Research Article| Volume 58, ISSUE 6, P652-658, July 2020

Study of fixation of a mandibular plate for favourable fractures of the mandibular angle: numerical predictions


      Fractures of the mandibular angle have been well-described and, in most societies, their incidence is decreasing. In this study we analysed the stabilisation of fractures using a single plate (standard or optimised model). The finite element model was developed based on a mandibular computed tomographic scan, together with a miniplate from DePuy Synthes and an optimised plate. Using the finite element model we looked in turn at the four screws for fixation of the standard plate, and the six screws for the optimised plate, in a complete and an incomplete favourable fracture of the mandibular angle, using two screw diameters, 1.5 and 2 mm.
      The results indicated that a complete fracture is critical, with 10% more strain at the bone holes. The maximum microstrain was found for the 1.5mm diameter, in screws number 2 and 4, with 7270με and 6872με in the complete fractures, respectively. There were similar microstrains in screws number 1 and 2 of the optimised plate with six screws showing similar strains. Micromovements in the fracture line achieved 60με. The position of the screws influences the microstrains along the fracture line, suggesting that the surgeon places the screws along that line at a distance of 2.5 times the diameter of the screw. The optimised geometry with more screws does not prevent screws from loosening.


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        • Sakr K.
        • Farag I.A.
        • Zeitoun I.M.
        Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt.
        Br J Oral Maxillofac Surg. 2006; 44: 107-111
        • Batbayar E.O.
        • Dijkstra P.U.
        • Bos R.M.
        • et al.
        Complications of locking and non-locking plate systems in mandibular fractures.
        Int J Oral Maxillofac Surg. 2019; 48: 1213-1226
        • Michelet F.X.
        • Deymes J.
        • Dessus B.
        Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery.
        J Maxillofac Surg. 1973; 1: 79-84
        • Bouguila J.
        • Zairi I.
        • Khonsari R.H.
        • et al.
        Mandibular fracture: a 10-year review of 685 cases treated in Charles-Nicolle Hospital (Tunis-Tunisia).
        Rev Stomatol Chir Maxillofac. 2009; 110 (paper in French): 81-85
        • Yoon W.-J.
        • Kim S.G.
        • Oh J.S.
        • et al.
        A clinical study of mandibular angle fracture.
        Maxillofac Plast Reconstr Surg. 2014; 36: 201-206
        • Ayali A.
        • Erkmen E.
        Biomechanical evaluation of different plating methods used in mandibular angle fractures with 3-dimensional finite element analysis: favorable fractures.
        J Oral Maxillofac Surg. 2017; 75: 1464-1474
        • Gonzales D.M.
        • Spagnol G.
        • Sverzut C.E.
        • et al.
        In vitro evaluation of the resistance of three types of fixation to treat fractures of the mandibular angle.
        Br J Oral Maxillofac Surg. 2017; 55: 136-140
        • Kharmanda G.
        • Kharma M.Y.
        Evaluating the effect of minimizing screws on stabilization of symphysis mandibular fracture by 3D finite element analysis.
        J Maxillofac Oral Surg. 2017; 16: 205-211
        • Vajgel A.
        • Camargo I.B.
        • Willmersdorf R.B.
        • et al.
        Comparative finite element analysis of the biomechanical stability of 2.0 fixation plates in atrophic mandibular fractures.
        J Oral Maxillofac Surg. 2013; 71: 335-342
        • Chiodo T.A.
        • Ziccardi V.B.
        • Janal M.
        • et al.
        Failure strength of 2.0 locking versus 2.0 conventional synthes mandibular plates: a laboratory model.
        J Oral Maxillofac Surg. 2006; 64: 1475-1479
        • Suer B.T.
        • Kocyigit I.D.
        • Kaman S.
        • et al.
        Biomechanical evaluation of a new design titanium miniplate for the treatment of mandibular angle fractures.
        Int J Oral Maxillofac Surg. 2014; 43: 841-845
        • Wilde F.
        • Kasper R.
        • Sakkas A.
        • et al.
        Biomechanical in-vitro study concerning the stability of customized CAD/CAM mandibular reconstruction plates. Comparison of additively and subtractively manufactured as well as hand-bended plates.
        Int J Oral Maxillofac Surg. 2019; 48: 150-151
        • Chacon G.E.
        • Dillard F.
        • Clelland N.
        • et al.
        Comparison of strains produced by titanium and poly D, L-lactide acid plating systems to in vitro forces.
        J Oral Maxillofac Surg. 2005; 63: 968-972
        • Esen A.
        • Ataoǧlu H.
        • Gemi L.
        Comparison of stability of titanium and absorbable plate and screw fixation for mandibular angle fractures.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: 806-811
        • Turgut G.
        • Kayali M.U.
        • Soydan A.T.
        • et al.
        Biomechanical comparison of a new technique of mandibular angle fractures: biplanar and bicortical superior proximal 3 holes and bicortical inferior plate fixation.
        J Craniofac Surg. 2008; 19: 428-432
        • Ramos A.
        • Duarte R.J.
        • Mesnard M.
        Strain induced in the condyle by self-tapping screws in the Biomet alloplastic temporomandibular joint: a preliminary experimental study.
        Int J Oral Maxillofac Surg. 2015; 44: 1376-1382
        • Huang H.M.
        • Ou K.L.
        • Wang W.N.
        • et al.
        Dynamic finite element analysis of the human maxillary incisor under impact loading in various directions.
        J Endod. 2005; 31: 723-727
        • Ramos A.
        • Nyashin Y.
        • Mesnard M.
        Influences of geometrical and mechanical properties of bone tissues in mandible behaviour–experimental and numerical predictions.
        Comput Methods Biomech Biomed Engin. 2017; 20: 1004-1014
        • Kim D.Y.
        • Sung I.Y.
        • Cho Y.C.
        • et al.
        Bioabsorbable plates versus metal miniplate systems for use in endoscope-assisted open reduction and internal fixation of mandibular subcondylar fractures.
        J Craniomaxillofac Surg. 2018; 46: 413-417
        • An J.
        • Jia P.
        • Zhang Y.
        • et al.
        Application of biodegradable plates for treating pediatric mandibular fractures.
        J Craniomaxillofacial Surg. 2015; 43: 515-520
        • Vázquez-Morales D.E.
        • Dyalram-Silverberg D.
        • Lazow S.K.
        • et al.
        Treatment of mandible fractures using resorbable plates with a mean of 3 weeks maxillomandibular fixation: A prospective study.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115: 25-28
        • Regev E.
        • Shiff J.S.
        • Kiss A.
        • et al.
        Internal fixation of mandibular angle fractures: a meta-analysis.
        Plast Reconstr Surg. 2010; 125: 1753-1760
        • Korkmaz H.H.
        Evaluation of different miniplates in fixation of fractured human mandible with the finite element method.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: e1-e13
        • Negreiros Lyrio M.C.
        • Monnazzi M.S.
        • De Moraes M.
        • et al.
        Comparison of compressive strength between three different plates for mandibular angle fractures fixation.
        J Craniomaxillofacial Surg. 2014; 42: e277-e280
        • Siddiqui A.
        • Markose G.
        • Moos K.F.
        • et al.
        One miniplate versus two in the management of mandibular angle fractures: A prospective randomised study.
        Br J Oral Maxillofac Surg. 2007; 45: 223-225
        • Al-Moraissi E.A.
        One miniplate compared with two in the fixation of isolated fractures of the mandibular angle.
        Br J Oral Maxillofac Surg. 2015; 53: 690-698
        • Yazdani J.
        • Taheri Talesh K.
        • Kalantar Motamedi M.H.
        • et al.
        Mandibular angle fractures: Comparison of one miniplate vs. two miniplates.
        Trauma Mon. 2013; 18: 17-20
        • Pereira Filho V.A.
        • Iamashita H.Y.
        • Monnazzi M.S.
        • et al.
        In vitro biomechanical evaluation of sagittal split osteotomy fixation with a specifically designed miniplate.
        Int J Oral Maxillofac Surg. 2013; 42: 316-320