Indian Journal of Dental Research

ORIGINAL RESEARCH
Year
: 2020  |  Volume : 31  |  Issue : 1  |  Page : 134--137

Comparative evaluation of 2D miniplates and 3D miniplates fixation in mandibular angle fracture - A clinical study


Rohit Singh1, Konark2, Anju Singh3, DK Singh4, Jazib Nazeer5, Supriya Singh6,  
1 Department of Prosthodontics and Crown Bridge and Implantology, Patna Dental College and Hospital, Patna, Bihar, India
2 Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
3 Department of Dentistry, NMCH, Patna, Bihar, India
4 Prosthodontics and Crown Bridge and Implantology, Patna Dental College and Hospital, Patna, Bihar, India
5 Oral Pathology and Microbiology, Patna Dental College and Hospital, Patna, Bihar, India
6 Private Practitioner, Multispecialty Dental Clinic Patna, Bihar, India

Correspondence Address:
D K Singh
Department of Prosthodontics and Crown Bridge and Implantology, Patna Dental College and Hospital, Ashok Raj Path (Near Bankipore Post Office), Patna - 800 004, Bihar
India

Abstract

Introduction: Mandibular angle fracture is common in road traffic accidents. This study was conducted to compare 3D miniplate system with 2D plates for treatment of mandibular angle fractures. Materials and Methods: The study was conducted on 120 patients with mandibular angle fracture of both genders. After selecting patients, patients were divided into 2 groups of 60 each. In group I, patients were treated with 3D, 2.0-mm titanium plates, and in group II, patients were treated with 2D, 2.0-mm titanium miniplate in mandibular angle fracture. Patients were evaluated regularly after 1, 3, and 6 months for outcome of treatment. Results: In group I, males were 22 and females were 38. In group II, males were 40 and females were 20. Right angle fracture was seen in 32 patients in group I and 26 in group II. Left angle fracture was seen in 24 in group I and 28 in group II. Right angle and left parasymphysis fracture was seen in 3 in group I and 4 in group II. Left angle and right parasymphysis fracture was seen in 1 in group I and 2 in group II. [Table 3], [Graph 1] shows that in group I, after 1 month sensory deficit was present in 5 patients and in group II in 12 patients. After 3 months, there were no patients with sensory deficit in group I and 2 in group II. Preoperatively in group I, mouth opening was 24 mm and in group II patients was 25.80 mm, which increased to 31.20 mm in group I and 28.20 mm in group II at 1 month, 32 mm in group I and 30 mm in group II at 3 months, and 37.20 and 32.12 mm in groups I and II, respectively, at 6 months. The difference was significant (P < 0.05). Conclusion: 3D miniplate system is reliable and effective treatment modality for mandibular angle fractures as compared with traditional 2D miniplates.[INLINE:1]



How to cite this article:
Singh R, Konark, Singh A, Singh D K, Nazeer J, Singh S. Comparative evaluation of 2D miniplates and 3D miniplates fixation in mandibular angle fracture - A clinical study.Indian J Dent Res 2020;31:134-137


How to cite this URL:
Singh R, Konark, Singh A, Singh D K, Nazeer J, Singh S. Comparative evaluation of 2D miniplates and 3D miniplates fixation in mandibular angle fracture - A clinical study. Indian J Dent Res [serial online] 2020 [cited 2021 Jun 17 ];31:134-137
Available from: https://www.ijdr.in/text.asp?2020/31/1/134/281823


Full Text

 Introduction



Facial trauma is common in road traffic accidents (RTA). Due to modernization, increased number of vehicles and failure to follow traffic rules are among various causes of facial trauma. Mandible is one of the frequently fractured bones in RTA. It has been observed that the most common sites of mandibular fracture are angle, body, and ramus.[1]

The incidence of mandibular fracture range between 40% and 65% of all facial fractures and so are twice as common as fractures of the midfacial bones. Fractures of the angle of mandible can present with long-term disabling sequelae and make up 23%–42% of all fractures in the mandible.[2]

There are several factors that lead to increased fractures at the site of the angle of the mandible. A thinner cross-sectional area than the tooth bearing region, the sharp curvature of the trajectories in the angle region and the fact that the lingual surface of the mandible in the region of second and third molars is the site of maximum tensile strain resulting from anterolateral application of force on same side are among various causes leading to mandibular angle as a favorable site for fractures.[3]

Three-dimensional plating system is regarded as one of the best methods for mandibular angle fracture management as compared to 2D plate system. The geometry of 3D miniplate theoretically allows for an increased number of screws and resistance against torque forces, etc.[4] This study was conducted to compare 3D miniplate system with 2D plates for treatment of mandibular angle fractures.

 Materials and Methods



The study was conducted in the Department of Oral and Maxillofacial Surgery. It comprised of 120 patients with mandibular angle fracture of both genders. Approval was obtained from the institutional ethical committee before commencing the study. All patients were informed regarding the study beforehand and written consent was obtained.

General information, such as name, age, gender, etc., was recorded in case history performa. Patients were selected via the simple random method. Inclusion criteria comprised of patients age ranging between 20–60 years irrespective of gender, socioeconomic status, and with good health (ASA-I and ASA-II) without any contraindication for surgery or anesthesia. Patients with pre-existing neurological or musculoskeletal disease, medically compromised patients, and patients with midface fractures were excluded.

After selecting patients, patients were divided into 2 groups of 60 each. In group I, patients were treated with 3D [Figure 1], 2.0-mm titanium plates, and in group II, patients were treated with 2D [Figure 2], 2.0-mm titanium miniplate in mandibular angle fracture.{Figure 1}{Figure 2}

In all patients, neurological evaluation was done to rule out head injury and cervical spine injury. General physical examination was done to ascertain the absence of any associated injury to the thorax, abdomen, genitourinary tract, or long bones. After obtaining required information, patients were subjected to radiographic (OPG) examination to consider the type of mandibular angle fracture.

Fracture site at mandibular angle was approached extra-orally through submandibular incision and any other associated fractures were approached intraorally depending on the site, severity of the fracture, and any pre-existing skin lacerations. Surgical open reduction and internal fixation was performed with 3D miniplates or 2D miniplates following standardized surgical procedures. Immediate postoperative OPG was taken to evaluate the fracture reduction and placement of plates.

All patients were evaluated for mouth opening, presence of edema, neurological status, ecchymosis, hematoma, presence of extra-oral and intraoral wounds, tenderness at the fracture site, step deformity at fracture site, tooth in line of fracture and presence of infection. All patients were recalled regularly and clinical and radiographic evaluation was done at 1 month, third and sixth month intervals.

Statistical analysis

Results thus obtained were subjected to statistical analysis using the statistical package for the social science (SPSS) version 21.0. Results were expressed as mean ± SD. Independent t-test and Chi-square test was used to determine significant association between the two variables. P value < 0.05 was considered significant.

 Results



[Table 1] shows that in group I, males were 22 and females were 38. In group II, males were 40 and females were 20. [Table 2] shows that right angle fracture was seen in 32 patients in group I and 26 in group II. Left angle fracture was seen in 24 in group I and 28 in group II. Right angle and left parasymphysis fracture was seen in 3 in group I and 4 in group II. Left angle and right parasymphysis fracture was seen in 1 in group I and 2 in group II. [Table 3], [Graph 1] shows that in group I, after 1 month sensory deficit was present in 5 patients and in group II in 12 patients. After 3 months, there were no patients with sensory deficit in group I and 2 in group II.{Table 1}{Table 2}{Table 3}

[INLINE:1]

[Table 4], [Graph 2] shows that preoperatively in group I, mouth opening was 24 mm and in group II patients was 25.80 mm, which increased to 31.20 mm in group I and 28.20 mm in group II at 1 month, 32 mm in group I and 30 mm in group II at 3 months, and 37.20 and 32.12 mm in groups I and II, respectively, at 6 months. The difference was significant (P < 0.05).{Table 4}

[INLINE:2]

 Discussion



In today's fast life, the number of RTA and hence facial fractures are increasing day by day. Among various facial bone fractures, mandibular angle fracture is very common. In the past three decades, there has been an increasing interest in achieving more immediate return to normal function by using different methods of direct fixation with an open approach and allowing anatomical reduction of the fragments in the management of these fractures.[5]

Direct fixation using different methods of plate and screw osteosynthesis has gained popularity. Various plate and screw osteosynthesis have been introduced such as AO bicortical plating system, 2D miniplating system and screws, and 3D miniplating system. In this study, we compared 2D miniplating system and screws with 3D miniplating system in patients with mandibular angle fractures.[6]

We classified and distributed patients randomly in two groups based on type of plating done. In group I, there were 22 males and 38 females. In group II, males were 40 and females were 20. Our results are in agreement with Almoraissi et al.[7]

Studies have shown that a thin cross-sectional area relative to the body, symphysis and parasymphysis anteriorly, and the presence of the third molars are amongst various factors that influence increased mandibular angle fracture. In addition to this, the fact that the angle of mandible is where there is abrupt change in the shape from horizontal body to vertical rami implies that this region might be subjected to more complex forces than a more linear geometry shape.[8],[9]

In this study, we used 3D miniplate in mandibular angle fractures. Some of the advantages of 3D miniplate osteosynthesis over other means of rigid internal fixation are low profile design, space between the plate holes permits excellent revascularization and excellent biocompatibility. Mostafa Farmand[10] introduced new 3D plating system in which stability of the 3D plate is achieved by its configuration, not by thickness or length. These unique plates are composed of linear, square, or rectangular units and may theoretically provide increased torsional stability.[7]

In this study, we found that right angle fracture was seen in 32 patients in group I and 26 in group II. Left angle fracture was seen in 24 in group I and 28 in group II. Right angle and left parasymphysis fracture was seen in 3 in group I and 4 in group II. Left angle and right parasymphysis fracture was seen in 1 in group I and 2 in group II. Chhabaria et al.[11] found that right side was involved in 70% cases, whereas 30% were of left side.

We observed that in group I, after 1 month sensory deficit was present in 5 patients and in group II in 12 patients. After 3 months, there were no patients with sensory deficit in groups I and 2 in group II. Cillo et al.[12] in their study found that sensory deficit was less in cases of 3D miniplating system as compared to 2D plating.

In this study preoperatively in group I, mouth opening was 24 mm and in group II patients was 25.80 mm which increased to 31.20 mm in group I and 28.20 mm in group II at 1 month, 32 mm in group I and 30 mm in group II at 3 months, and 37.20 and 32.12 mm in groups I and II, respectively, at 6 months. This is in agreement with the study by Patel et al.[13]

Modern traumatology has gained popularity with the development of osteosynthesis. In the mandibular region, the introduction of different plating systems, which are smaller and easier to use has enabled avoidance of extraoral scarring. In addition, the tissue compatibility of titanium over stainless steel has resulted in lesser infection. It is also the metal of choice for fixation plates.[14] Titanium has proved to be a highly biocompatible material with resultant decreased need for resurgery. The flexibility of titanium is also very similar to bone. This causes less stress shielding effect as compared to stainless steel.[15] It has now become the treatment of choice for most of the surgeons. They have obtained excellent results with these plates. Titanium has an elastic modulus, i.e. stiffness, which is about half that of stainless steel. Consequently, titanium plates most likely require less manipulation during insertion. The ductility of titanium is less compared to SS, because of its hexagonal crystal structure. This makes contouring of titanium plates difficult when compared to stainless steel plates.[16] The limitation of the study is the small sample size and limited follow-up.

 Conclusion



3D miniplates system is reliable and effective treatment modality for mandibular angle fractures as compared to traditional 2D miniplates. Authors found that 3D minipates were superior comparing 2D plates in patients with mandibular angle fractures. Sensory deficit was less with 3D minipates and there was significant mouth opening in patients with 3D minipates as compared with 2D plates. However, large-scale studies are required to substantiate the results obtained in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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