Three-dimensional fixation of fractures of the mandibular condyle with a resorbable three-dimensional osteosynthesis mesh

We describe the use of a resorbable mesh fixed by ultrasound-activated pins, and report the satisfactory outcome in the first 5 patients treated

Analysis of Complications after Reconstruction of Bone Defects Involving Complete Mandibular Resection Using Finite Element Modelling

Background: In a retrospective study, risk factors for complications after the bridging of mandibular defects using reconstruction plates were reviewed. Especially the loosening of the plate-screw-mandible complex should be analyzed with a finite element model in order to reduce plate complications in future. Patients and Methods: We examined 60 patients who underwent a treatment with reconstruction plates after tumor resection during a period of 10 years. The problem of screw loosening was additionally reviewed by means of a finite element study, and a model for the loosening process was developed. Results: Our postoperative examination showed that 26 patients suffered from complications that required an early removal of the plate. These complications were oral or extraoral plate exposures, the looseness of screws with or without plate displacement, and plate fractures. Thereby, we noticed that maxillary and mandibular areas of opposing teeth, the size of the mandible defect, and the crossing of the orofacial midline are all risk factors for plate complications. On the basis of the finite element model, a modified arrangement of the screws was derived. Hence, a new type of resection plate was established. Conclusions: By repositioning the screw holes along the long axis of the plate, the transition from tensile force to torque force of the screws in the screw-plate-bone complex can be minimized. Thereby, the complication of screw loosening will be considerably reduced.Hintergrund: In einer retrospektiven Studie wurden Risikofaktoren für Komplikationen nach Überbrückung von Unterkieferdefekten mit Rekonstruktionsplatten geprüft. Insbesondere die Lockerungsvorgänge des Schrauben- Platten-Unterkiefer-Verbundes sollten mit einer Finite- Elemente-Modellierung analysiert werden, um in Zukunft eine Reduzierung der Plattenkomplikationen erreichen zu können. Patienten und Methoden: Es wurden 60 Patienten untersucht, welche im Zeitraum von 10 Jahren im Rahmen von Tumoroperationen mit Rekonstruktionsplatten versorgt wurden. Das Problem der Lockerung der Plattenschrauben wurde zusätzlich mittels einer Finite-Elemente-Studie überprüft und ein Modell für den Lockerungsvorgang erarbeitet. Ergebnisse: Die Nachuntersuchungen ergaben, dass bei 26 Patienten die Platte wegen Komplikationen vorzeitig entfernt werden musste. Die Komplikationen traten als orale und extraorale Plattenfreilage, als Schraubenlockerung ohne oder mit Plattendislokationen und als Plattenbrüche auf. Dabei konnte festgestellt werden, dass bestehende Stützzonen des körpereigenen Restgebisses, die Größe des Unterkieferdefektes und dessen Mittellinienüberschreitung Risikofaktoren für Plattenkomplikationen darstellen. Anhand der Finite-Elemente-Modellierung wurde eine veränderte Schraubenanordnung abgeleitet. Daraus resultiert eine neue Form der Resektionsplatte. Schlussfolgerungen: Durch die Verschiebung der Schraubenlöcher aus der Längsachse der Platte kann der Übergang von der Zugbelastung zur Drehmomentbelastung der Schrauben im Schrauben-Platten-Knochen-Verbund der Platte minimiert werden. Dadurch werden Schraubenlockerungen als Komplikationen wesentlich seltener auftreten.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Comparison of bone-implant contact and bone-implant volume between 2D-histological sections and 3D-SRµCT slices

Histological imaging is still considered the gold standard for analysing bone formation around metallic implants. Generally, a limited number of histological sections per sample are used for the approximation of mean values of peri-implant bone formation. In this study we compared statistically the results of bone-implant contact (BIC) and bone-implant volume (BIV) obtained by histological sections, with those obtained by X-ray absorption images from synchrotron radiation micro-computed tomography (SRµCT) using osseointegrated screw-shaped implants from a mini-pig study. Comparing the BIC results of 3-4 histological sections per implant sample with the appropriate 3-4 SRµCT slices showed a non-significant difference of 1.9 % (p = 0.703). The contact area assessed by the whole 3D information from the SRµCT measurement in comparison to the histomorphometric results showed a non-significant difference in BIC of 4.9 % (p = 0.171). The amount of the bone-implant volume in the histological sections and the appropriate SRµCT slices showed a non-significant difference by only 1.4 % (p = 0.736) and also remains non-significant with 2.6 % (p = 0.323) using the volumetric SRµCT information. We conclude that for a clinical evaluation of implant osseointegration with histological imaging at least 3-4 sections per sample are sufficient to represent the BIC or BIV for a sample. Due to the fact that in this study we have found a significant intra-sample variation in BIC of up to ± 35 % the selection of only one or two histological sections per sample may strongly influence the determined BIC

Biomechanical evaluation of a titanium implant surface conditioned by a hydroxide ion solution

Two groups of titanium dental implants, identical in geometry but different in the treatment of their surfaces, were tested in an in vivo minipig model of the mandible. The surfaces that were tested were, first, sandblasted and acid-etched; and secondly, sandblasted, acid-etched, and conditioned. The removal torque was assessed at 2, 4, and 8 weeks after implantation (n=6 animals in each healing period). The interfacial stiffness was also evaluated. All dental implants were well-integrated at the time of death. Removal torque values increased significantly over the course of 8 weeks. Removal torque and interfacial stiffness were increased for conditioned surfaces after 2 weeks, but there were no significant differences between the two surfaces. The sandblasted and acid-etched implants are the standard, and conditioning of the surface showed a tendency to increase early peri-implant formation of bone

Treatment of fractures of the condylar head with resorbable pins or titanium screws: an experimental study

We aimed to compare in vivo the stability of fixation of condylar fractures in sheep using sonic bone welding and standard titanium screws. We assessed stability of the osteosynthesis and maintenance of the height of the mandibular ramus. Height decreased slightly in both groups compared with the opposite side. The volume of the condyle increased considerably in both groups mainly because callus had formed. The results showed no significant disadvantages for pin fixation compared with osteosynthesis using titanium screws

Site-Specific Variations in Bone Mineral Density under Systemic Conditions Inducing Osteoporosis in Minipigs

Osteoporosis is a systemic bone disease with an increasing prevalence in the elderly population. There is conflicting opinion about whether osteoporosis affects the alveolar bone of the jaws and whether it poses a risk to the osseointegration of dental implants. The aim of the present study was to evaluate the effects of systemic glucocorticoid administration on the jaw bone density of minipigs. Thirty-seven adult female minipigs were randomly divided into two groups. Quantitative computed tomography (QCT) was used to assess bone mineral density BMD of the lumbar spine as well as the mandible and maxilla, and blood was drawn. One group of minipigs initially received 1.0 mg prednisolone per kg body weight daily for 2 months. The dose was tapered to 0.5 mg per kg body weight per day thereafter. The animals in the other group served as controls and received placebo. QCT and blood analysis were repeated after 6 and 9 months. BMD was compared between the two groups by measuring Hounsfield units, and serum levels of several bone metabolic markers were also assessed. A decrease in BMD was observed in the jaws from baseline to 9 months. This was more pronounced in the prednisolone group. Statistically significant differences were reached for the mandible (p < 0.001) and the maxilla (p < 0.001). The administration of glucocorticoids reduced the BMD in the jaws of minipigs. The described model shows promise in the evaluation of osseointegration of dental implants in bone that is compromised by osteoporosis

Ultrasound-aided resorbable osteosynthesis of fractures of the mandibular condylar base: an experimental study in sheep

We evaluated the osteosynthesis of condylar fractures using resorbable mini plates and ultrasound-aided insertion of pins clinically and histologically. Stability was greater than that with resorbable screws because of the fusion of pin and plate. Long term evaluation showed complete resorption of the polymeric osteosynthesis material

Fractures of the mandibular condyle:A comparison of patients, fractures and treatment characteristics between Groningen (The Netherlands) and Dresden (Germany)

Purpose: To explore differences in patient, fracture, accident and treatment characteristics between patients treated for a mandibular condyle fracture in the University Centres of Dresden and Groningen, as an explanation for differences treatment results. Materials and methods: Patients' fracture, accident and treatment characteristics were obtained from the medical records of Dresden and Groningen from January 1, 2008, to August 31, 2011, and were analysed using logistic regression analysis. Results: In Dresden, compared to Groningen, patients were generally older (OR 1.03, 95% CI 1.02; 1.05, per year), were more often male (OR 2.54, 95% CI 1.48; 4.34) and more often had intracapsular (OR 2.95, 95% CI 1.67; 5.22) and low condylar (OR 1.86, 95% CI 1.14; 3.04) fractures. In Groningen 98% of patients received closed treatment and in Dresden 42%. Conclusion: Significant differences in patients and fractures and treatments were found between both Centres. These differences can partly be explained by the demographics of the cities and differences in imaging techniques (e.g., computed tomography, Orthopantomogram, Towne projection) applied to identify fractures. This study illustrates that differences in diagnosis, treatment and outcome are not only related to the health care system but also to differences in patient characteristics between centres. (C) 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved