Use of Rectangular Grid Miniplates for Fracture Fixation at the Mandibular Angle

Purpose: The aim of this study was to evaluate the clinical outcome of patients with mandibular angle fractures treated by intraoral access and a rectangular grid miniplate with 4 holes and stabilized with monocortical screws.Patients and Methods: This study included 45 patients with mandibular angle fractures from the Department of Oral and Maxillofacial Surgery São Paulo State University, Araraquara, Brazil, and from the Clinic of Oral and Maxillofacial Surgery at the University of Frankfurt, Germany. The 45 fractures of the mandibular angle were treated with a rectangular grid miniplate of a 2.0-mm system by an intraoral approach with monocortical screws. Clinical evaluations were postoperatively performed at 15 and 30 days and 3 and 6 months, and the complications encountered were recorded and treated.Results: The infection rate was 4.44% (2 patients), and in 1 patient it was necessary to replace hardware. This patient also had a fracture of the left mandibular body; 3 patients (6.66%) had minor occlusal changes that have been resolved with small occlusal adjustments. Before surgery, 15 patients (33.33%) presented with hypoesthesia of the inferior alveolar nerve; 4 (8.88%) had this change until the last clinical control, at 6 months.Conclusions: The rectangular grid miniplate used in this study was stable for the treatment of simple mandibular angle fractures through intraoral access, with low complication rates, easy handling, and easy adjustment, with a low cost. Concomitant mandibular fracture may increase the rate of complications. This plate should be indicated in fractures with sufficient interfragmentaty contact. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:1436-1441, 2011

Reducao fechada e fixacao percutanea em fraturas supracondilianas do umero em criancas. Estudo retrospectivo de 32 casos

This retrospective study evaluated 32 cases of supracondylar fractures of the humerus in children, according to percutaneous crossed Kirschner-wire fixation. Follow-up was performed by radiographs of Baumann's angle and clinical evaluation of joint movement and carrying angle. According to Flynn's criteria, results were satisfactory in all cases, indicating that this method is a safe and efficient method in the treatment of such fractures.

Miniplate fixation for the repair of segmental mandibular defects filled with autogenous bone in cats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Miniplate 1.5 fixation for the repair of mandibular osteotomies in cats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mandibular Angle Fracture Treated With New Three-Dimensional Grid Miniplate

Fractures of the mandibular angle deserve particular attention because they represent the highest percentage of mandibular fractures and have the highest postsurgical complication rate, making them the most challenging and unpredictable mandibular fractures to treat. Despite the evolution in the treatment of maxillofacial trauma and fixation methods, no single treatment modality has been revealed to be ideal for mandibular angle fractures. Several methods of internal fixation have been studied with great variation in complications rates, especially postoperative infections. Recently, new studies have shown reduction of postsurgical complications rates using three-dimensional plates to treat mandibular angle fractures. Nevertheless, only few surgeons have used this type of plate for the treatment of mandibular angle fractures. The aim of this clinical report was to describe a case of a patient with a mandibular angle fracture treated by an intraoral approach and a three-dimensional rectangular grid miniplate with 4 holes, which was stabilized with monocortical screws. The authors show a follow-up of 8 months, without infection and with occlusal stability.

Rigid internal fixation with titanium versus bioresorbable miniplates in the repair of mandibular fractures in rabbits

The purpose of this study was to compare by qualitative histology the efficacy of rigid internal fixation with titanium system and the Lacto Sorb® system in mandibular fractures in rabbits. Thirty male adult rabbits Oryctolagus cuniculus were used. Unilateral mandibular osteotomies were performed between the canine and first premolar. The animals were divided into two groups: for Group I - rigid internal fixation was performed with titanium system 1.5 mm (Synthes, Oberdorf, Switzerland), with two screws of 6 mm (bicortical) on each side of the osteotomy. For Group II-rigid internal fixation was performed with PLLA/PGA system 1.5 mm (Lacto Sorb®, WLorenz, Jacksonville, FL, USA). The histological analysis evaluated the presence of inflammatory reaction, degree of bone healing and degree of resorption of the Lacto Sorb® screws. The results of both fixation systems were similar, only with a small difference after 15 and 30 days. In Group I a faster bony healing was noted. But after 60 days, bony healing was similar in both groups. It is concluded that both PLLA/PGA and titanium plates and screws provide sufficient strength to permit mandibular bone healing. The resorption process of PLLA/PGA osteosynthesis material did not cause acute or chronic inflammatory reaction or foreign body reaction during the studied period. © 2004 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparative Analysis of 2 Techniques of Double-Gloving Protection During Arch Bar Placement for Intermaxillary Fixation

Purpose: This study was conducted to comparatively evaluate, in a prospective and randomized manner, 2 techniques for providing double-gloving protection during arch bar placement for intermaxillary fixation. Materials and Methods: A total of 42 consecutive patients in whom application of an Erich bar was indicated for intermaxillary fixation were equally divided into 2 groups. In group 1, 2 sterile surgical gloves were used; in group 2, a nonsterile disposable inner glove was used under a sterile surgical glove. Wilcoxon, Mann-Whitney, Kruskal-Wallis, and binomial statistical tests were used to analyze the findings. Results: A total of 103 perforations were found in the outer gloves (47 in group 1 and 56 in group 2), along with 5 perforations in inner gloves in both groups (α = .01). No significant statistical difference was found between groups in terms of inner glove perforations (α = .05). The nondominant hand presented with 70.9% of the perforations, statistically significant to 1%. Conclusions: Both double-gloving techniques were found to provide effective clinician protection. The use of a nonsterile disposable glove under the surgical glove is possible for less-invasive procedures, offering the same safety as using 2 sterile surgical gloves while decreasing operational costs. This method does not eliminate the need to change gloves when a perforation is suspected or noted during the surgery, however. © 2007 American Association of Oral and Maxillofacial Surgeons.

Severe fracture of the maxillary alveolar process associated with extrusive luxation and tooth avulsion: A case report

Aim: The aim of this report is to present a case of severe fracture of the maxillary anterior alveolar process with substantial bone dislodgement associated with extrusive tooth luxation and avulsion. Background: Dentoalveolar trauma is a challenge to dentistry, especially in young patients, for it can lead to early tooth loss which compromises oral function, esthetics, self-esteem, and alter the long-term plan of care for the victim. Case Report: A 12-year-old girl with severe dentoalveolar trauma to the maxillary anterior region presented for emergency care for her injury. Treatment consisted of fracture reduction of the alveolar process, repositioning of the teeth that had suffered extrusive luxation, placement of a semi-rigid splint, and suturing of soft tissue lacerations. The traumatized teeth presented with pulpal necrosis and were treated endodontically. After 24 months of follow up, the fracture of the alveolar process was completely healed and the displaced teeth presented no signs of ankylosis or root resorption. Summary: First-aid care contributed remarkably to this case allowing the re-establishment of esthetics, function, and patient's self-esteem. In spite of trauma extension the treatment outcomes were favorable. Clinical Significance: Cases of dentoalveolar trauma should be evaluated on an individual basis. However, early emergency management and adequate follow-up can prevent further complications and contribute to treatment success.

In vitro biomechanical evaluation of sagittal split osteotomy fixation with a specifically designed miniplate

Recent studies have evaluated many methods of internal fixation for sagittal split ramus osteotomy (SSRO), aiming to increase stability of the bone segments while minimizing condylar displacement. The purpose of this study was to evaluate, through biomechanical testing, the stability of the fixation comparing a specially designed bone plate to other two commonly used methods. Thirty hemimandibles were separated into three equal groups. All specimens received SSRO. In Group I the osteotomies were fixed with three 15 mm bicortical positional screws in an inverted-L pattern with an insertion angle of 90°. In Group II, fixation was carried out with a four-hole straight plate and four 6 mm monocortical screws. In Group III, fixation was performed with an adjustable sagittal plate and eight 6 mm monocortical screws. Hemimandibles were submitted to vertical compressive loads, by a mechanical testing unit. Averages and standard deviations were submitted to analysis of variance using the Tukey test with a 5% level of significance. Bicortical screws presented the greatest values of loading resistance. The adjustable miniplate demonstrated 60% lower resistance compared to bicortical screws. Group II presented on average 40% less resistant to the axial loading. © 2012 International Association of Oral and Maxillofacial Surgeons.

Failure of miniplate osteosynthesis for the management of atrophic mandibular fracture

Fractures of the severely atrophic (<10 mm) edentulous mandible are not common, and these fractures with a vertical height of 10 mm or less have long been recognized as being particularly problematic. Although there are advances in the treatment of the atrophic mandibular fracture, the treatment remains controversial. There are some options for treatment planning because of using small miniplates to large reconstruction plates. However, when the fixation method fails, it causes malunion, nonunion, and/or infection, and sometimes it has been associated with large bone defects. The authors describe a clinical report of a failed miniplate fixation for atrophic mandibular fracture management. The authors used a load-bearing reconstruction plate combined with autogenous bone graft from iliac crest for this retreatment. The authors show a follow-up of 6 months, with union of the fracture line and no complication postoperatively. © 2013 by Mutaz B. Habal, MD.

Biomechanical Study in Polyurethane Mandibles of Different Metal Plates and Internal Fixation Techniques, Employed in Mandibular Angle Fractures

The aim of this study was to perform a physicochemical and morphological characterization and compare the mechanical behavior of an experimental Ti-Mo alloy to the analogous metallic Ti-based fixation system, for mandibular angle fractures. Twenty-eight polyurethane mandibles were uniformly sectioned on the left angle. These were divided into 4 groups: group Eng 1P, one 2.0-mm plate and 4 screws 6 mm long; group Eng 2P, two 2.0-mm plates, the first fixed with 4 screws 6 mm long and the second with 4 screws 12 mm long. The same groups were created for the Ti-15Mo alloy. Each group was subjected to linear vertical loading at the first molar on the plated side in a mechanical testing unit. Means and standard deviations were compared with respect to statistical significance using ANOVA. The chemical composition of the Ti-15Mo alloy was close to the nominal value. The mapping of Mo and Ti showed a homogeneous distribution. SEM of the screw revealed machining debris. For the plates, only the cpTi plate undergoes a surface treatment. The metallographic analysis reveals granular microstructure, from the thermomechanical trials. A statistically significant difference was found (P < 0.05) when the comparison between both internal fixation techniques was performed. The 2P technique showed better mechanical behavior than 1P.

Estudo mecânico da estabilidade dorsal da osteossíntese intramedular associada à fixação externa (método de Ulson)

OBJETIVO: Avaliar o método de Ulson de fixação intramedular associado à fixação externa variando a altura do travamento externo dos fios de Kirschner e sem fixação externa. MÉTODO: Foram utilizadas 18 tíbias de porcos, sendo realizada osteotomia transversal na região da tuberosidade e introduzidos dois fios de Kirschner intramedulares em cada peça, em três diferentes padrões de montagem: grupo I - travamento com minifixador externo com 3,0cm de altura; grupo II - travamento com 4,5cm de altura; grupo III: sem travamento externo. Realizaram-se ensaios mecânicos de cisalhamento, obtendo-se: carga máxima, limite de proporcionalidade e coeficiente de rigidez. RESULTADOS: Não foram encontradas diferenças significativas de carga máxima e limite de proporcionalidade entre os grupos; o grupo II apresentou maior coeficiente de rigidez. CONCLUSÃO: A altura do travamento dos fios de Kirschner no método de Ulson, dentro dos limites avaliados, não prejudicou a estabilidade do sistema de fixação da fratura.

Production and heat treatment of cast graphitic steels with additions of niobium

The optimal combination of the mechanical characteristics of austempered spheroidal graphitic cast steel together with modern casting techniques yielded an economically promising product. The maximum potential of the usage of these steels is related to fabrication and characterization techniques, among which, one of the most important is the cooling diagram (TTT curve). In this work, 3 heats of graphitic steels with the following nominal compositions were cast: 1.0 % C, 2.3 % Si, 0.4 % Mn, and with niobium contents of. 0.0 %, 0.5 % and 1.0 %. TTT curves were determined by dilatometric testing and test specimens of these steels were austempered. The samples were then characterized by hardness testing and optical and SEM microscopy. Tensile, impact (no notch) and wear testing were also performed. The addition of niobium produced significant alterations in the TTT diagrams. Increasing niobium content moves the pearlite transformation nose to the right and the bainitic transformation nose to the left. Tensile strength of these alloys was high, in the range of 1700 MPa and impact values were around of 45 Joules for alloy with 1 % Nb, 49 Joules for alloy with 0.5 % Nb and fracture did not occur for the alloy without the addition of Nb.

Effect of the number of screws on the stability of locking mandibular reconstruction plates

Atrophic mandible fractures are frequently a challenge to stabilize. This study evaluated, through mechanical testing in vitro, the number of locking screws that is sufficient to withstand loading when applied with a locking reconstruction plate in the fixation of atrophic mandible fractures. Polyurethane mandibles with a simulated linear fracture at the midline were used as substratum. Results show that resistance of the fixation is poor when one and two screws are used on each side of the fracture. Three screws on each side of the fracture significantly increases the resistance to displacement. However, no additional strength is added to the construct when more than three screws per side are used. © 2013 International Association of Oral and Maxillofacial Surgeons.

Tratamento cirúrgico intrabucal das fraturas de ângulo mandibular com uma miniplaca de titânio: estudo clínico e radiográfico

Pós-graduação em Odontologia - FOA