Comparison of Titanium bone plates and screws vs. stainless steel bone plates and screws in the management of mandibular fractures – A long term clinical study
Introduction: In the past inter-maxillary fixation has been the traditional method for supporting bone ends in close apposition to allow undisturbed bone healing of the fractures of mandible. The most recent as well as versatile method of management of mandibular fractures is the miniplate fixation, which uses the principle of monocortical osteosynthesis. Several metals have been tried since 1920’s. Although gold, silver, copper and its alloys, lead and aluminium and its alloys were used and tested, stainless steel emerged through the era as the new corrosion resistant material. At about the same time or later on other metals or alloys like titanium were introduced with claims of lots of advantages over the classic stainless steel. These observations prompt a study to compare titanium bone plates and screws with stainless steel bone plates and screws used in the treatment of fractures of mandible. Objectives: The objectives of the present study was to study the versatile nature and the biocompatibility of the titanium material and to determine the usefulness of titanium mini plates over the stainless steel plates in the management of fractures of mandible. Materials and methods: The present study comprised of thirty four subjects with fractures of mandible at various anatomical sites. All patients included in this study were found to be of good health without any evidence of clinical infections. The procedure was done under general anesthesia. The fractures were exposed through appropriate incisions. Sixteen of the patients were treated with titanium bone plating system and eighteen with stainless steel plating system. The plates and screws used were of standard design, size and calibration. The patients were recalled for follow-up at 3 weeks, 3 months and 6 months and the data was recorded. Results: In a total of 34 patients the T-test revealed a significant difference in the average time taken for adaptation and plating of the 2 system of plates. The average time taken for stainless steel plate was 6.82min and for that of titanium was 3.64 min. The test for comparison of infection rate showed that 20% of the patient treated with stainless steel plates and screws had local infection while the success rate for titanium plates was 100%. 20% of cases treated with titanium system encountered the complication of shearing and fracture of the titanium screw head while fitting the screw. Wound dehiscence in case of stainless steel bone plates was noted in one out of ten patients (10%) while in the group treated with titanium plates it was 0%. Conclusion: In this study of short duration, titanium plates were found to be very ideal in the management of mandibular fractures. Titanium plates were more biocompatible when compared to stainless steel plates as evidenced by the rate of infection. In all cases the plates were found to be rigid, stable and satisfactory for use in the facial skeleton. Titanium plates being more malleable were easily adapted to the varying contours of the mandible which clinically translated into reduced time required for plating
