The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 24 , ISSUE 10 ( October, 2023 ) > List of Articles


Z-shaped Miniplates vs Conventional Miniplates for Fixation of Mandibular Parasymphyseal Fractures

Mohamed Abd EL-Rahman Abdou Ata, Hamdy Abd-Elmegeed Mohammed Marzook, Mohamed Abdel-Monem Tawfik, Ziad Mohamed Amr Elmissiry

Keywords : Conventional miniplate, Parasymphseal fractures, Three-dimensional plate, Z-shaped miniplate

Citation Information : Ata MA, Marzook HA, Tawfik MA, Elmissiry ZM. Z-shaped Miniplates vs Conventional Miniplates for Fixation of Mandibular Parasymphyseal Fractures. J Contemp Dent Pract 2023; 24 (10):761-770.

DOI: 10.5005/jp-journals-10024-3578

License: CC BY-NC 4.0

Published Online: 05-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: The aim of this study was to evaluate a clinically and radiographically Z-shaped miniplate for the fixation of the parasymphyseal fractures. Patients and methods: Twenty patients (10 patients in each group) who had parasymphseal mandibular fractures were randomly selected for this study. In this study, open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using two miniplates as group I, and open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using a newly designed Z-shaped miniplate as group II. Clinical and radiographic evaluations were made. Each patient was evaluated: (1) clinically evaluated preoperatively and postoperatively for operating time, ease of placement of the miniplate, and occlusion and (2) radiological: postoperative reduction of fracture was evaluated radiologically at 5-day, 1-month, 2-month, and 3-month intervals with orthopantomogram, and lingual splaying was evaluated by cone-beam computed tomography (CBCT) immediately postoperatively and at an interval of 3 months. The collected data were subjected to statistical analysis. Data analysis was performed by SPSS software, version 25 (SPSS Inc., PASW statistics for Windows version 25). Chicago: SPSS Inc. Results: There was a statistically significant difference (p < 0.001) between the mean intraoperative time. This indicates that group I had a longer time for fracture fixation than group II. Group I had a longer time elapsed for plate adaptation and definitive fixation than group II. Occlusion and reduction stability in both groups were similar. There was a statistically significant difference in postoperative lingual display control after 5 days and 3 months between the studied groups. This indicates that lingual display control in group II is better than in group I. Conclusion: The Z-shaped miniplate is effective and provides three-dimensional stability for the fixation of parasymphyseal fractures, ease of use, easily adapted in cases of fractures near the mental nerve reduced operative time, and better control of lingual splaying than conventional miniplates. Clinical significance: The newly designed Z-shaped miniplate is a valuable option for fixation parasymphysis fractures that need open reduction and internal fixation instead of using conventional miniplates, which are less successful in controlling lingual splaying.

  1. Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 1990;48(9):926–932. DOI: 10.1016/0278-2391(90)90004-l.
  2. Jariod Ferrer ÚM, Blanco Sanfrutos S, Gavin Clavero MA, et al. Epidemiological study of the socioeconomic impact of mandible fractures in a Spanish tertiary hospital: review of the literature. J Oral Maxillofac Surg 2019;18:217–223. DOI: 10.1007/s12663-018-1148-6.
  3. Al-Belasy FA. A short period of maxillomandibular fixation for treatment of fractures of the mandibular tooth-bearing area. J Oral Maxillofac Surg 2005;63(7):953–956. DOI: 10.1016/j.joms.2005.02.008.
  4. Giri KY, Singh AP, Dandriyal R, et al. Incidence and pattern of mandibular fractures in Rohilkhand region, Uttar Pradesh state, India: A retrospective study. J Oral Biol Craniofac Res 2015;5(3):140–145. DOI: 10.1016/j.jobcr.2015.07.007.
  5. Ji B, Wang C, Liu L, et al. A biomechanical analysis of titanium miniplates used for treatment of mandibular symphyseal fractures with the finite element method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(3):e21–27. DOI: 10.1016/j.tripleo.2009. 11.003.
  6. Farwell DG. Management of symphyseal and parasymphyseal mandibular fractures. Oper Tech Otolayngol Head Neck Surg 2008;19(2):108–112.
  7. Champy M, Lodde JP, Schmitt R, et al. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg 1978;6:14–21. DOI: 10.1016/s0301-0503(78)80062-9.
  8. Sadhwani BS, Anchlia S. Conventional 2.0 mm miniplates versus 3-D plates in mandibular fractures. Ann Maxillofac Surg 2013;3(2):154. DOI: 10.4103/2231-0746.119231.
  9. Kroon FH, Mathisson M, Cordey JR, et al. The use of miniplates in mandibular fractures: An in vitro study. J Craniomaxillofac Surg 1991;19(5):199–204. DOI: 10.1016/s1010-5182(05)80547-5.
  10. Farmand M, Dupoirieux L. The value of 3-dimensional plates in maxillofacial surgery. Revue de stomatologie et de chirurgie maxillo-faciale 1992;93(6):353–357. PMID: 1475603.
  11. Agarwal M, Meena B, Gupta DK, et al. A prospective randomized clinical trial comparing 3D and standard miniplates in treatment of mandibular symphysis and parasymphysis fractures. J Maxillofac Oral Surg 2014;13:79–83. DOI: 10.1007/s12663-013-0483-x.
  12. Kende PP, Wadewale M, Ranganath S, et al. An in vitro evaluation of a novel design Z plate for fixation of mandibular symphysis and parasymphysis fractures: A finite element analysis. J Maxillofac Oral Surg 2022;21(3):929–935. DOI: 10.1007/s12663-021-01576-3.
  13. Hart RT, Hennebel VV, Thongpreda N, et al. Modeling the biomechanics of the mandible: A three-dimensional finite element study. J Biomech 1992;25(3):261–286. DOI: 10.1016/0021-9290(92)90025-v.
  14. Thapliyal S, Mowar A, Bansal V. Comparison between conventional titanium miniplates and indigenous detachable custom made 3D titanium plates (VAS 3D Bone Plate) for fixation of mandibular fracture in mental foramen region: a randomized clinical trial and finite element analysis J Maxillofac Oral Surg 2020:1–8. DOI: 10.1007/s12663-020-01397-w.
  15. Wusiman P, Taxifulati D, Weidong L, et al. 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. J Dent Sci 2019;14(1):66–80. DOI: 10.1016/j.jds.2018.04.004.
  16. Niederdellmann H, Akuamoa-Boateng E. Internal fixation of fractures. Int J Oral Surg 1978;7(4):252–255. DOI: 10.1016/s0300-9785(78)80 090-8.
  17. De Jesus GP, Vaz LG, Gabrielli MF, et al. Finite element evaluation of three methods of stable fixation of condyle base fractures. Int J Oral Maxillofac Surg 2014;3(10):1251–1256. DOI: 10.1016/j.ijom.2014.07.011.
  18. Guimond C, Johnson JV, Marchena JM. Fixation of mandibular angle fractures with a 2.0-mm 3-dimensional curved angle strut plate. J Oral Maxillofac Surg 2005;63(2):209–214. DOI: 10.1016/j.joms.2004.03. 018.
  19. Bui P, Demian N, Beetar P. Infection rate in mandibular angle fractures treated with a 2.0-mm 8-hole curved strut plate. J Oral Maxillofac Surg 2009;67(4):804–808. DOI: 10.1016/j.joms.2008.08.034.
  20. Zix J, Lieger O, Iizuka T. Use of straight and curved 3-dimensional titanium miniplates for fracture fixation at the mandibular angle. J Oral Maxillofac Surg 2007;65(9):1758–1763. DOI: 10.1016/j.joms.2007.03.013.
  21. Jain MK, Manjunath KS, Bhagwan BK, et al. Comparison of 3-dimensional and standard miniplate fixation in the management of mandibular fractures. J Oral Maxillofac Surg 2010;68(7):1568–1572. DOI: 10.1016/j.joms.2009.07.083.
  22. Gokkulakrishnan S, Singh S, Sharma A, et al. An analysis of postoperative complications and efficacy of 3-D miniplates in fixation of mandibular fractures. Dent Res J 2012;9(4):414. PMID: 23162581. PMCID: PMC3491327.
  23. Parmar S, Menat S, Raghani M, et al. Three dimensional miniplate rigid fixation in fracture mandible. J Maxillofac Oral Surg 2007;6(2):14.
  24. Singh V, Puri P, Arya S, et al. Conventional versus 3-dimensional miniplate in management of mandibular fracture: A prospective randomized study. Otolaryngol Head Neck Surg 2012;147(3):450–455. DOI: 10.1177/0194599812449437.
  25. Malhotra K, Sharma A, Giraddi G, et al. Versatility of titanium 3D plate in comparison with conventional titanium miniplate fixation for the management of mandibular fracture. J Maxillofac Oral Surg 2012;11:284–290. DOI: 10.1007/s12663-012-0340-3.
  26. Kuik K, Ho JP, Klop C, et al. Biomechanical evaluation of a new fixation method for stabilization of sagittal split ramus osteotomy after mandibular advancement. Craniomaxillofac Trauma Reconstr 2021;6. DOI: 10.1177/24727512211019230.
  27. Ellis III E. A study of 2 bone plating methods for fractures of the mandibular symphysis/body. J Oral Maxillofac Surg 2011;69(7):1978–1987. DOI: 10.1016/j.joms.2011.01.032.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.