for the five miniplates with their screws and integrated into a virtually fractured mandible that was derived from a computed tomographic image of living human. Patient-specific finite element models were analyzed to compare the performances of the miniplates. Miniplates were compared for titanium hardware volume, condylar head displacement, bone strains and miniplates' stresses. ResultsLeast condylar head displacement, and thereby best fixation primary stability, was found in the trapezoid miniplate. On the other hand, the greatest displacements were found in lambda and strut miniplates. Bone strains, as an indicator of secondary stability, predicted high strains in bone around the screws affixing the delta miniplate. Therefore, high risk of failure due to screws loosening is expected when using the delta miniplate. Stresses in miniplates were excessive in the strut and lambda miniplates, which implies a high risk of miniplate fracture. ConclusionsThe current findings predicted significant differences in performance among the different designs of three-dimensional miniplates. The trapezoid miniplate seems to have the best performance, as it provided the greatest rigidity with relatively low bone strains.

Update on mandibular condylar fracture management.

Fractures of the mandibular condyle have provided a lasting source of controversy in the field of facial trauma. Concerns regarding facial nerve injury as well as reasonable functional outcomes with closed management led to a reluctance to treat with an open operative intervention. This article reviews how incorporating new technologies and surgical methods have changed the treatment paradigm. Multiple large studies and meta-analyses continue to demonstrate superior outcomes for condylar fractures when managed surgically. Innovations, including endoscopic techniques, three-dimensional miniplates, and angled drills provide increased options in the treatment of condylar fractures. The literature on pediatric condylar fractures is limited and continues to favor a more conservative approach. There continues to be mounting evidence in radiographic, quality of life, and functional outcome studies to support open reduction with internal fixation for the treatment of condylar fractures in patients with malocclusion, significant displacement, or dislocation of the temporomandibular joint. The utilization of three-dimensional trapezoidal miniplates has shown improved outcomes and theoretically enhanced biomechanical properties when compared with traditional fixation with single or double miniplates. Endoscopic-assisted techniques can decrease surgical morbidity, but are technically challenging, require skilled assistants, and utilize specialized equipment.

In vitro mechanical assessment of 2.0-mm system three-dimensional miniplates in anterior mandibular fractures

This study constituted a comparative assessment of the mechanical resistance of square and rectangular 2.0-mm system three-dimensional miniplates as compared to the standard configuration using two straight miniplates. 90 polyurethane replica mandibles were used for the mechanical trials. Groups 1, 2, and 3 simulated complete symphyseal fractures characterized by linear separation of the central incisors; groups 4, 5, and 6 simulated parasymphyseal fractures with an oblique configuration. Groups 1 and 4 represented the standard method with two straight miniplates set parallel to one another. Square miniplates were used in groups 2 and 5, and rectangular miniplates in groups 3 and 6. A universal testing machine set to a velocity of 10mm/min and delivering a vertical linear load to the first left molar was used to test each group. Maximum load values and load values with pre-established dislocation of 5mm were obtained and submitted to statistical analysis using a calculated reliability interval of 95%. The mechanical performances of the devices were similar, except in the case of rectangular plates used in the parasymphyseal fractures. The innovative fixation methods used showed significantly better results in the case of symphyseal fractures.