A Comparative Prospective Study of Three different Bone Plating Methods for treatment of Mandibular Symphysis and Parasymphysis Fractures

  • Moin Iftikhar Shapoo Maharana Pratap College of Xentistry and Research Centre
  • Sateesh Bhatele
  • Udit Prakash
  • Deepak Sharma
  • Peyush Pratap Singh
Keywords: Champy’s Principle, Mandible fracture, Symphysis/parasymphysis fracture, Miniplate, Tension band, 3D Plates.


Background Recently, various modifications in placing miniplates for direct fixation of the mandibular fracture are gaining popularity. The modifications have various advantages like more rigidity, less foreign material, less time in application, etc. Thus the purpose of this prospective study was to evaluate outcomes for three bone plating techniques used in the treatment of mandibular symphysis/ parasymphysis fractures.Methods A prospective study was conducted on 45 patients with mandibular symphysis/parasymphysis fractures and the patients were divided into 3 groups (A, B and C). Patients were followed for 3 months. Outcome parameters like occlusion, distraction of lower border radiologically, parasthesia, infection, failure of bone plate (plate fracture) and screw loosening, postoperative segmental stability and radiological evaluation of fixation were recorded.Results Distraction of lower border was seen in all the groups which were noticed radiographically at all follow ups. There was no occlusal discrepancy present in all the groups after three months post operatively. The fracture segments were stable in all groups at all times. Parasthesia was noticed in all the groups, which gradually decreased in one month and resolved completely by third month follow up. The degree of parasthesia, distraction of lower border, occlusal discrepancy was not statistically significant between the three groups. Hardware failure was not found in all the groups.Conclusion It can be concluded that conventional miniplate system is a better and easier method than the 3D miniplate system for fixation of mandibular fractures. In comparison, the 3D miniplate system is unfavorable for use in cases of oblique fractures and those involving the mental nerve, and is also difficult to adapt. 


1. Khan A, Salam A, Khitab U, Tariq M. Pattern of Mandibular Fractures - A Study. Pak Oral Dent J 2009; 29(2):221-224.
2. Zix J, Lieger O, Lizuka T. Use of straight and curved 3- dimensional titanium miniplates for fracture fixation at the mandibular angle. J Oral Maxillofac Surg 2007; 69:1758-1763.
3. Champy M, Lodde JP, Schmidt R. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg. 1978;6:14-21.
4. Champy M, Pape HD, Gerlach KL, et al. The Strasbourg miniplate osteosynthesis. In: Kru¨ger E, Schilli W. eds, Oral and Maxillofacial Traumatology. Vol 2. Chicago: Quintessence; 1986.
5. Michelet FX, Deymes J, Dersus B. Osteosynthesis with miniature screwed plates in maxillofacial surgery. J Oral mMaxillofac Surg. 1973;1:79-84
6. Ellis E III. A Study of 2 Bone Plating Methods for Fractures of the Mandibular Symphysis/Body. J Oral Maxillofac Surg 2011; 69:1978-1987.
7. Thapliyar GK, Sinha R, Menon PS, Chaknarayan A. Management of Mandibular fractures. MJAFI 2008; 64:218- 220.
8. Mukerji R, Mukerji G, McGurk M. Mandibular fractures: Historical perspective. Br J Oral Maxillofac Surg 2006;44: 222-228.
9. Chuong R, Donoff RB, Guralnick WC. A Retrospective analysis of 327 mandibular fractures. J Oral Max Fac Surg 1983; 42:305-309.
10. Dodson TB, Perrott DH, Kaban LB, Gordon NC. Fixation of mandibular fractures: A comparative analysis of rigid internal fixation and standard fixation techniques. J Oral Max Fac Surg 1990; 48:362-366.
11. Valentino J, Marentere LJ. Supplemental maxillomandibular fixation with miniplate osteosynthesis. Otolaryngol Head Neck Surg 1995; 112:215-220.
12. Sami SM, Al-Muala HD, Al-Mahdi AH, Alaboudy AT. The Uses of Bony Mini Plate Osteosynthesis with or without Intermaxillary Fixation in Mandibular Fractures. A Comparison Study and Literature Review. Int J Science Basic and Applied Research 2014; 14(1):136-146.
13. Gear AJ, Apasova E, Schmitz JP, et al: Treatment modalities for mandibular angle fractures. J Oral Maxillofac Surg 63:655, 2005
14. Farmand M. The 3-dimensional plate fixation of fractures and osteotomies. Facial Plast Surg Clin North Am. 1995;3:39-56.
15. Feledy J, Caterson EJ, Steger S, et al: Treatment of mandibular angle fractures with a matrix miniplate. A preliminary report. Plast Reconstr Surg 114:1711, 2004
16. Babu S, Parmar S, Menat M, Raghani, Kapadia T: Three dimensional miniplate rigid fixation in fracture mandible. Journal of Maxillofacial and Oral Surg 6:2, 14-16, 2007
17. Guimond C, Johnson JV, Marchena JM: Fixation of mandibular angle fractures with a 2.0-mm3-dimensional curved angle strut plate. J Oral Maxillofac Surg 63:209, 2005
18. Saluja H, Kini Y, Mahindra U, Kharkar V, Rudagi B, Dehane V. A comparative evaluation of different treatment modalities for parasymphysis fractures: a pilot study. Int J Oral Maxillofac Surg 2012; 41(8):906-911.
19. Ellis E, Moos KF, EL-Attar A. Ten years of mandibular fractures: An analysis of 2137 patients. J Oral Surg 1985: 59:120-129.
20. Thapliyar GK, Sinha R, Menon PS, Chaknarayan A. Management of Mandibular fractures. MJAFI 2008; 64:218- 220.
21. Alpert B, Gutwald R, Schmelzeisen R. New innovation in craniomaxillofacial fixation the 2.0mm lock system. Keio J Med 2003; 52:120-7.
22. Feller KU, Richter G, Schneider M, Eckelt U. Combination of microplate and miniplate for osteosynthesis of mandibular fractures: an experimental study. Int J Oral Maxillofac Surg 2002; 31(1):78–83.
23. Ellis E, Graham J. Use of a 2 mm locking plate/screw system for mandibular fracture surgery. J Oral Maxillofac Surg 2002; 60: 642-645.
24. Jain MK, Manjunath KS, Bhagwan BK. Comparison of 3- Dimensional and standard miniplate Fixation in the management of mandibular fractures. J Oral Maxillofac Surg 2010; 68: 1568-1572
25. Alkan A, Celebi N, Ozden B, Baº B, Inal S. Biomechanical comparison of different plating techniques in repair of mandibular angle fractures Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104:752-6.
26. Rehman AU, Khan M, Baber BZ. Frequency and reasons for removal of stainless steel plates in maxillofacial trauma. Pak Oral and Dent J 2009; 29:216
27. Booth PW, Schendel SA, Hausamen J-E: Maxillofacial Surgery, Vol 1 (ed 2). London, UK, Churchill Livingstone, 2007, pp 74-76
Original Articles