“A comparative evaluation between single noncompression titanium miniplate and three dimensional titanium miniplate in treatment of mandibular angle fracture” e A randomized prospective study Vineeth K. a, * , R.M. Lalitha a , Kavitha Prasad a , K. Ranganath a , V. Shwetha b , Jasmeet Singh c a Department of Oral and Maxillofacial Surgery, M.S. Ramaiah Dental College and Hospital, Bangalore 54, Karnataka State, India b Department of Oral Medicine and Radiology, M.S. Ramaiah Dental College and Hospital, Bangalore 54, Karnataka State, India c Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India article info Article history: Paper received 2 August 2010 Accepted 31 May 2012 Keywords: Mandibular angle fracture 3-D plate Strut plate Rigid fixation Stability abstract Purpose: The aim of this study was to compare efficacy between the single non-compression titanium miniplate and single three-dimensional titanium miniplate in mandibular angle fracture treatment. Method and materials: A prospective study of 20 patients with mandibular angle fractures. Patients were randomly categorized into two groups with 10 patients in each group. Group-I patients were treated with single 2.0 mm conventional titanium miniplate, Group-II patients were treated with single 2.0 mm three- dimensional titanium miniplate according to Champy’s principles. Parameters such as stability of fracture fragments, occlusion, mouth opening, additional fixation required and complications were evaluated at different time intervals. Results: In Group-I, about 40% (n ¼ 4) of patients showed unstable fracture fragments on immediate postoperative day whereas in Group-II only 10% (n ¼ 1) of patients with fracture instability. In Group-I, 30% (n ¼ 3) had mild occlusal derangement and 20% (n ¼ 2) had deranged occlusion on immediate postoperative day, where as in Group-II only 20% (n ¼ 2) of patients had mild occlusal derangement. Additional fixation required in 30% (n ¼ 3) of patients in group-I, and 10% (n ¼ 1) in Group-II. 20% (n ¼ 2) of patients in Group-I developed infection. All patients in both the groups had inadequate mouth opening on immediate post operative day, later resumed normal mouth opening. 10% (n ¼ 1) in group-I and 20% (n ¼ 2) of patients in group-II presented with postinjury/preoperative inferior alveolar nerve sensory disturbance with no incidence of postoperative sensory disturbance. None of the patients in both the groups had malunion, nonunion, plate fracture, and loosening of plates and screws. Conclusion: 3-D titanium miniplates showed more favorable results compared to single conventional titanium miniplate with respect to initial interfragmentary stability and complications. Ó 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. 1. Introduction Treatment of mandibular angle fracture requires a thorough understanding of the surgical anatomy, muscle insertion, associ- ated biomechanical forces at the angle, their action, the importance of occlusion and the presence of a third molar in the line of fracture. The ideal method of treatment of mandibular fracture should have the objectives of perfect anatomical reduction, stable fixation and painless mobilization of the injured region around its articulation (Gear et al., 2005). Current practice uses a variety of combinations of transorally placed small plates secured with monocortical screws for fixation of angle fractures (Alkan et al., 2007). A decade ago, two point fixations with miniplates and mono- cortical screws for angle fractures was popular, but was found to have a much higher complication rate when compared with one point fixation. Hence, the single miniplate has become the stan- dard technique for angle fractures in many units (Siddiqui et al., 2007). Questions concerning the stability provided by miniplate fixa- tion of mandibular angle fractures have become a point of contention among surgeons. This is based on recent clinical and experimental studies wherein some authors have attributed infe- rior border distraction to application of loading forces close to the fracture line (Siddiqui et al., 2007; Schierle et al., 1997). * Corresponding author. Tel.: þ91 9620100084. E-mail address: drvineethk@gmail.com (Vineeth K.). Contents lists available at SciVerse ScienceDirect Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com 1010-5182/$ e see front matter Ó 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jcms.2012.05.015 Journal of Cranio-Maxillo-Facial Surgery 41 (2013) 103e109