3D Titanium Plates for Mandibular Parasymphyseal Fracture Fixation

The face is the window through which we perceive the world around us, and the world noted us. It serves a crucial role in human interaction and injuries to it result in devastating emotional sequelae. The human face constitutes the first contact point in several human interactions, thus injuries and/or mutilation of the facial structures may have a disastrous influence on the affected person.

The facial area is one of the most frequently injured parts of the body, and the mandible is one of the most commonly fractured maxillofacial bones. For the past decades, there has been a significant increase in maxillofacial traumas involving mandible. They are mainly caused by vehicular accidents, sport activities, penetrating injuries, physical assault, work-related accident, metabolic diseases or tumors.

The position, prominence, anatomic configuration, mobility and less bone support of the mandible make it one of the most frequent facial bones to be fractured. The mandibular fracture accounts for 36% to 54% of all fractures in the maxillofacial region. Mandible is the 10th most fractured bone in the whole body. They may occur alone or in combination with other facial bone fractures.

It plays a major role in mastication, speech, and deglutition. Its fractures result in severe loss of function and disfigurement. Fractures through the mandible at the level of the Symphysis and or parasymphysis are relatively common and account for approximately 20% of mandibular fractures. These fractures are often associated with a second fracture of the mandible, especially in the subcondylar region.

Fractures of the symphyseal region are often associated with the clinical findings of a widened intragonial distance with resultant malocclusion. Fractures of the anterior mandible lack two of the stabilizing factors provided to fractures of the posterior tooth-bearing mandible: the splinting effects of the masseter and internal pterygoid muscles, which form a natural sling, and the interlocking cusps and fossae of bicuspid and molar teeth.

Internal fixation in long bones has been adapted with particular modifications for the mandible. The disadvantage with these rigid plates was movement of the fracture fragment while tightening the screws resulting in malocclusion. Also, these plates could only be minimally adapted to the fracture fragments and produced more tension on the bone resulting in loosening of screws. They also require an extraoral approach and are highly technique sensitive.

The introduction of the 3-dimension (3D) system for the treatment of mandibular fractures has offered certain advantages over other plating systems. These plates function as internal fixator, achieving stability by 3D plates. A unique advantage of 3D system is that there is no need to adapt plate over the underlying bone, making plate adaptation easier.

Theoretical advantages proposed include close approximation, greater stability across the fracture site, less precision required in plate adaptation because of the internal/external fixator, less alteration in osseous or occlusal relationship upon screw tightening and, and less time required.

Although several materials can be used for manufacture of small plates, generally titanium is used because of its excellent biocompatibility, resistance to corrosion and pliability. Champy's miniplates require intra oral approach, less technique sensitive and produce consistently good results with regard to occlusion and also avoid the need for intermaxillary fixation