Does the biplane three‑dimensional miniplate design provide stable fixation for mandibular angle fractures? A clinical study and proposal for novel radiographic criteria

Abstract

Background: The posterior anatomical position and complex biomechanics of mandibular angle
fractures (MAF) make their management more complicated than other mandibular fractures.
The shortcomings of semi‑rigid and rigid fixations have led to the development of a biplane
three‑dimensional (3D) miniplate design to fixate angle fractures in two perpendicular planes. The
aim is to determine whether using a Biplane 3D miniplate could provide a feasible, effective, and
reliable fixation for displaced MAFs.
Materials and Methods: This prospective, quasi‑experimental, clinical study was conducted
on adult patients with displaced MAFs. The primary outcome (occlusion) and secondary clinical
outcomes (fracture stability and adequate mouth opening) were recorded in the first 2 weeks and
the 2nd and 6th months postoperative. Appropriate reduction (secondary outcome) was assessed with
novel radiographic criteria in the vertical and horizontal planes. Statistical analysis was performed
using SPSS version 22 and included Fisher’s exact and Chi‑square tests. The level of significance
was set at P < 0.05.
Results: Twenty‑one patients with MAFs (nine isolated fractures) were operated on and followed
for 3–6 months (mean: 4.95 months). Only two cases (9.52%) in the nonisolated fracture group
showed mild occlusal derangement, which resolved with heavy elastic therapy. Adequate mouth
opening was gradually resumed in both groups within the 1st month. No postfixation complications
were observed. Radiographic criteria measurement revealed 14.29% and 28.6% mild vertical and
horizontal radiographic malalignment without detectable clinical signs.
Conclusion: Biplane 3D miniplate fixation shows promising results in the management of MAFs
with minimal complications, suggesting that it is safe and effective. Concomitant management of
displaced mandibular fractures does not seem to affect treatment outcomes.
Key Words: Displaced angle fracture, internal rigid fixation, mandibular angle fracture,
miniplate angle fixation, radiographic criteria, three‑dimensional miniplate

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 Kazem Khiabani: Pubmed,Google Scholar