Comparative Evaluation of Three-Dimensional Plating Systems in Maxillofacial Trauma: An Original Research.

Introduction: Many advanced techniques and materials have been introduced in the recent years with the advent of the new designing technology. Hence, in our study, we aimed to compare in maxillofacial trauma, the three-dimensional (3D) plating systems. Materials and
Methods: We piloted a prospective clinical study among 50 subjects of both genders with mandibular parasymphysis fracture. We compared the 3D miniplates with the two-dimensional (2D) miniplates where the subjects were divided into 2 groups equally. The clinical parameters were compared at different times of follow-up after the surgery.
Results: We observed that there was a similar distribution of the genders and the side of the fracture of the parasymphysis. There was a significant difference between the groups for the mouth opening while there was no significant difference for the sensory deficit. The subjects recovered better with the 3D mini-plates.
Conclusion: The mandibular fractures can be successfully treated with the 3D miniplates that help in a quick and efficient recovery. Copyright:

INTRODUCTION

With the surge in the usage of the vehicles for the commute, the numbers of the accidents are also on the raise. The mandibular fractures are the most common among the trauma cases that are recorded after the road traffic accidents, domestic violence, and after the fall.[12] From closed to open reduction methods, there are many techniques that have been described for the management of the fracture of the mandible.

In the recent times, the three-dimensional (3D) system of plating for the open reduction has gained popularity. There are previous studies that have concluded the efficiency of the 3D plating. However, there are very few studies that have compared the efficiency of the 3D plates with the conventional two dimensional (2D) plating system.[34] Hence, in our study, we aimed to compare the 3D plating systems with the 2D systems in maxillofacial trauma of the mandibular parasymphysis.

MATERIALS AND METHODS

We piloted a prospective clinical study among 50 subjects of both genders with mandibular parasymphysis fracture. The ethics clearance was obtained for the study and the patient written consent was acquired after the study design was explained to them. We selected subjects of age 18–45 years with mandibular parasymphysis fractures and no other medical complications and not on any medications that might interfere with the healing.

We compared the 3D miniplates (titanium) with the 2D mini-plates (titanium) where the subjects were divided to 2 groups equally of 25 in each group. The surgery was performed following the protocols under strict aseptic conditions. The clinical parameters of the mouth opening and the sensory deficit were compared along with the other signs of healing at 4, 8, 12 weeks of follow-up after the surgery using the radiographic images and clinical evaluations. The obtained values were compared using the IBM SPSS Statistics for Windows, version XX (IBM Corp., Armonk, N.Y, USA. Version 20) applying the Chi-square test while deliberating P < 0.05 as significant.

RESULTS

We observed that there was no significant variation of the genders between the groups or the side of the parasymphysis fracture (right and left). We observed that there was a significant variation of the mouth opening between the groups at the different time intervals. When the sensory deficit was compared, the number of subjects exhibiting the deficit gradually decreased at the end of the 12 weeks. There was no significant variation in the groups. The subjects in the 3D group recovered faster and better [Table 1].

Table 1

Comparison of the groups for the various parameters after the surgery

Variables	3D mini-plates	2D mini-plates	P
	Mouth opening (mm)
Preoperative	24.01±1.21	25.00±1.30	0.02
4-week postoperative	30.25±5.66	27.33±2.66	0.01
8-week postoperative	31.25±5.89	29.48±7.25	0.04
12-week postoperative	36.58±4.89	31.25±4.56	0.01
Sensory deficit	Number of subjects		P
Preoperative	20	18	NS
4-week postoperative	8	10	NS
8-week postoperative	3	4	NS
12-week postoperative	0	0	NS

NS: Not significant

DISCUSSION

The parasymphysis fractures of the mandible are quite common incidence in the maxillofacial trauma. The primary objective of any surgery is the restoration of the function. In the facial fractures, along with the functional recovery, the chief focus is the esthetics and the quick recovery.[45] The 3D plating systems have been gaining popularity in the maxillofacial structure. Hence, we compared the same for the efficiency with the routine 2D plating system. We observed a significant variation for the mouth opening. The 3D plating performed better than the 2D system. Although not significant, the subjects recovered better for the neurological signs and fewer were recorded in the 3D plating group than the 2D plating systems. Our observations are similar to the study of Cillo and Ellis[6] and Patel et al.[7]

There were few limitations in our study, one being the small sample size. The socioeconomic conditions and the nutritional status were not compared in our study that might have influenced the recovery.

CONCLUSION

Within the limitations of the study, we can determine that the 3D miniplates systems are effective and performed better than the conventional plating systems. Further studies with larger sample size and longer follow-up are suggested to corroborate our findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.