Precision of patient specific screw holes locating surgical guide and pre-bent plates osteosynthesis versus classical workflow in management of class III mandibular fracture

Abstract

Background

Several treatment modalities have been reported in the management of mandibular fractures using an alternative computer-guided approach through the utilization of different designs of guiding devices. However, these computer-guided methods do not always guarantee accurate anatomical bone reduction. This study aimed to assess the reduction precision of the computer-guided mandibular fracture and internal fixation using screw holes locating surgical guide, as presented earlier in the orthognathic surgery field in various studies to be applied in the field of mandibular traumatology, comparing it with the conventional approach.

Methods

Twenty-six patients with Brown Class III mandibular fracture, defined by a single fracture line involving the body, parasymphysis or symphysis regions, were randomly assigned to two groups for open reduction and internal fixation. The study group underwent reduction and fixation using patient-specific screw-hole locating guide and pre-bent titanium miniplates, whereas the control group received conventional reduction and fixation with intraoperatively adapted titanium miniplates. Virtual reduction of the fractured mandible was performed in all cases of both groups utilizing CT scan and mimics software. Then, the actual postoperative mandibular model was superimposed over the virtually operated mandibular model based on predefined reference points and plans to obtain dental and bony linear measurements. The recorded measures were statistically analysed.

Results

The actual postoperative mandibular model in the computer-guided group showed minimal deviation from the virtual mandibular model. While the deviation of the actual post operative model in the conventional group from the virtual model was higher, the difference in deviation between the two groups was statistically significant. The mean bony deviation was 0.09 ± 0.29 mm in the computer-guided group, versus 0.70 ± 0.33 mm in the control group p < 0.001. The mean dental deviation was 0.05 ± 0.16 mm in the computer-guided group versus 0.56 ± 0.32 mm in the control group p < 0.001.The mean operative time of the computer-guided group(1.49 ± 0.19)(hours) was significantly shorter than the mean operative time of control group (1.82 ± 0.37)(hours) which is statistically significant p < 0.001.

Conclusions

The use of screw-hole locating guide and pre-bent plates enhanced surgical accuracy and efficiency. It also highlighted how patient-specific design can reduce dependence on surgeon experience and standardized outcomes in complex mandibular fractures.

Trial registration

The study is registered at ClinicalTrials.gov Protocol Registration and Results System Receipt, ID: NCT05444829.