Titanium Miniplates Research Articles

Comparison of bite force evaluation for mandibular angle fracture fixation by conventional miniplates versus new design miniplates: a clinical study.

To evaluate postoperative masticatory efficacy of a new design non-compression titanium miniplate compared to conventional non-compression titanium miniplate on the basis of bite force for treatment of mandibular angle fractures. The prospective study included 20 patients with mandibular angle fractures randomly categorized into 2 groups: Group I, fixation of angle fractures by conventional miniplates, and Group II, fixation of angle fractures by new design miniplates. Evaluation was done for clinical outcome, primarily bite force; radiological outcome; and associated postoperative morbidities at different time intervals. The results showed to be highly significant in terms of mean operating time for plate adaptation and fixation and bite force adaptation (p = 0.003 at follow-up of 6 months) for the newer miniplate compared to the conventional miniplate. No statistically significant difference was seen for postoperative paresthesia, malunion, non-union, occlusal discrepancy, or hardware failure. Within the limits of the study, it appears that the single, monocortical, non-compression, superior border new design miniplate proved to be a successful procedure for treating non-comminuted mandibular angle fractures specifically in terms of enhanced postoperative masticatory efficiency as compared to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.

Mandibular Titanium Miniplates Change the Biomechanical Behaviour of the Mandible in the Case of Facial Trauma: A Three-Dimensional Finite Element Analysis.

Our study aimed to compare the biomechanical behaviour of mandibles with or without titanium miniplates when subjected to an impact after bone healing using a finite element model (FEM) of the human mandible. We simulated mandibular trauma on an FEM of a human mandible carrying or not two parasymphyseal miniplates and applying a concentrated force of 2000 N to four different areas, including the insertion area, the area straddling the edge of the miniplates and the adjacent bone, at a distance from the miniplates on the symphysis, and on the basilar border of the mandible below the miniplates. Then, we compared the Von Mises stress distributions between the two models. In the case of an impact on the miniplates, the maximum Von Mises stress occurred in two specific areas, on the cortical bone at the posterior border of the two miniplates at a distance from the impact, while in the model without miniplates, the Von Mises stresses were homogenously distributed in the impact area. The presence of titanium miniplates in the case of trauma affects the biomechanical behaviour of the mandible and could cause more complex fractures. We recommend informing patients of this potential risk.

Impact of C3 laminectomy on cervical sagittal alignment in cervical laminoplasty: a prospective, randomized controlled trial comparing clinical and radiological outcomes between C3 laminectomy with C4–C6 laminoplasty and C3–C6 laminoplasty

Background ContextC3 laminectomy in cervical laminoplasty is a modified laminoplasty technique that can preserve the semispinalis cervicis muscle attached to the C2 spinous process. Several previous studies have shown that this technique can lead to better outcomes of postoperative axial neck pain and C2–C3 range of motion (ROM) than conventional cervical laminoplasty. However, there is still a lack of understanding of total and proportional postoperative cervical sagittal alignment outcomes. PurposeTo assess the effects of C3 laminectomy in cervical laminoplasty on postoperative cervical alignment and clinical outcomes. DesignA single-center, patient-blinded, randomized controlled trial. Patient SampleWe included consecutive 126 patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) who were scheduled for cervical laminoplasty from March 2017 to January 2020. Outcome MeasuresThe primary outcome measures were C2–C7 Cobb angle (CA) and neck disability index (NDI). Secondary outcomes measures included other clinical outcomes and radiographic parameters including segmental Cobb angle and presence of C2–C3 interlaminar fusion. MethodsPatients were randomly allocated to either the C3 laminectomy with C4–C6 laminoplasty group (LN group) or the C3–C6 laminoplasty group (LP group) at a 1:1 ratio. Laminoplasty was performed using a unilateral open-door technique and stabilized with titanium mini plates. A linear mixed model analysis was employed to examine the longitudinal data from postoperative 1-year through 3-year. Additional analysis between three types of cervical sagittal alignment morphology was done. ResultsAmong 122 patients who were randomly allocated to one of two groups (LN group, n=61; LP group, n=61), modified intent-to-treat analysis was done for 109 patients (LN group, n=51, LP group, n=58) who had available at least a year of postoperative data. Postoperative C2–C7 CA was not significantly different between the two groups. However, NDI was significantly different between the two groups (12.8±1.0 in the LN group vs 8.6±1.0 in LP group, p=.005), which exceeded the minimum clinically important difference (MCID). The postoperative C2–C3 CA was significantly greater in the LN group (7.1±0.5° in LN group vs 3.2±0.5° in LP group, p<.001) while C4–C7 CA was significantly smaller in the LN group (3.9±0.8° in LN group vs 7.7±0.7° in LP group, p<.001) with greater cSVA in the LN group (31.6±1.4 mm in LN group vs 25.5±1.3 mm in LP group at postoperative 3-year, p=.002). Postoperative Euro-Quality of Life-5 Dimension (EQ-5D), numerical rating scores for neck pain (NRS-N) were significantly better in the LP group than in the LN group (all p<.05) and only EQ-5D surpassed the MCID. The C2-C3 fusion rate was significantly different between the LN group (9.8%) and the LP group (44.8%) (p<.001). The LN group showed a higher prevalence of a specific cervical alignment morphology characterized by a sigmoid shape with proximal lordosis and distal kyphosis (S curve). This S curve demonstrated significantly unfavorable outcomes across multiple outcome variables. ConclusionThe impact of C3 laminectomy in cervical laminoplasty on postoperative kyphosis among patients with CSM or OPLL did not significantly differ from that of C3–C6 laminoplasty. However, C3 laminectomy in cervical laminoplasty might result in an unfavorable clinical outcome with an unbalanced cervical sagittal alignment characterized by a sigmoid shape with proximal lordosis and distal kyphosis.

Evaluation of Titanium Mini Plates for Repair of Mandibular Fractures in Clinical Cases of Dogs

Evaluation of Titanium Mini Plates for Repair of Mandibular Fractures in Clinical Cases of Dogs

BIOMECHANICAL EVALUATION FOR COMPARISON OF 3D TITANIUM MINIPLATES WITH CONVENTIONAL TITANIUM MINIPLATES IN THE MANAGEMENT OF MANDIBULAR FRACTURES

Aim of the Study:The aim of the study was to evaluate and compare the efficacy of the 3-dimensional titanium miniplates against conventional titanium miniplates in the management of mandibular fractures. Materials and Method:This study included 20 cases of either trauma, reconstructive or orthognathic surgery in which internal fixation is indicated. Patients were assigned to any one of the two equal groups randomly. Group A consisted of 10 patients treated by 3-dimensional titanium miniplates and group B consisted of 10 patients treated by conventional titanium miniplates. Intra-operative parameter included operating time of both the groups. Postoperative clinical examination was carried out on the 1st, 2nd, 3rd, 4th, 6th weeks and the 3rd postoperative month. Postoperative clinical evaluation included assessment of pain, stability, infection, bite force, wound dehiscence. The results of two groups were compared statistically. Results:A statistically significant difference was found in the operating time which was less in group A as compared to group B (p = 0.001). The bite forces recorded on 1st postoperative week were more in group A as compared to group B and were found to be statistically significant at incisor region (p=0.012), right canine region (p=0.014), left canine region (p=0.001), right premolar region (p=0.013) and left premolar region (p=0.046). No significant difference was found in other clinical parameters. Conclusion:Due to simultaneous stabilization at superior and inferior borders, operating time was relatively less. It provides three-dimensional stability at the fracture site. 3-dimensional miniplate seems to be an easy alternative to conventional miniplates.

Initial clinical experiences of the muscle-preserving double door cervical laminoplasty with adjustable mini plates.

Shirashi's double door laminoplasty method was a popular decompression procedure for cervical myelopathy. In this paper, we introduced a modified double door laminoplasty based on Shirashi's method with preliminary results. This study retrospectively analyzed 22 patients who underwent modified double door laminoplasty. During procedure, a single segment of the unilateral lamina was separated from the cervical semispinalis muscle and the multifidus muscle space for the preparation of lamina groove. A self-developed mini titanium plate was used to fix the inner side of the spinous process to complete the fixation after open-door process. The VAS, JOA scores and QoL scale were recorded for pain assessment, neurological and functional recovery. The overall curvature and range of motion of C2-C7 were measured with x-ray images. Changes in sagittal diameter of spinal canal were measured by CT scans. MRI was used to measure the cross-sectional area of cervical paravertebral muscles. All 22 patients successfully recovered with this procedure. The mean operation time, blood loss and follow-up durations were 117 ± 25 min, 149 ± 32 ml and 16.1 ± 3.6 months respectively. The preoperative, 3-month postoperative and 12-month postoperative JOA scores were 9.35 ± 3.25, 13.74 ± 4.86 and 15.73 ± 5.19 respectively. with improvement rates of 57.4% and 83.4%. Mean VAS scores before, 3 months after and 12 months after surgery were 1.81 ± 0.79, 2.82 ± 1.56 and 2.18 ± 1.34 respectively. The C2-7 lordotic angle and overall range of motion shows no statistical difference preoperatively and 12 post-surgery. The average sagittal diameter of the cervical spinal canal was enlarged from 9.15 ± 1.55 mm to 14.25 ± 1.46 mm. The average area of cervical paravertebral volume measured preoperatively and 3 months post operation was 84% of pre-operative value respectively. This value was improved to 93% of the preoperative value at 12 months post-surgery. This paper introduced initial experience on a modified posterior cervical double-door laminoplasty that was based on Shirashi's method, featuring creating bilateral laminar grooves on both sides and fixing central gap with self-developed mini plates. This procedure prevented obvious axial symptoms and improved patients' quality of life, which provided a baseline for further research with larger cohorts.

New design titanium miniplate versus conventional miniplate in treatment of mandibular angle fractures: A comparative study.

Mandibular angle fracture (MAF) is the second most common site of all fractures of the mandible with the highest complication rate. Management of MAF has evolved in the past four decades. The purpose of the prospective study was to compare the efficacy of new design titanium miniplate (NDM) with conventional titanium miniplate (CTM) in the treatment of MAF. Mouth opening, occlusion, bite force measurement, and radiographs compared preoperatively and first week, first month and third month postoperatively. Fourteen patients diagnosed with MAF were randomly divided into two groups: Group A (seven patients) was treated with NDM and Group B (seven patients) with CTM. Patients were assessed preoperatively and postoperatively at an interval of one week, one month and three months. Repeated measures ANOVA and Post hoc Tukey test showed a significant increase in bite force and mouth opening for both groups in first and third postoperative months. Unpaired t-test showed slightly better mouth opening in Group B and slightly higher bite force in Group A. Both miniplates fulfilled all the study objectives and equally satisfactory healing was seen at the end of third month. NDM offers better stability, rigidity, and anatomic reduction of the fracture with a drawback of difficulty in adaptation and increased operative timing compared to CTM. Hence, we would like to conclude that both miniplates are equally efficient in the treatment of non-comminuted angle fractures with the NDM having upper hand in stability.

Displaced Mandibular Fracture in an Infant - A Case Report

Introduction: Mandibular fractures in infants are rare. We aim to describe a case of displaced mandibular fracture of an infant who was managed by a combination of treatment modalities to achieve favourable outcome. Case report: A healthy 11 months old girl was referred to the Department of Paediatric Dentistry for management of a mandibular fracture following a fall. Clinical and radiographic examination demonstrated a displaced symphysis fracture of the mandible with concomitant right intra-capsular condylar fracture. Open reduction and internal fixation with titanium miniplate and screws were fixated at the lower border of the mandible with additional immobilisation with cap splint. The cap splint was stabilised with circum-mandibular wirings. The splint and implants were removed after 4 weeks and 3 months, respectively. Post-operative healing was uneventful. The face was symmetrical with the primary teeth erupted into occlusion. Conclusion: The treatment approach should be customised for each case by considering the patient’s age, level of co-operation of the child, degree of fracture displacement, pre-treatment occlusion derangement, and stage of dentition development.

ORTOGNATİK CERRAHİ SONRASI OSTEOSENTEZ TİTANYUM MİNİPLAKLARIN ÇIKARILMA NEDENLERİ VE İNSİDANSI

This paper investigated the incidenceand causes of osteosynthesis plate removal after orthognathic surgery. The sample consisted of 250 patients (141 women and 109 men) who underwent orthognathic surgery between April 2011 and February 2017 at the Oral and Maxillofacial Surgery Hospital of the Faculty of Dentistry of Erciyes University. Follow-up files, operation notes, and radiographic images were reviewed retrospectively. Operation dates, age, sex, malocclusion type, fixation methods, and orthognathic surgery methods were classified. The incidence and causes of osteosynthesis titanium miniplate removal and the average time between placement and removal were determined. Patients had a mean age of 22.9 ± 6.5 [min: 17; max: 55]. Fourteen patients (5.6%) developed fixation-related complications. They underwent plate removal due to plate-infections (nine cases- 3.6%) or plate exposure (five cases- 2.0%). The total number of plates used was 1242 [800 (64%) in the maxilla and 442 (36%) in the mandible]. Twenty-three plates were removed from the maxilla [11 (1.3%)] or mandible [12 (2.7%)] due to fixation material-related complications. The mean plate removal time was 11.21± 8.21 months (min:3- max:34 months). Osteosynthesis plates should be removed due to infections and plate exposure after orthognathic surgery. There should be left in place unless complications arise.

Biomechanical Comparison of WE43-Based Magnesium vs. Titanium Miniplates in a Mandible Fracture Model in Sheep.

In fractures of the mandible, osteosynthesis with titanium plates is considered the gold standard. Titanium is an established and reliable material, its main disadvantages being metal artefacts and the need for removal in case of osteosynthesis complications. Magnesium, as a resorbable material with an elastic modulus close to cortical bone, offers a resorbable alternative osteosynthesis material, yet mechanical studies in mandible fracture fixation are still missing. The hypothesis of this study was that magnesium miniplates show no significant difference in the mechanical integrity provided for fracture fixation in mandible fractures under load-sharing indications. In a non-inferiority test, a continuous load was applied to a sheep mandible fracture model with osteosynthesis using either titanium miniplates of 1.0 mm thickness (Ti1.0), magnesium plates of 1.75 mm (Mg1.75), or magnesium plates of 1.5 mm thickness (Mg1.5). No significant difference (p > 0.05) was found in the peak force at failure, stiffness, or force at vertical displacement of 1.0 mm between Mg1.75, Mg1.5, and Ti1.0. This study shows the non-inferiority of WE43 magnesium miniplates compared to the clinical gold standard titanium miniplates.

Biomechanical evaluation of Chinese customized three-dimensional printed titanium miniplate in the Lefort I osteotomy: A finite element analysis

ObjectivesThis work aims to evaluate the biomechanical behavior of Chinese customized three-dimensional (3D) −printed miniplates by means of finite element analysis (FEA). MethodsA 3D Lefort I osteotomy model was established by Mimics. Two models were established to compare the strain behaviors of customized miniplate and conventional L-shaped miniplate. Hypermesh and ABAQUS were used to establish computer-aided engineering finite element models. The stress distribution on the mini-plates, screws and bone and the relative displacement of the maxilla segments were analyzed by loading postoperative occlusal force. ResultsThe displacements for customized mini-plate fixation were notably smaller than L-shaped mini-plate fixation. The maximum stresses on the screws, mini-plates and cortical bone for customized mini-plates were smaller than that for L-shaped miniplates. ConclusionChinese customized 3D-printed miniplates provide better postoperative stability and offer a good alternative to the conventional L-shaped miniplate system.

Prevention of complications after the surgical treatment of the facial fractures

In modern society, with a high rate of industrialization and, at the same time, a decrease in the standard of living, an increase in maxillofacial injury (MFI) has been noted, ranging from 6 to 16% of the total number of injuries. In addition, MFI is a public health problem due to its high prevalence and the need for resources to treat it, as well as the financial and social impact of MFI victims on the health care system. Osteosynthesis of the bones of the facial skeleton with titanium miniplates and screws is an effective way to treat fractures of the bones of the facial skull. According to the studied literature sources, researchers continue to search for the most inert materials for surgical otheosynthesis. Samples of various materials are examined for the adhesive ability of the main pathogens of purulent-inflammatory diseases, inertness, toxicity and other indicators. But studies are few and there is no conclusive evidence in favor of either material. However, the use of titanium miniplates and screws coated with silicon carbide is advisable for the prevention of postoperative complications. The use of titanium miniplates and screws coated with silicon carbide is the method of choice in the treatment of infected fractures of the bones of the facial skeleton.

Managing acute acromioclavicular joint dislocation during COVID 19 pandemic by minimally invasive technique with suture anchor and miniplate: A pilot study

BackgroundAcromioclavicular (AC) joint dislocation is common in sportsmen and physically active population. Its management depends upon the grade of injury and functional demands of the patient. A variety of surgical procedures have been described with different limitations and advantages. The present study has assessed the clinical and radiological outcome of acute AC joint dislocation managed with a 3.5 mm Titanium suture anchor and 2 mm miniplate construct which requires lesser dissection, surgical time and thus contact with the patient as mandated by COVID-19 pandemic. MethodsWe enrolled 10 patients of Rockwood type-III, IV and V acute AC joint injury (<3 weeks old) reporting at this hospital from Feb 2020 to May 2021. All were tested for COVID-19 using reverse transcriptase polymer chain reaction test (RTPCR) and managed by closed/open reduction and fixation with a 3.5 mm Titanium Suture Anchor and a 2 mm Titanium miniplate construct. Follow-up was done at 3, 6 and 9 month post-operatively. ResultsThe average age of patients was 31 yrs. RTPCR test for COVID-19 was negative in all patients. Median surgical time was 25 min (Interquartile Range[IQR] = 16–34 min) and median follow-up duration was 36 weeks (IQR = 33–39 weeks). Median visual analogue scale score and IQR at pre-operative, 3 month, 6 month and 9 month follow-up was 7(IQR = 6–8), 3.5(IQR = 2.5–4.5), 2(IQR = 0) and 1(IQR = 0), respectively. Median constant score at pre-operative, 3 month, 6 month and 9 month follow-up were 34(IQR = 25–43), 65.5(IQR = 60.5–70.5), 82.5(IQR = 77.5–87.5) and 88(IQR = 81–95). There was significant improvement in clinical status (non parametric-Friedman test p < 0.001). Radiographs showed no loss of reduction, fracture or implant failure till last follow-up. ConclusionsMinimally invasive technique with a 3.5 mm Ti-suture anchor and 2 mm plate is an easy, fast and reliable construct for the management of acute AC dislocation in physically active population.

Titanium miniplate removal after joint orthodontic-orthognathic surgery treatment: a 10-year retrospective hospital-based audit.

The reported incidence of titanium miniplate removal after orthognathic surgery varies widely, making delivery of risk information to patients problematic. This variation relates to potential biases introduced during the study design, for example, with the pooling of different patient types, creating heterogeneous study samples. This study reduces sampling bias by limiting the cohort to only consecutive orthognathic cases. The primary aim of the study was to identify the incidence of miniplate removal following orthognathic surgery. The secondary aim was to assess the indications and any risk factors for miniplate removal. Data from the clinical records of 907 orthognathic surgery cases treated within a centralised oral and maxillofacial hospital service over a 10-year period were collected by two operators and analysed. Every identified case qualified for inclusion. Patient demographics (age, sex, medical comorbidity, smoking), operations (type of surgery, duration, third molar removal, complications) and the indication, timing and site of miniplate removal were analysed. Only 19 patients required postoperative miniplate removal, with the most common indication being infection (63%). There was no significant difference in any of the factors assessed except that significantly more miniplates were removed from female patients (68%) (p<0.001) and from mandibular sites (84.2%) (p=0.003). The incidence of miniplate removal for this sample was 2.1%. Female sex and miniplate location in the mandible were the only statistically significant risk factors for miniplate removal.

First complex maxillofacial reconstruction with free flaps in the Gaza Strip, occupied Palestinian territory: case series from an area under conflict

BackgroundLarge mandibular and maxillary defects are repaired by maxillofacial reconstructive microsurgery (MRM) using free flaps, which is challenging to perform in austere settings owing to its demanding nature in terms of time, equipment, and trained personnel. Humanitarian missions refrain from performing MRM procedures in the host country and instead transfer patients to their home country to perform surgery. We report on the first nine MRM procedures in Gaza. MethodsA French medical mission performed the surgical operations at Al Shifa Hospital, Gaza, occupied Palestinian territory. Fibula free flap, radial forearm free flap, scapular free flap, and thoracodorsal perforator free flap were performed. We recorded the patients’ demographics, diagnoses, and immediate postoperative and follow-up status. We also report the special considerations required to perform the surgery in Gaza's austere and resource-poor environment. FindingsNine patients (five female, four male; mean age 22 years) underwent ablative head and neck surgery from January, 2017, to March, 2019. Before arrival, the missions closely coordinated with local surgeons, who assisted in performing the surgeries and followed the patients postoperatively. Essential surgical equipment needed for the surgery (such as loupes, microvascular sutures, and titanium plates) were donated by the foreign missions. Patients were followed up by local surgeons for a period ranging from 5 to 12 months. No complications occurred at the donor or recipient sites. There was no extrusion of hardware or breakage of the titanium mini plates or reconstructive plates. Patients remained in the intensive care unit postoperatively for at least 48 h. Owing to financial restraints, removable prostheses were used. Rehabilitation was provided by a local dental team despite the lack of professional dental rehabilitation services. Patients had stable bony union and acceptable facial contour. Patients regained satisfactory masticatory function, resumed their normal diets after 6 months without weight loss, and maintained intelligible speech. InterpretationMRM can be successfully performed in conflict settings such as Gaza. Although the study population was small, the study suggests that further investigation into the conditions and elements needed to perform complex surgeries in conflict settings is warranted. Selection of health-care professionals in the surgical and postoperative care teams, effective coordination with local doctors, availability of essential equipment, and postoperative follow-up protocols could all be carefully considered to optimise the results of surgery. In addition, starting rehabilitation as soon as possible following surgery may restore and improve functional and aesthetic outcomes. FundingThe Palestine Children's Relief Fund (PCRF).

A Comprehensive Review of Orthognathic Surgery: Fixation, Relapse, and Complications

Background: This study aims to investigate all papers on orthognathic fixation to better understand changes in operative techniques and fixation materials and to better compare relapse and complication rates. Methods: A PubMed search was conducted of “orthognathic” AND “fixation” in the title or abstract between 1989 and 2020. Results: Three reviewers independently screened 439 papers and extracted data from 166 included papers. Of these studies, 118 investigated sagittal split ramus osteotomies (SSRO), 96 LeFort osteotomies, 25 genioplasties, and 21 intraoral vertical ramus osteotomies (IVRO). The most used fixation materials in the maxilla were titanium miniplates with monocortical screws (n = 65), followed by resorbable miniplates (n = 10); in the mandible, the most common were titanium miniplates (n = 67) and titanium bicortical screws (n = 49). Wide variability was demonstrated in relapse rates by operation, fixation type, and relapse time-point studied. Meta-analysis revealed a significantly higher infection rate in SSRO versus LeFort ( P = .003) and, surprisingly, a trend toward higher relapse rate in titanium versus resorbable fixation at 6 months in SSRO setback ( P = .08). Conclusion: This study reports all the available data on relapse rates across techniques, with non-inferiority of bicortical screws versus miniplates.

SPECTRUM AND MANAGEMENT OF ISOLATED ZYGOMATICOMAXILLARY COMPLEX FRACTURES- A RETROSPECTIVE REVIEW FROM A TERTIARY CARE HOSPITAL IN PUNJAB, INDIA

Introduction - Zygoma forms a centrolateral bony prominence of midface. The contour of the cheek, midface width and height are attributed to the normal anatomy of this bone along with its articulation with surrounding bones. Injury to zygoma is common and its management has various options. We planned to retrospectively study the spectrum of zygomatic fractures presenting to our tertiary care hospital and to enumerate the various types of treatments given to them. This study was retrospectively planned to study the epidemiology of patientsMaterial and methods- who presented to hospital from January 2015 to December 2019 and were diagnosed with isolated Zygomaticomaxillary Complex (ZMC) fractures. The type and clinical features of zygoma fractures, CT ndings, Indications, Surgical or Non Surgical treatment given to them and timing of surgery were enumerated. Post operative complications like enopthalmos, diplopia, scarring were recorded. A total number of 320 patients were found to have isolated Zygoma fractures duringResults- the duration of these 5 years. Males outnumbered females in this study group. Road trafc accident was the most common etiology followed by assault. Tetrapod fracture was reported in 288 patients (p&lt;0.005). Most of the surgeries were done between 3 to 7 days of injury. Most common surgical procedure done was Open reduction and internal xation with titanium miniplates. Post operative residual enopthlomos was seen in 10 patients, diplopia in 5 patients, scleral show in 4 patients. There was not a single plate infection reported and 92.5 % patients were satised with the aesthetic recovery. ClinicalDiscusion- features, radiological ndings along with intraoperative ndings play an important role in deciding fracture management of different parts of ZMC fracture. Besides isolated arch fracture and undisplaced low velocity ZF fractures, all other sites need open reduction and internal xation for maintaining strong lateral midface buttress and orbital anatomy. WeConclusion- concluded that surgical management and approach should be customized for each patient, the decision of which can be reached following a stair case approach pre and intra operatively.

Light-Propelled Nanorobots for Facial Titanium Implants Biofilms Removal.

Titanium miniplates are biocompatible materials used in modern oral and maxillofacial surgery to treat facial bone fractures. However, plate removal is often required due to implant complications. Among them, a biofilm formation on an infected miniplate is associated with severe inflammation, which frequently results in implant failure. In light of this, new strategies to control or treat oral bacterial biofilm are of high interest. Herein, the authors exploit the ability of nanorobots against multispecies bacterial biofilm grown onto facial commercial titanium miniplate implants to simulate pathogenic conditions of the oral microenvironment. The strategy is based on the use of light-driven self-propelled tubular black-TiO2 /Ag nanorobots, that unlike traditional ones, exhibit an extended absorption and motion actuation from UV to the visible-light range. The motion analysis is performed separately over UV, blue, and green light irradiation and shows different motion behaviors, including a fast rotational motion that decreases with increasing wavelengths. The biomass reduction is monitored by evaluating LIVE/DEAD fluorescent and digital microscope images of bacterial biofilm treated with the nanorobots under motion/no-motion conditions. The current study and the obtained results can bring significant improvements for effective therapy of infected metallic miniplates by biofilm.

Do mandibular titanium miniplates affect the biomechanical behaviour of the mandible? A preliminary experimental study

IntroductionWhether to conserve or remove titanium miniplates after rigid internal fixation of mandibular fractures still remains controversial. Miniplates could affect the biomechanical behaviour of the mandible in case of trauma, and therefore cause more complex fractures. Materials and methodsAn experimental study, consisting in simulating a mandibular trauma, was designed in order to compare the fractures caused by an impact on the mandible in the presence or absence of an internal fixation. We simulated an impact on the right parasymphysis region in 10 post-mortem human subjects, according to the Charpy impact test method at an impact speed of 7.4 m/s, using a 5 kg test impactor. ResultsIn the control group, the fracture lines were vertical and straight, without comminution. In the miniplate group, the fractures occurred close to the miniplates (4 cases) and under the miniplates (one case). The fracture lines were more complex, even comminuted in 2 cases. Thus, miniplates impacted the biomechanical behavior of the mandible, resulting in more complex fractures. ConclusionOur experimental study highlighted the impact of the presence of miniplates on the mandible in case of trauma, and the risk of causing more complex fractures. We therefore recommend further investigations to determine if titanium miniplates should be systematically removed after bone healing, in patients with a higher risk of trauma in relation with previous assault injuries, alcohol or substance abuse, the practice of fighting or contact sport/activities, and soldiers.

Comparative evaluation of bite force in patients treated for unilateral mandibular condylar fractures by open and closed methods.

Condylar fractures account for a large proportion (20% to 52%) of mandibular injuries. The goal of treating these fractures is to restore the occlusion, thereby re-establishing the masticatory function as close as possible to the patient's pre-trauma state. The aim of this study was to compare the bite forces following unilateral condylar fractures treated by open reduction and internal fixation (ORIF) with those managed by the closed method. Patients with unilateral mandibular condylar fractures were divided into two groups (n=20) using a simple randomization method. Patients in group I were treated by open reduction and internal fixation (ORIF) using titanium miniplates and screws. Patients in group II were treated by the closed method with inter-maxillary fixation. Patients in both groups were evaluated pre-operatively and then post-operatively at one week, one month and three months for maximum bite force achieved at the central incisor, premolar and molar regions. Pre-operative bite forces on the unaffected site were significantly higher than the affected site in both groups, whereas no significant difference was observed in bite forces between the unaffected and affected sites in both groups post-operatively. The bite forces achieved at both the unaffected and affected sites in the ORIF group were significantly higher than in the closed group. Maximum bite forces differed significantly when the treatment was done with the open method, and the patients treated with the open method needed less time to achieve the maximum bite forces, thereby making an earlier return to function.