Computer manufactured Patient-specific Auto-reducible plate versus standard Trapezoid plate in Unilateral Subcondylar fractures | ||||
| Egyptian Dental Journal | ||||
| Article 18, Volume 64, Issue 4 - October (Oral Surgery), October 2018, Page 3267-3276 PDF (2.9 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/edj.2018.78552 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Khaled Amr1; Heba M. Kamel1; Hussein Hatem2 | ||||
| 1Lecturer of Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, Faculty of DentistryCairo University. | ||||
| 2Associate Professor of Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. | ||||
| Abstract | ||||
| Purpose: Subcondylar fractures account for a high incidence of mandibular fractures representing a frustrating clinical dysfunction and serious complications when maltreated. This study aimed to compare the computer designed and manufactured patient-specific auto-reducible plate to the standard trapezoid plate in attempt to reach the optimal geometrical design for subcondylar fracture plate fixation. Patients and methods: A total of sixteen patients suffering from unilateral subcondylar fracture were included in this study from the outpatient clinic of the department of oral and maxillofacial surgery, faculty of Dentistry, Cairo University. All patients were subjected to preoperative clinical evaluation and 3-D CT examination to assess the degree of fracture displacement and condylar location. The selected patients were divided into two groups, eight patients each. In group A patients, virtual fracture reduction through mirroring of the unaffected intact side was performed, which was then used as a template for designing and processing of the titanium patient-specific condylar plate via direct metal laser sintering. While in group B patients, the unilateral sub-condylar fractures were manually reduced into position and fixed in place by the standard trapezoidal mini-plate. Fixation of the plates in both groups was then performed using 2.0 mini-screws. Postoperative clinical assessment of the occlusion, Maximum inter-incisal opening (MIO) and mandibular deviation was done at one week, 1 month & 3 months. Immediate postoperative radiographic assessment was performed through the superimposition of the postoperative CT data of the fixed fracture on the preoperative virtually reduced mandibular model as a reference CT data to validate and compare the accuracy of the achieved postoperative fixation in both groups. Results: The surgeries in all cases proceeded without any complications. Surgical site examination was normal with no signs of infection. The occlusion was satisfactory at the end of the study interval despite the initial slight immediate postoperative occlusal discrepancy found in both groups. Deviation was not completely absent in both groups at the end of the follow-up period. The MIO ranged from 39-47 mm at the end of the study with no significant difference between both groups. The CT scan revealed the almost precise adaptation of both plates in place with no significant difference, however, with the advantageous fracture auto-reduction, intra-operative time saving and ease of application recorded with the use of the PS-condylar plate in group A patients. The mean operating time for reduction and fixation using the PS-condylar plate was 90 minutes compared to a mean of 88 minutes using the standard reduction and trapezoid plate fixation technique. Conclusion: Despite of the approaching accuracy of both plates, preoperative digital virtual planning and PS-plate processing were highly beneficial in the auto-reduction of the fractured segments. The intra-operative time saving and ease of application with less obtained surgical errors due to the planned surgery and the perfect fit of the prosthesis were found very valuable. Therefore, accommodating with the continuous technological updates, the integration of computer programs in surgery planning and plate designing and manufacturing in subcondylar fractures is highly desirable due to its great benefits. | ||||
| Keywords | ||||
| Subcondylar fracture; Computer-manufactured plate; auto-reducible | ||||
|
Statistics Article View: 102 PDF Download: 240 |
||||
