Abdominal Dermal Fat Graft Versus Nasolabial Flap in Oral Submucous Fibrosis: A Randomized Clinical Trial.

Introduction: A prospective study was conducted to find out an effective alternative in the form of non-vascularized abdominal dermal fat graft (ADFG) and to compare its efficacy with the vascularised nasolabial flap (NLF) for the treatment of oral submucous fibrosis (OSMF). Method: Comparative study comprising of 30 patients with Grade 3 and 4A OSMF, randomly divided into 2 groups: Group A (ADFG) and Group B (NLF). They were evaluated for mouth opening (MO), graft uptake, time taken for mucosalization, pain, intercommissure distance (ICD), scar, duration of surgery (DOS), patient satisfaction and thickness of masseter muscle on ultrasonography. Findings: At 6 months, MO improved by 22.4 and 36.2 mm in Group A and Group B, respectively. There was statistically significant difference (p < 0.05) seen for the values between the groups for all the parameters except for ICD and VAS score, which was statistically insignificant (p > 0.05). Intraoral hair growth, facial scar, orocutaneous fistula and commissure tear was seen in Group B. Complete necrosis of graft followed by recurrence was seen in three cases in Group A. Conclusion: NLF holds better as compared to ADFG in the management of OSMF. However, the cornerstone of success remains habit cessation and aggressive physiotherapy. The limitations of the study are small sample size and short duration of follow-up.

Comparison of three different approaches in treatment of mandibular condylar fractures - Our experience.

Background: The principal transfacial routes described to approach condylar process fractures are preauricular, retromandibular, high submandibular, and their various modifications. The selection of a specific surgical approach mainly depends on the level of condylar fracture, displacement/dislocation of the proximal segment and time elapsed from the date of trauma. Not too many studies proclaim a unanimous consensus on "gold standard" approaches for particular levels of fracture. Aim: This study was conducted with the aim to lay down guidelines for determining the ideal surgical approach for treating different condylar fractures based on different clinical situations. Methodology: This prospective study was conducted on 60 patients that underwent open reduction internal fixation of condylar fractures according to preset study design. Inclusion criteria were fracture displacement more than 10 degrees, dislocation, shortening of ramal height more than 2 mm. Patients having maxillofacial fractures other than mandible and condylar fractures in edentulous patients were excluded from this study. Results: The risk of facial nerve injury was more in endaural group and parotid fistula was more evident in retromandibular subparotid group but there was no statistical difference between the groups. The surgical scar was inconspicuous in all three groups. Excellent results were achieved in the other parameters such as mouth opening, range of motion, bite force, and occlusion with all the three approaches. Postoperative CT scan showed satisfactory anatomical reduction. Conclusion: This study concludes that the decision-making on the approach to be selected for any particular condylar fracture depends on the level of fracture, presence of fracture dislocation, and time elapsed from the date of trauma.

Simultaneous TMJ Ankylosis Release with Uniplanar Mandibular Distraction Osteogenesis for Correction of Facial Deformity and Obstructive Sleep Apnoea in Growing Patients: A Pilot Study.

Aim: To evaluate the efficacy of simultaneous TMJ ankylosis (TMJA) release with uniplanar mandibular distraction in the management of facial deformity, improvement in function and obstructive sleep apnoea in growing patients. Material and Methods: Ten patients in the age group of 5-15 years with unilateral/bilateral TMJA and mild to moderate OSA and short body length but ramus height within normal limits were treated with simultaneous ankylosis release and uniplanar mandibular distraction osteogenesis. Clinical, radiographic, and OSA parameters were evaluated and followed up for 1 year. Results: Average mandibular body length increased by 16.6 mm, mouth opening by 26.9 mm, SNB angle by 9.53°, pharyngeal airway space by 6.29 mm, chin discrepancy corrected by 5.05 mm, apnoea-Hypopnoea index decreased by 15.9, N┴Pog by 12.27 mm, oxygen saturation (Spo2) by 4.1%, and oxygen desaturation index by 17.89%. All clinical, radiographic, and OSA parameters improved and were statistically significant except for mandibular plane angle and with minimal complications. Conclusion: Simultaneous TMJA release with uniplanar mandibular Distraction osteogenesis may be recommended as the treatment of choice in growing patients with mild to moderate OSA and facial deformity, as it causes simultaneous correction of micrognathia, facial asymmetry, OSA and prevents the need for an additional surgery.

Arthrocentesis Versus Level 1 Arthroscopy in Internal Derangement of Temporomandibular Joint.

Introduction: Internal derangement of the temporomandibular joint is defined as an abnormal position of the articular disc in relation with mandibular condyle and articular eminence presenting as disc displacement with or without reduction. Methodology: This study was conducted on thirty patients diagnosed with Internal derangement of TMJ consisting of 8 males and 22 females averaging 34.6 years. Two groups Conventional Arthrocentesis (Group A) and Level 1 Arthroscopy (Group B) consisted of 15 cases each divided alternately. Clinical evaluation parameters included VAS for pain, maximal interincisal opening, deviation on mouth opening, range of motion including lateral excursion & protrusion movements recorded at 1 week, 1 month & 6 months postoperatively. Wilke's Staging according to MRI findings was recorded preoperatively and 6 months postoperatively. Results: At 6 month follow-up, average reduction in VAS for pain & deviation on mouth opening was 72.43% & 24.73% in Group A and 77.66% & 65.41% in Group B, respectively. Average increase in MIO, right & left excursion & protrusion movements was 29.55%, 31.33%, 20.12% & 32.45% in Group A and 34.94%, 41.37%, 39.29% and 36.51% in Group B, respectively. Improved results were obtained clinically for all Wilke's stages in both groups with more number of patients improving in Group B. Conclusion: On comparing results, improvement was observed in various clinical evaluation parameters of both the groups at 6 months follow-up. However, statistically significant & better results were obtained for the Arthroscopy group.

Versatility of Basal Cortical Screw Implants with Immediate Functional Loading.

Background: The purpose of this study is to evaluate the survival rate of the basal cortical screw (BCS) implant system inserted in healed edentulous ridges (E) or extraction sockets (ES) with immediate loading functional protocol in varying clinical situations. Methods: A total of 125 BCS implants were placed in 14 patients, immediately loaded and observed for 20.07(± 4.23) months. Ninety-four were placed in E sites and 31 were placed in ES sites. They were evaluated for bone loss, soft tissue shrinkage around the prosthesis, improvement in quality of life (QOL), and their survival after 1 year. Results: Total of 121/125(96.8%) implants survived while 4/125(3.2%) failed at the end of follow-up. Average bone loss after 1 year was 0.33 mm (E) and - 1.57 mm (ES), average soft tissue shrinkage was 0.50 mm (E) and 1.42 mm (ES) and average Patient's Global Impression of Change (PGIC) scale score was 6.36(± 0.63) at 1 year. The complications observed were mobility {3(2.4%)}, pain/discomfort {1(0.8%)} and fracture of abutment at the neck {1(0.8%)}, prosthesis loosening {2(9%)} and requirement of relining {3(13%)}. No periimplantitis was observed. Conclusion: This is the only study to report the marginal bone loss and soft tissue changes around BCS implants and an index-based improvement in QOL of such patients. The BCS implant system with immediate functional loading protocol is a versatile modality to rehabilitate a single tooth, a segment or a full arch with healed ridges as well as extraction sites; it gives high success rate and minimal complications.

Bilateral Biplanar Distraction Osteogenesis in Facial Deformity Secondary to Temporomandibular Ankylosis.

Background: The purpose of this single-centre prospective clinical study was to evaluate the correction of severe facial deformity and Obstructive sleep apnoea hypopnoea syndrome (OSAHS) in 22 patients aged from 9 to 42 years (mean 20.09) of bilateral Temporomandibular joint ankylosis. Materials and Methodology: Patients underwent multisegment distraction using external bilateral bidirectional distractors. Facial deformity was evaluated clinically in terms of mouth opening and neck chin angle and cephalometrically in terms of corpus length (gonion-pogonion), ramal height (articulare-gonion), chin deficiency (N perpendicular to Pog and SNB). OSAHS was evaluated through Epworth sleepiness scale, Berlin's questionnaire, pharyngeal airway space, apnoeic hypoapnoeic index, oxygen desaturation index, average arterial oxygen saturation and minimal fall in O2 saturation. Patients were followed up for a period of 13-74 months (mean 28.68). Results: Statistically highly significant results were obtained in all parameters. Complications encountered were pin infection (13.63%), loosening of pins (4.5%), wound dehiscence (9.09%), tooth fracture (4.5%) and parotid fistula (9.09%). Intermediate segment necrosis and vector loss were not observed. Conclusion: This study is a large case series using two corticotomy cuts for external bilateral bidirectional distracters with concomitant neo callous moulding in patients both pre- and post-ankylosis release. It is extremely efficient in correcting mandibular corpal and ramal deficiency as well as improving OSAHS.

Current Treatment Strategies for the Management of the Internal Derangements of the Temporomandibular Joint: A Global Perspective.

Internal joint derangement is a disruption of the internal aspects of the TMJ-disc displacements/adhesions/impingements, causing alterations in the normal dynamic motions of the joint. Clinicians must be diligent in establishing the correct diagnosis and cause of TMJID, which ultimately leads to the appropriate management of such patients. While many patients adapt over time or with non-surgical treatment, surgery may be indicated for those with ongoing problems. The surgical pyramid provides a stepwise progression for TMJ surgical patients. This paper aims to review TMJID and its management with special emphasis on arthroscopic minimally invasive surgery, as practised in other countries around the world, and compare this to current education, understanding and practice in India. Currently, India is lagging behind in providing the full scope of TMJ services as there are very few surgeons trained in the skill of arthroscopic techniques. There needs to be continued expansion of our understanding of TMJID treatment in India to bring it level with the rest of the world.

Dredging: A conservative surgical approach for treatment of large cystic lesions of the jaws.

Background: Treatment modalities of odontogenic cystic lesions of the jaws range from conservative to radical. "Dredging" may be considered the "middle path" between conservative and radical treatment options. It comprises three entities-decompression, followed by repeated scraping of the lesion, and finally, peripheral ostectomy providing margin clearance but without significant morbidity. Aim: To evaluate the outcome of "dredging" in the management of large cystic lesions of the jaws, without major resections and maintaining normal functions. Methodology: This prospective study was conducted on 30 patients. Inclusion criteria were odontogenic cystic lesions at least 2 cm in size either in the proximity of vital structures or in children with developing tooth germs or so large that upon enucleation, can result in pathological fracture. All underwent decompression followed by dredging performed at every 2 to 3 months intervals. Results: Drastic decrease in size of the lesion as measured on Cone Beam Computed Tomography (CBCT) and new bone formation was evident in all patients. The total Reduction Rate (RR) of the cystic lesions was 88.79% in 9.2 months. RR was highest in Calcifying epithelial odontogenic cyst (CEOC) followed by Unicystic Ameloblastoma (UA), Odontogenic Keratocysts (OKC), Dentigerous cyst (DC), and Radicular Cyst (RC) in CBCT. The mean speed of shrinkage was fastest in CEOC, followed by OKC, UA, RC, and DC after dredging. Shrinkage was higher in patients below 20 years of age (P 0.012) and patients with large cystic lesions (P 0.00447). Conclusion: The results suggest that dredging with regular, long-term follow-up can be a successful treatment method for large cystic lesions in young adults. This method includes the benefits of both conservative and radical treatment methods but lacks the disadvantages of either.

Arthrocentesis Followed by Autologous Blood Injection in the Treatment of Chronic Symptomatic Subluxation of Temporomandibular Joint.

Introduction: Temporomandibular joint subluxation is defined as self-reducing partial dislocation of the TMJ during which the condyle passes anterior to the articular eminence. Material and Method: The study consisted of 30 patients, 19 females and 11 males with 14 unilateral and 16 bilateral cases of chronic symptomatic subluxation. Treatment consisted of arthrocentesis followed by 2 ml of autologous blood injection into upper joint space and 1 ml into pericapsular tissues using an autoclaved soldered double needle with single puncture technique. Parameters evaluated were pain, maximum mouth opening, excursive jaw movements, deviation on mouth opening and quality of life, hard and soft tissue changes on X-ray TMJ view and MRI. Results: At 12 month follow-up, average reduction in maximum interincisal opening, deviation on mouth opening, range of excursive movements on right and left sides and VAS scores were 20.54%, 32.84%, 29.59%, 27.37% and 74.53%, respectively. Out of 93.3% who responded to therapy, 66.7%, 20% and 6.7% responded after 1st, 2nd and 3rd AC + ABI, respectively. Remaining 6.7% patients had persistent painful subluxation and underwent open joint surgery. 93.3% patients responded to therapy, 80% were relieved of painful subluxation, 13.3% had painless subluxation and kept on follow-up. X-ray TMJ and MRI did not show any hard and soft tissue changes. Conclusion: A soldered double needle, single puncture, AC + ABI are a simple, safe, cost-effective, repeatable and minimally invasive nonsurgical therapy for treatment of CSS without any permanent radiographically evident soft or hard tissue changes.

Guidelines for Single-Stage Correction of TMJ Ankylosis, Facial Asymmetry and OSA in Adults.

INTRODUCTION: Treatment for TMJ Ankylosis aims at restoring joint function, improving the patient's aesthetic appearance and quality of life and preventing re-ankylosis. Mouth opening is achieved by gap arthroplasty with various options of interpositional materials. Ramus-condyle unit (RCU) reconstruction maintains the height of the ramus and prevents secondary occlusal problems. Advancement genioplasty corrects chin deformities as well as increases the posterior airway space (N-PAS) by the forward pull exerted on geniohyoid and genioglossus. MATERIALS AND METHODS: This prospective single-centre study on 43 joints in 25 adult patients with TMJ Ankylosis aimed at providing a single-staged management plan of ankylosis release, RCU reconstruction and extended advancement centering genioplasty. Interpositional arthroplasty was done using temporalis myofascial flap, abdominal dermis fat or buccal fat pad. RCU reconstruction was done either by vertical ramus osteotomy or L osteotomy. OBSERVATIONS AND RESULTS: Follow-up ranged from 12 to 20 months (mean 14.4). Average mouth opening at maximum follow-up was 34.36 mm with re-ankylosis in no case. Cephalometric parameters showed increase in point P to Pog, decrease in N perpendicular to Pog, angle N-A-Pog, Cg-ANS to Cg-Menton, neck-chin angle and labiomental angle. N-PAS increased, and average 50% improvement in AHI was seen in all patients with OSA. Most common complications involved transient paraesthesia of temporal and zygomatic branches of facial nerve. CONCLUSION: Based on the findings of the above study, we propose treatment guidelines for treatment of TMJ ankylosis in adult patients with AHI < 20.

Temporomandibular Joint Ankylosis Release: 17 Years of Experience with 521 Joints.

OBJECTIVE: Various surgical techniques to release temporomandibular joint (TMJ) ankylosis have been described in the literature. The purpose of this paper is to report our Institution's experience regarding the post-surgical outcome of different surgical techniques for the release of ankylosis of the TMJ. MATERIALS AND METHODS: The records from our hospital of 386 patients (521 joints) treated for TMJ ankylosis were reviewed. Data analysis included the etiology of TMJ ankylosis, gender distribution, age group, distribution of ankylosis based on location, type, interincisal opening and complications in the perioperative period. RESULTS: Out of 521 joints, 65.02% were unilateral and 73.89% had bony ankylosis. The mean maximal incisal opening preoperative was 5.4 mm (SD 3.63 mm) and at 1-year follow-up was 36.9 mm (SD 3.3 mm). There was no permanent facial nerve paralysis. However, transient facial nerve paresis was 14.78%. There was an overall recurrence rate of 8.82%. CONCLUSION: We conclude that after TMJ ankylosis release with interpositional arthroplasty, reconstruction of the RCU with L ramus osteotomy is the most favorable. This procedure not only causes least complications, but also maintains height of ramus, facilitating surgeries for secondary asymmetry correction.

Buccal Fat Pad-Derived Stem Cells for Repair of Maxillofacial Bony Defects.

AIM: The purpose of this study was to evaluate the use of buccal fat pad-derived stem cells (BFPSCs) as a source for full thickness bone defect repair secondary to pathology in maxilla or mandible. METHODS: Fat-derived stem cells were isolated from buccal fat pad, differentiated into osteocytes in osteogenic medium, and seeded onto human bone defects. Autologous buccal fat pad was harvested and BFPSCs cultured within 4-6 weeks. Bone defects secondary to enucleation of pathologic cyst or tumors were reconstructed with osteogenically differentiated fat-derived stem cells. Hematoxylin and eosin staining, immunohistochemical staining for osteocalcin, alkaline phosphatase and genotypic and phenotypic marker analysis, and histomorphometric measurements of new bone were performed. RESULTS: Maxillofacial bone defects were successfully reconstructed by BFPSCs, which after implantation at an in vivo site yielded faster osseous regeneration. BFPSCs were associated with superior bone density formation, better blending of margins with enhanced bone trabecular formation, well-organized and well-vascularized lamellar bone with Haversian channels and osteocytes resulting in superior functional and cosmetic results with better quality of life and with significant decrease in secondary complications. CONCLUSION: Buccal fat pad is an ideal tool in the hands of an oral and maxillofacial surgeon for tissue engineering and clinical use requiring bone tissue growth and repair, secondary to large osseous defects. This study demonstrates the feasibility of reconstructing bony defects with fat-derived stem cells.

Novel Use of Orbita Plates in Mandibular Body Fractures.

BACKGROUND: Isolated fractures of the mandibular body separate the dentate border and compress lower border when subjected to masticatory forces. This study aims at evaluating the efficacy of two Orbita plates in Champy's osteosynthesis lines along with achieving 3D configuration and preventing trauma to mental foramen. AIMS: (1) To achieve a near 3D configuration by fixing the terminal parts of both plates in contact with each other; (2) to preserve the mental nerve within the ellipse created by two Orbita plates; and (3) to prevent damage to the root apices from the upper plate. MATERIALS AND METHODS: This study was performed on 20 patients with mandible body fracture through the mental foramina. With the intraoral vestibular approach, two Orbita miniplates were fixed in Champy's osteosynthesis lines. A geometrically closed quadrangular relationship was achieved in the shape of an ellipse, with the mental nerve emerging from it. RESULTS: Fracture healing was optimum in all the cases along with satisfactory occlusion. Postoperative intermaxillary fixation was not required. Mental nerve function impairment was insignificant. CONCLUSION: This served to achieve satisfactory functional outcomes in patients with mandible body fracture without injury to roots and along with achieving a geometrically close quadrangular relationship even where 3D miniplates cannot be placed.

Conservative Management of Unicystic Ameloblastoma in Young Patients: A Prospective Single-Center Trial and Review of Literature.

AIMS: The study intends to evaluate the clinical outcome of treating young patients of unicystic ameloblastoma, by various conservative treatment modalities such as marsupialization, enucleation with bone curettage and aid in establishing sound treatment guidelines. MATERIALS AND METHODS: A case series of fifteen patients is presented of unicystic ameloblastoma, who presented to our Department over the past 6 years (2010-2015) and conservative method of treatment elected in all the patients. Also, a methodical literature review of studies discussing treatment of unicystic ameloblastoma in young age group (<20 years) patients over the last 15 years from 2001 to 2015 is added. RESULTS: Faster osseous regeneration after conservative treatment was noted, owing to the young age and growth potential. Over a mean follow-up of 4 years, uneventful secondary healing, no clinical or radiographic evidence of recurrence and no apparent deformity were noted in any of the cases. CONCLUSION: Unicystic ameloblastoma is a benign, locally invasive odontogenic neoplasm of young age which can develop during the stage of tooth formation and hence its early inception and vast proliferation is not uncommon in this age group, due to which it can grow into a huge lesion causing significant morbidity. Conservative surgical management may be a viable option to reduce morbidity and increase the probability of uneventful secondary healing and bone regeneration in the younger population.

Adult-onset cystic hygroma: A case report of rare entity.

Cystic hygroma is a benign congenital malformation of the lymphatic system that occurs in infant or children younger than 2 years of age. Although cystic hygroma is well recognized in pediatric practice, it seldom presents de novo in adulthood. These are commonly present in head and neck but can be present anywhere. Cystic hygroma is very rare in adults, but it should be considered in the differential diagnosis of adult neck swellings. Patients presenting with a painless, soft, fluctuant, and enlarging neck mass should have a careful history and physical examination along with radiological imaging to assist with diagnosis. Surgical intervention is the treatment of choice for this rare condition. Here, we are reporting a case of cystic hygroma in a 32-year-old male patient in the neck region. The objectives of this case report are to discuss the clinical presentation, diagnosis, histopathological findings and management of this malformation.

Unicystic plexiform ameloblastoma with mural proliferation: a full-blown lesion.

Ameloblastoma is the most common aggressive benign odontogenic tumour of the jaws and has received considerable attention due to its frequency, clinical subtypes and high tendency to infiltrate and recur. There are various types of this tumour and confusion still exists among clinicians as to its correct classification. Multicystic ameloblastoma is the most frequent subtype while unicystic ameloblastoma can be considered a variant of the solid or multicystic subtype. Unicystic ameloblastoma is considered a less aggressive tumour with a variable recurrence rate. However, its frequency is often underestimated. Ameloblastoma is often asymptomatic, presenting as a slowly enlarging facial swelling or an incidental finding on radiograph. It is seen in all age groups but is most commonly diagnosed in the third and fourth decades. We report a case of unusual unicystic ameloblastoma and present its clinical, radiological and full-blown histological changes and treatment modalities, providing new insights into ameloblastomas.

Glandular odontogenic cyst: a rare entity revealed and a review of the literature.

A glandular odontogenic cyst (GOC) is a developmental cyst that is a clinically rare and histopathologically unusual type of odontogenic cyst. GOCs are now relatively well-known entities; their importance relates to the fact that they exhibit a propensity for recurrence rates from 21% to 55%, similar to odontogenic keratocysts, and may be confused microscopically with central mucoepidermoid carcinoma. Furthermore, some microscopic features of GOCs may also be found in dentigerous, botryoid, radicular and surgical ciliated cysts. The present case report aims to describe a typical case of GOC, throwing light on its epidemiology and origin, as well as on its clinical, radiographic and microscopic features, which may be helpful for diagnosis in problematic cases, long-term follow-up and to determine the most appropriate treatment.

Gorlin-Goltz syndrome in twin brothers: an unusual occurrence with review of the literature.

Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome, is caused by genetic alteration produced by a mutation in the 'patched' tumour suppressor gene, and is inherited in a dominant autosomal way. Although sporadic cases have been found, this syndrome has rarely been reported in twin patients. The syndrome is characterised by a wide range of developmental abnormalities and has a predisposition to neoplasms such as multiple pigmented basal cell carcinomas and keratocysts in jaws; it also has other features such as palmar and/or plantar pits and calcification of falx cerebri. Owing to the critical oral and maxillofacial manifestations of this syndrome, it is important to recognise its characteristics in order to make a diagnosis, and to plot early preventive treatment and establish the right genetic evidence. Based on a combination of imaging, clinical and histopathological findings, we present a diagnosed case of Gorlin-Goltz syndrome in 18-year-old twin brothers. All cystic lesions were enucleated and 1 year follow-up showed no recurrence.

Sinus elevation with an alloplastic material and simultaneous implant placement: a 1-stage procedure in severely atrophic maxillae.

AIMS AND OBJECTIVE: The aim of the study is to evaluate clinically and radiographically the long term success of one-stage direct (lateral) sinus lift procedure using alloplastic bone graft material and bio-absorbable membrane in conjunction with two stage implant placement in atrophic partially edentulous posterior maxilla. MATERIALS AND METHODS: One stage direct maxillary sinus lift in conjunction with two stage implant placement was carried out in 12 patients at 13 sites. All the patients were partially edentulous with posterior maxillary alveolar ridge height of >5 mm and were in the age group of 20-50 years. Bioactive glass putty, bio-absorbable collagen membrane and 3.75 × 11.5 mm implants were used. Loading of implants was done 6 months after placement of implants. Patients were evaluated clinically and radio-graphically 6, 18, 30 months after placement of implants to assess increase in residual ridge height, peri-implant condition (marginal bone loss, plaque and gingival index) and implant stability. RESULTS: Maxillary first molar was the most common site (69.23 %) for sinus lift and implant placement. Caries was the most common cause (76.92 %) for loss of tooth. Increase in residual ridge height ranged from (71.43 to 133.33 %) as measured by Denta-Scan. Implant survival rate was 100 %. Marginal bone loss ranged from 0.68 to 1.22 mm. Implant stability was measured by periotest (-2.7 to -3.6). Only one patient had perforation of sinus membrane, but it was sealed satisfactorily by bio-absorbable membrane. CONCLUSION: One stage lateral sinus lift procedure with alloplastic bone graft material in combination with 2 stage implant placement has a predictable outcome in patients with severe resorption of posterior maxilla.

Conventional 2.0 mm miniplates versus 3-D plates in mandibular fractures.

AIM: To compare and evaluate the treatment outcome and postoperative complications in mandibular fractures using 2- and 3-dimensional miniplates. MATERIALS AND METHODS: This study consisted of a sample of 28 patients (40 fracture sites) divided randomly but equally (single-blind control trial study) into two groups. Each group contains 14 patients (20 similar fracture sites in each group). Group 1 was treated with open reduction and internal fixation using 3-dimensional (3-D) miniplates. Group II was treated using 2-dimensional (2-D) 2-mm miniplates. RESULTS: Out of 14 patients treated by conventional 2-mm miniplates, 2 patients developed occlusal discrepancy, another 2 had postoperative mobility at fracture site, and 1 developed plate failure and subsequent infection, which was treated by removal of the plate under antibiotic coverage. One patient treated by 3-dimensional plates had tooth damage. STATISTICAL ANALYSIS: Chi-square test. CONCLUSION: The results of this study suggested that the treatment of mandibular fractures (symphysis, parasymphysis, and angle) with 3-dimensional plates provided 3-dimensional stability and carried low morbidity and infection rates. The only probable limitations of 3-dimensional plates were excessive implant material due to the extra vertical bars incorporated for countering the torque forces.