Condylar remodeling after osteosynthesis of fractures of the condylar head or close to the temporomandibular joint

Skroch, Linda; Fischer, Ingo; Meisgeier, Axel; Kozolka, Felicián; Apitzsch, Jonas; Neff, Andreas

doi:10.1016/j.jcms.2020.02.005

Cited by 36 publications

(36 citation statements)

References 34 publications

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“…This shorter time can be initially considered an advantage. In Neff staff, since the initiation of ORIF for head fractures in 1993, clinicians have routinely removed fixation material (1.8 mm small fragment screws since 2007) during a second-look procedure, which is mainly performed to prevent or mobilize screw-associated intra-and periarticular scar formation [41,44,45]. For more conservative or less experienced surgeons, it may be beneficial to leave osteosynthesis material for spontaneous resorption.…”

Section: Discussionmentioning

confidence: 99%

Are Magnesium Screws Proper for Mandibular Condyle Head Osteosynthesis?

Kozakiewicz

2020

Materials

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Recently, magnesium alloys have gained a significant amount of recognition as potential biomaterials for degradable implants for craniofacial bone screws. Purpose: The aim of this work was to compare screws made specifically for mandibular head osteosynthesis from different materials. Materials and Methods: Screws measuring 14 mm made by one manufacturer specifically for mandibular head osteosynthesis out of the following materials were selected: magnesium (MgYREZr), titanium (Ti6Al7Nb), and polymer (PLGA). The axial pull-out strength and torsional properties were investigated. Results: Each type of screw presented different pull-out forces (Kruskal–Wallis test, p < 0.001). The magnesium screw had the highest pull-out force of 399 N (cracked without the screw out being pulled out), followed by the titanium screw, with a force of 340 N, and the PLGA screw, with a force of 138 N (always cracked at the base of the screw head without the screw being pulled out). ANOVA was performed for the maximal torques before damage to the screw (torsional properties), revealing that the maximal torque of the magnesium screw was 16 N·cm, while that of the titanium screw was 19 N·cm. The magnesium screw was significantly weaker than the titanium screw (p < 0.05). The measured torque and pull-out force were not related to each other (p > 0.05). Conclusion: Among the screws compared, the metal biodegradable magnesium screw seems to be the most suitable material for multiscrew mandibular head osteosynthesis, considering the condition of the fragile screwdriver socket.

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Section: Discussionmentioning

confidence: 99%

Are Magnesium Screws Proper for Mandibular Condyle Head Osteosynthesis?

Kozakiewicz

2020

Materials

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“…There are several previous studies on bone remodelling after surgical treatment of CHF [15,18,19] , each of which uses a different analytical approach. Recent studies have described either three-dimensional or volumetric measurements; therefore, we decided to combine both measurements of volumetric alterations and two-dimensional changes of the condylar head, which were modi ed according to Skroch et al 2020 [19] . By using sophisticated automated segmentation algorithms in the present study, the volume bias during segmentation is reduced.…”

Section: Discussionmentioning

confidence: 99%

“…Osteosynthesis with two positional screws has proven to be appropriate for treating CHF [16] . Although the removal of osteosynthesis material was formerly only recommended in cases of implant failure [17,18] , some of the latest studies using volumetric and three-dimensional evaluation of bone resorption strongly recommend standardised removal four to six months after surgery to prevent screw protrusion and reduce the rate of subsequent joint disorders [15,[19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

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Minimal bone resorption after open treatment of mandibular condylar head fractures

Neuhaus

Gellrich

Zeller

et al. 2021

Preprint

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Open treatment of condylar base and neck fractures is widely recommended, whereas treatment of condylar head fractures is still controversial and just is removal of osteosynthesis material. In this study, bone resorption and remodelling after open treatment of condylar head fractures were three-dimensionally (3D) assessed and correlated with clinical parameters in a medium follow-up. Of 18 patients with 25 condylar head fractures who underwent open reduction and internal fixation, clinical data and cone beam computed tomography (CBCT) datasets were analysed. Condylar processes were segmented in the postoperative and follow-up CBCT scans. Volumetric and linear changes were measured using a sophisticated 3D-algorithm. In the course after surgery, patients function and pain improved significantly. Low rates of postoperative complications were observed. All 3D measurements showed no significant bone resorption during the follow-up period. Open reduction of condylar head fractures leads to good patients outcomes and low rates of long-term complications. This study underlines the feasibility and importance of open treatment of condylar head fractures and may help to spread its acceptance as the preferred treatment option.

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“…If the alloy comes into contact with the oral cavity, its relatively rapid surface degradation [ 13 ] causes undesirable biological reactions of surrounding soft and hard tissues, loss of osseointegration weakening the maintenance of the implant in the bone, chemical reactions, functional stresses, and bacterial attack [ 14 ]. For this reason, and because of the mechanical irritation of surrounding tissues during movement in the joints [ 15 ], a planned removal of the entire fixation material 2–3 months after implantation is postulated [ 15 , 16 ]. The solution to these problems would be to use a fixing material that would disappear after the period of bone healing.…”

Section: Introductionmentioning

confidence: 99%

Change in Pull-Out Force during Resorption of Magnesium Compression Screws for Osteosynthesis of Mandibular Condylar Fractures

Kozakiewicz

2021

Materials

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Background: Magnesium has been used as degradable fixation material for osteosynthesis, but it seems that mechanical strength is still a current issue in these fixations. The aim of this study was to evaluate the axial pull-out force of compression headless screws made of magnesium alloy during their resorption. Methods: The tests included screws made for osteosynthesis of the mandible head: 2.2 mm diameter magnesium alloy MgYREZr (42 screws) and 2.5 mm diameter polylactic-co-glycolic acid (PLGA) (42 pieces, control). The screws were resorbed in Sørensen’s buffer for 2, 4, 8, 12, and 16 weeks, and force was measured as the screw was pulled out from the polyurethane block. Results: The force needed to pull the screw out was significantly higher for MgYREZr screws than for PLGA ones (p < 0.01). Within eight weeks, the pull-out force for MgYREZr significantly decreased to one third of its initial value (p < 0.01). The dynamics of this decrease were greater than those of the pull-out force for PLGA screws (p < 0.05). After these eight weeks, the values for metal and polymer screws equalized. It seems that the described reduction of force requires taking into account when using magnesium screws. This will provide more stable resorbable metallic osteosynthesis.

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Condylar remodeling after osteosynthesis of fractures of the condylar head or close to the temporomandibular joint

Cited by 36 publications

References 34 publications

Are Magnesium Screws Proper for Mandibular Condyle Head Osteosynthesis?

Are Magnesium Screws Proper for Mandibular Condyle Head Osteosynthesis?

Minimal bone resorption after open treatment of mandibular condylar head fractures

Change in Pull-Out Force during Resorption of Magnesium Compression Screws for Osteosynthesis of Mandibular Condylar Fractures

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