Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Biomechanical Evaluation of Locking Reconstruction Plates Fixed with Three Versus Four Screws Perside for Lateral Segmental Defects of Mandible with A Servohydraulic Testing Method: An In Vitro Study Mandibular Lateral
Segmental Defektin Her İki Tarafına Üçer veya Dörder Vida ile Sabitlenen Kilitli Rekonstrüksiyon Plaklarının Servohidrolik Test Metodu ile Biyomekanik Değerlendirmesi: In Vitro Çalışma
Esin DEMİRa
aDepartment of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2022;28(1):1-6
doi: 10.5336/dentalsci.2021-83293
Article Language: EN
Full Text
ABSTRACT
 Objective: Surgical treatments of neoplasias may result in segmental loss of mandible with limited remaining bone stumps. Locking recontruction plates are being used to bridge mandibular discontinuities caused by resections. The aim of this study is to evaluate biomechanical resistance of mostly recommended numbers of screws when locking systems were used for lateral segmental defects. Material and Methods: This in vitro study was conducted on polyurethane mandibles with simulated lateral segmental defects extending to angulus. 13 synthetic polyurethane mandibles were used in this study. Mandibles were fixed with four screws and three screws on each segment in Group I and II, respectively. Mean yield displacement, yield load, loading values at 1, 3, 5 mm diplacement and displacement at 80 N, 100 N, 200 N, 300 N loading were compared among the 2 groups. Results: Group I withstood significantly greater average force before failure than that of Group II (p=0,000). There was no statistically significant difference in displacement at failure between groups. There was no statistically significant difference in loading at 1 mm displacement between 2 groups. Conclusion: Fixation with 3 screws on each side of such lateral segmental defects does not provide sufficient stability. Therefore minimum 4 screws should be adopted.

Keywords: Mandibular reconstruction; mouth neoplasms; jaw neoplasms
ÖZET
 Amaç: Neoplazilerin cerrahi tedavisi, çene kemiğinde geniş segmental kayıplara neden olup, kalan çene kemiği miktarını kısıtlamaktadır. Mandibula rezeksiyonu sonucunda meydana gelen devamlılık defektlerinin köprülenmesinde, kilitli rekonstrüksiyon plakları kullanılmaktadır. Bu çalışmanın amacı, lateral segmental defektlerin rekonstrüksiyonunda kilitli plaklar kullanıldığında sıklıkla önerilen vida sayılarının biyomekanik dayanımının değerlendirilmesidir. Gereç ve Yöntemler: Bu in vitro çalışma, angulusa uzanan lateral segmental defektlerin simule edildiği poliüretan mandibulalar üzerinde yürütülmüştür. Bu çalışmada, 13 poliüretan mandibula model kullanılmıştır. Grup I ve Grup II'deki modellerde mandibula segmentleri sırasıyla her segmente dörder vida ve üçer vida ile fikse edilmiştir. İki grubun maksimum yer değişikliği, maksimum kuvvet, 1, 3, 5 mm displasmana neden olan kuvvetler ve 80, 100, 200, 300 N kuvvet altında displasman değerleri karşılaştırılmıştır. Bulgular: Grup I'de başarısızlığa neden olan kuvvet ortalaması, Grup II'ye göre anlamlı olarak daha fazladır. İki grup arasında, maksimum yer değişikliği miktarları açısından anlamlı bir fark bulunmamıştır. İki grup arasında 1 mm deplasmana neden olan kuvvet miktarları da anlamlı bir fark göstermemiştir. Sonuç: Bu çalışmadaki gibi lateral segmental defektlerde, defektin 2 yanına üçer vida yeterli stabiliteyi sağlayamamıştır. Bu nedenle minimum dörder vida uygulanması benimsenmelidir.

Anahtar Kelimeler: Mandibular rekonstrüksiyon; ağız neoplazileri; çene neoplazmaları
REFERENCES:
  1. Isler SC, Keskin Yalcin B, Cakarer S, Cansiz E, Gumusdal A, Keskin C. The use of reconstruction plates to treat benign mandibular pathological lesions: A retrospective clinical study. J Stomatol Oral Maxillofac Surg. 2018;119(5):379-83. [Crossref]  [PubMed] 
  2. Pereira-Filho VA, da Silva BN, Nunes Reis JM, Spin-Neto R, Real Gabrielli MF, Monnazzi MS. Effect of the number of screws on the stability of locking mandibular reconstruction plates. Int J Oral Maxillofac Surg. 2013;42(6):732-5. [Crossref]  [PubMed] 
  3. Schupp W, Arzdorf M, Linke B, Gutwald R. Biomechanical testing of different osteosynthesis systems for segmental resection of the mandible. J Oral Maxillofac Surg. 2007;65(5): 924-30. [Crossref]  [PubMed] 
  4. Haug RH. Effect of screw number on reconstruction plating. Oral Surg Oral Med Oral Pathol. 1993;75(6):664-8. [Crossref]  [PubMed] 
  5. Haug RH. The effects of screw number and length on two methods of tension band plating. J Oral Maxillofac Surg. 1993;51(2):159-62. [Crossref]  [PubMed] 
  6. Gutwald R, Jaeger R, Lambers FM. Customized mandibular reconstruction plates improve mechanical performance in a man dibular reconstruction model. Comput Methods Biomech Biomed Engin. 2017;20(4): 426-35. [Crossref]  [PubMed]  [PMC] 
  7. Armstrong JE, Lapointe HJ, Hogg NJ, Kwok AD. Preliminary investigation of the biomechanics of internal fixation of sagittal split osteotomies with miniplates using a newly designed in vitro testing model. J Oral Maxillofac Surg. 2001;59(2):191-5. [Crossref]  [PubMed] 
  8. Sugiura T, Yamamoto K, Murakami K, Kawakami M, Kang YB, Tsutsumi S, et al. Biomechanical analysis of miniplate osteosynthesis for fractures of the atrophic mandible. J Oral Maxillofac Surg. 2009;67(11):2397-403. [Crossref]  [PubMed] 
  9. Atilgan S, Erol B, Yardimeden A, Yaman F, Ucan MC, Gunes N, et al. A three dimensional analysis of reconstruction plates used in different mandibular defects. Biotechnology & Biotechnological Equipment. 2010;24(2):1893-6. [Crossref] 
  10. Haug RH, Street CC, Goltz M. Does plate adaptation affect stability? A biomechanical comparison of locking and nonlocking plates. J Oral Maxillofac Surg. 2002;60(11):1319-26. [Crossref]  [PubMed] 
  11. Bujtár P, Simonovics J, Váradi K, Sándor GK, Avery CM. The biomechanical aspects of reconstruction for segmental defects of the mandible: a finite element study to assess the optimisation of plate and screw factors. J Craniomaxillofac Surg. 2014;42(6):855-62. [Crossref]  [PubMed] 
  12. Glória JCR, Fernandes IA, Silveira EMD, Souza GM, Rocha RL, Galvão EL, et al. Comparison of bite force with locking plates versus non-locking plates in the treatment of man dibular fractures: a meta-analysis. Int Arch Otorhinolaryngol. 2018;22(2):181-9. [Crossref]  [PubMed]  [PMC] 
  13. Arden RL, Rachel JD, Marks SC, Dang K. Volume-length impact of lateral jaw resections on complication rates. Arch Otolaryngol Head Neck Surg. 1999;125(1):68-72. [Crossref]  [PubMed] 
  14. Yi Z, Jian-Guo Z, Guang-Yan Y, Ling L, Fu-Yun Z, Guo-Cheng Z. Reconstruction plates to bridge mandibular defects: a clinical and experimental investigation in biomechanical aspects. Int J Oral Maxillofac Surg. 1999;28(6): 445-50. [Crossref]  [PubMed] 
  15. Bredbenner TL, Haug RH. Substitutes for human cadaveric bone in maxillofacial rigid fixation research. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(5):574-80. [Crossref]  [PubMed] 
  16. Ellis E 3rd, Miles BA. Fractures of the mandible: a technical perspective. Plast Reconstr Surg. 2007;120(7 Suppl 2):76S-89S. [Crossref]  [PubMed] 
  17. Narra N, Valá?ek J, Hannula M, Marcián P, Sándor GK, Hyttinen J, et al. Finite element analysis of customized reconstruction plates for mandibular continuity defect therapy. J Biomech. 2014;47(1):264-8. [Crossref]  [PubMed] 
  18. Demir E, Yalçın G, Kalaycı A, Sağlam H. Biomechanical evaluation of caudally and buccally screwed customized reconstruction plates for lateral segmental defects of man dible. Br J Oral Maxillofac Surg. 2020. [Crossref]  [PubMed] 

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