Evaluation of Z-shaped Bone Plates in Management of Mandibular Fractures

Introduction: Various miniplate systems have been developed in recent years including three-dimensional miniplate, microplates and bioresorbable plate, and their advantages and disadvantages have been compared and studied. To overcome the shortcomings of 3D plating system such as difficulty in adaptation and fixation in fractures involving the mental nerve, a Z plate has been designed. Aim: to evaluate Z shaped bone plates in mandibular fracture management clinically, radiographically, and histologically. Methodology: sixteen patients with mandibular fracture grouped to two groups group A managed by Z plates, group B managed by two miniplates. Patients will follow up clinically postoperative. Radiographic evaluation will be performed immediately postoperative, 1 month and 4 months Experimental study will be on dogs and histological evaluation.

• open reduction and internal fixation with bone plate (Procedure): mandibular fracture were reduced and fixed with bone plates.
• z-plates. (Procedure): mandibular fracture were reduced and fixed with z-plate miniplates.
• conventional miniplates. (Procedure): mandibular fracture were reduced and fixed with conventional two miniplates.

Primary outcomes

• Radiographic evaluation (Bone density ratio at fracture line ) measured using orthopantomograms (OPGs) by ImageJ software. [within 1week postoperative, 1month, 4month]: Radiographic evaluation using orthopantomograms (OPGs) is performed immediately postoperatively, at 1 month and 4 months. To assess bone density along the fracture line, a densitometric analysis was conducted using the ImageJ system. Digital images are analyzed using ImageJ software. The mean gray value of a region of interest (ROI) drawn along the entire length of the fracture line was calculated. This gray value represents the relative bone density within the fracture site. Range: 0.0 - 1.0 (unitless ratio). Higher values indicate greater bone density and better healing
• Postoperative pain assessed using the Visual Analog Scale (VAS) [day 1 , day 3, and 1week postoperative]: postoperative pain assessed using the Visual Analog Scale (VAS). Range: 0 (no pain) - 10 (worst imaginable pain). Higher scores indicate worse pain

Secondary outcomes

• Clinical fracture stability evaluated by manual mobility test and tenderness on palpation. [1 week postoperative,1month, 3 months, 6 months]: Outcome: Stable vs. unstable fracture (binary measure) assessed through bimanual digital manipulation i. Stable >> no movement of fragments. ii. Nonstable>> presence of movement

Sex: All, ages: 19 Years to 50 Years

Inclusion Criteria:

1. Patients who are suffering from recent, uninfected, and minimally displaced or unfavorable fractures at the symphysial or parasymphysis region of the mandible.
2. Adult patients with no gender predilection that agreed to present for follow-up visits for minimum postoperative period of immediate, month, 3 months,6 months.
3. A fracture that demands open reduction and internal fixation
4. Medically fit patients for general anesthesia

Exclusion Criteria:

1. Comminuted, infected mandibular fracture.
2. Pediatric patients below 14 years of age
3. geriatric patients with completely edentulous mouth.

• Mohamed S. Hamed, professor, Study chair, Oral and Maxillofacial Surgery, Faculty of Dentistry, Suez Canal University
• Mohamed A. Elsholkamy, professor, Study director, Oral and Maxillofacial Surgery, Faculty of Dentistry, Suez Canal University
• Amr A. Gomaa, associate professor, Study director, plastic Surgery, Faculty of medicine, Suez Canal University
• Eman M. Eldemardash, assistant lecturer, Principal investigator, Oral and Maxillofacial Surgery, Faculty of Dentistry, Suez Canal University