Keerthana Ponvel,Elavenil Panneerselvam,Sasikala Balasubramanian,Krishna Kumar Raja V.B..[J].中华创伤杂志英文版,2019,22(5):261-269
Evaluation of labial versus labio-inferior lines of osteosynthesis using 3Dminiplate for fractures of anterior mandible: A finite element analysis with a pilotclinical trial
  
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KeyWord: Mandibular fracturesFinite element analysisOsteosynthesis3D miniplate
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Author NameAffiliation
Keerthana Ponvel Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600089, Tamil Nadu, India 
Elavenil Panneerselvam Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600090, Tamil Nadu, India 
Sasikala Balasubramanian Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600091, Tamil Nadu, India 
Krishna Kumar Raja V.B. Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai 600092, Tamil Nadu, India 
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Abstract:
      Purpose: The fractures of anterior mandible are subject to severe torsional forces due to muscles acting in opposite directions. 3D miniplate has been suggested as a good alternative by some researchers. How ever, finite element model (FEM) studies indicate that labio-inferior positioning of two miniplates perpendicular to each other offers better stability as compared to labial positioning. This study aims at combining the advantages of a single 3D miniplate and labio-inferior positioning of two conventional miniplates, which was assessed by finite element analysis along with a pilot clinical trial. Methods: Two FEM models were created using CT data of a 24-year-old patient with Angle class I oc clusion: control model with labial plating and study model with labio-inferior plating. The models were processed with MIMICS® (materialise, Leuven, Belgium), CATIA® (Dassault Systemes) and finite element analysis softwares. Parameters adopted for analysis were (1) displacement (mm) of fracture fragments during each screw fixation, (2) lingual splay and post fixation stability of fracture fragments with masticatory load, and (3) stress distribution (MPa) across fracture fragments. Moreover, a pilot clinical trial including five patients with anterior mandible fracture was conducted. The fractures were managed by intraoral open reduction and 3D miniplate fixation in labio-inferior position. Intraoperative inter fragmentary gap, post fixation lingual splay and radiographic fracture union and complications were assessed clinically. Results: Labio-inferior plating demonstrated less displacement (mm) of fracture fragments during screw fixation (0.059 vs. 0.079) as well as after application of masticatory load (1.805 vs. 1.860). Negligible lingual splay and less stress distribution (MPa) across fracture fragments (1.860 vs. 1.847) were appre ciated in the study group as compared to control group. Clinical trial support the favorable outcome related to intraoperative and postoperative assessment parameters. Conclusion: FEM analysis and clinical trial reveal better results with labio-inferior positioning of 3D miniplate when compared to labial positioning.
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