3d reconstruction plates

1. SYNOPSIS FOR DISSERTATION
PRESENTED BY :
Dr. SANSKRITI SHAH
POST GRADUATE
OMFS
GUIDED BY:
DR. MADAN N
DEPT. OF ORAL& MAXILLOFACIAL SURGERY

2. 1. NAME AND ADDRESS OF THE
CANDIDATE
Dr. SANSKRITI SHAH
DEPARTMENT OF ORAL AND
MAXILLOFACIAL SURGERY
VOKKALIGARA SANGHA
DENTAL COLLEGE &
HOSPITAL, K.R. ROAD,
BANGALORE-560004
2. NAME OF THE INSTITUTION VOKKALIGARA SANGHA
DENTAL COLLEGE &
HOSPITAL, K.R.
ROAD,BANGALORE-560004
3. COURSE OF THE STUDY AND
SUBJECT
MASTER OF DENTAL
SURGERY
ORAL AND MAXILLOFACIAL
SURGERY
4. DATE OF ADMISSION 17/12/2021
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION

3. TITLE OF THE TOPIC
Management of angle mandibular fracture by 3D
rectangular grid plates – a prospective study

4. NEED FOR THE STUDY
•Mandibular fractures are among the most frequently encountered type of facial
injury in developing countries.
•Fracture of mandibular angle account for 20-36% of all mandibular fractures.
•Several methods of internal fixation have been studied with great variations in
rates of complications, especially infections. Lag screws, reconstruction plates,
dynamic compression plates, miniplates with monocortical screws, locking
plates are used.
•Angle fractures management is complicated as they are bounded by unique
anatomic area, biomechanical relations and the presence of third molars. They
have higher frequency of complications particularly in relation to the
insufficient stability of the fixation system.
•The inconveniences led to the development of 3-dimensional plates, whose
stability, unlike traditional plates, does not depend on the thickness of the plate
but depends on its format.

5. • In the three-dimensional plating system, the screws are arranged in
the configuration of a box on both sides of the fracture which creates
a broadband platform, increasing the resistance to twisting and
bending of the plate and reducing the possibility of flaring at the
inferior border of the fracture site.

6. AIM OF THE STUDY
To evaluate the clinical outcomes of treatment of mandibular angle
fractures using 3D rectangular grid plates.

7. The objectives of this study are:
• To assess the accuracy of anatomical reduction.
• Intra-operative and post-operative assessment for:
1) Stability of occlusion
2) Mobility of fracture fragments
• To assess the post-op complications.
OBJECTIVES OF THE STUDY

8. Source of Data
The study will be conducted on -- patients with mandibular angle fracture
reporting to the department of Oral and Maxillofacial Surgery, V. S. Dental
College and Hospital, Bengaluru and to the casualty department of
Kempegowda Institute of Medical Science (KIMS), Bengaluru
Method of collection of data
STUDY SUBJECTS: Patients with mandibular angle fracture.
STUDY DURATION: 18 months
STUDY DESIGN: Prospective study
SAMPLE SIZE:
STATISTICALANALYSIS:
MATERIALS AND METHODS

9. INCLUSION CRITERIA:
• Patients between 15-70 years of age, reporting to
our institution with mandibular angle fractures with
or without associated facial fractures that require
open reduction and internal fixation.
• Patient who are willing to participate in the study
and filled and signed an informed consent form for
the same.

10. EXCLUSION CRITERIA:
• Patients not willing for the study.
• Patient with comminuted mandibular fracture.
• Patient not medically fit to undergo the procedure under general
anesthesia or local anesthesia.

11. METHODOLOGY :
• Patients who fulfilled the inclusion criteria and are confirmed
radiologically to have mandibular angle fracture will be included in the
study.
• Depending on the location of fracture, the fracture site will be exposed
either through intraoral lower vestibular incision/ extraoral sub-mandibular
incision or an existing extraoral laceration.
• After obtaining adequate exposure of the fractured segments, occlusion will
be established by reduction of the fractured fragments.
• The plate will be adapted to the bone in such a way that the horizontal bars
will be perpendicular to fracture line and vertical bars will be parallel to it.
Diagonally opposite screws will be placed first, followed by the remaining
two screws. At the mandibular angle region, the 3D plate will be bent over
the oblique line so that the vertical bars are aligned perpendicular to the
external oblique ridge and secured with screws.

12. • Adequacy of fixation and occlusion will be verified after placement of the grid
plates. The area will be irrigated with betadine and saline and after adequate
haemostasis is achieved, the incision or wound will be closed in layers with
appropriate suture material.
• After the whole procedure adhesive pressure bandage will be given.
• All patients will be evaluated on the 1st post-operative day, 7th post-operative
day, 1st month and 3rd month and 6th month for certain clinical and
radiographic parameter.
• The parameters to be assessed will be:
1. Stability of occlusion - assessed according to the following criteria:
(i) Satisfactory -No gap between upper and lower first molars,
(ii) Mildly deranged - Gap of 1- 2 mm between upper and lower first molars,
(iii) Deranged - Gap more than 2 mm between upper and lower first molars,
2. Mobility of fracture fragments - checked by a single operator by digital
palpation with the help of thumb and index finger of both the hands. Applying
pressure alternatively assessed the stability;
(i) Stable - no movement of fragments,
(ii) Unstable - movement present

13. 3. The accuracy of anatomical reduction will be assessed on the basis of
post op radiographs.

14. Investigations required:
• Routine Blood Investigations.
• Radiographic investigation: OPG. CT wherever
necessary.
• Intervention: Open reduction with internal fixation
under general anesthesia or local anesthesia.

15. THANK YOU….