Three-dimensional versus standard miniplate, lag screws versus miniplates, locking plate versus non-locking miniplates: Management of mandibular fractures, a systematic review and meta-analysis

Abstract

Background/purpose The aims of the present study were to 1) evaluate the clinical outcomes between different fixation methods in the management of mandibular fractures (MFs) and 2) determine which fixation method is the best option for the treatment of mandibular fractures. Materials and methods A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. Inclusion criteria were studied in humans, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. In addition, the incidence of complications was evaluated. Results Thirty-two publications were included: 20 randomized controlled trials, 4 controlled clinical trials, and 8 retrospective studies. There were statistically significant advantages for 3-dimensional miniplate and lag screws. There was no statistically significant difference between locking plates and standard miniplates (P = 0 0.2). The cumulative odds ratio was 0.64, meaning that the use of locking miniplate in the fixation of MFs decreases the risk for postoperative complications by 36% over the use of standard miniplates. Conclusion The results of the three-Dimensional Versus Standard miniplate showed that 3-dimensional miniplate is the best option for mandibular fractures. Regarding Lag Screws Versus Miniplates results of the meta-analysis found that the use of lag screws is superior to using miniplates in reducing the incidence of postoperative complications. And in regards to locking miniplates versus non-locking miniplate, the analysis indicates that the 2.0-mm locking miniplate is a prospective fixation system in the treatment of maxillofacial fractures.

Adequacy of Three Dimensional Miniplate In Treatment Of Mandibular Fracture In Interforaminal Region

“…These advantages include easy application, simplified adaptation to the bone without distortion or displacement of the fracture, simultaneous stabilization at both superior and inferior borders, and hence less operative time. 7,23 Our study agrees with them, with an average operative time of 41 minute. However, this reduced time cannot be attributed to simplified adaptation.…”

“…Another advantage of 3D plate is their improved biomechanical stability compared to conventional miniplates. 7 In our study, stability was adequate in most cases except one case. This might be due to difficulty in achieving principles of 3D plate fixation (horizontal bar perpendicular and vertical bar parallel to fracture line 3 and using 4-holed rectangular plates where probably the use of 6-holed rectangular plate would have been more beneficial.…”

“…Various experimental studies on biomechanics have confirmed sufficient stability of the 3D plating system. [4][5][6][7] The observations in these few studies are encouraging, with fewer complications. [4][5][6][7] This prospective clinical study was carried out to evaluate the adequacy of 3D miniplate fixation in the management of mandibular fractures occurring in between the two mental foramens (interforaminal region).…”

Comparison of lag-screw versus miniplate for osteosynthesis of anterior mandibular fracture: A Randomized Control study

“…1-3). For group 2, two 2.0 mm miniplates were prepared and adapted on the target area according to the guided protocol using two monocortical 6-9mm length screws on each side of the fracture line according to Champy's principles (7) ( fig. 4-6).…”

“…(6) The original principal of Champy recommended using of 2 miniplates for internal fixation of anterior mandibular fractures is the standard routine method for management of these fractures until now. (7) However the thick cortices, curvature shape and absence of anatomical hazards of the anterior mandible uniquely makes lag screw application appear to be simple, safe and reasonable in internal fixation of anterior mandibular fractures. (8)(9)(10) Hence, the purpose of the present study was to compare the clinical and radiographic outcomes of osteosynthesis of mandibular anterior fracture by using of two different techniques for internal open reduction and fixation, titanium miniplates versus cortical lag screws.…”