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Efficiency of locking miniplate/screw system versus non-locking miniplate/ screw system in manegment of mandibular fracture: Systematic review and meta analysis

Thesis

Last updated: 06 Feb 2023

Subjects

-

Tags

Oral & Maxillofacial Surgery

Authors

Thabet, Ahmad Thabet

Accessioned

2018-08-26 05:48:05

Available

2018-08-26 05:48:05

type

M.Sc. Thesis

Abstract

Objectives: The aim of this study is to verify whether there is a significant difference in clinical outcomes between locking and non-locking miniplate fixation in the management of mandibular fractures. Materials and methods: Systematic and electronic searches through databases, hand searching of relevant scientific journals, reference lists of all trials identified were checked as well as manual search in Cairo, Ain Shams, and Alexandria universities were conducted (till 11th March 2017). The following databases were searched was applied to PubMed (to 2nd of March 2017), The Cochrane Library (Cochrane Database of Systematic Reviews) (to 4th of March 2017), Web of Science (Science/Social Sciences Citation Index) (to 1st of March 2017), we finished our search on (11th of March 2017). Inclusion criteria of the studies were clinical human studies, Randomized clinical trial, non-randomized clinical trials, cohort studies, cross-section studies and case series which compared the use of locking and non-locking miniplate fixation techniques in the management of mandibular fractures. Search was restricted in the English language, without date restrictions were performed in March 2017, for published and unpublished papers.Result: the search retrieved 1000 studies, only twenty of which met our inclusion criteria (fourteen RCTs, five studies non-RCT and one study was a retrospective cohort study), 858 patients with 1027 fracture sites enrolled into the analysis. We used (OR) together with 95% confidence intervals (CIs) to calculate the estimate of the effect of an intervention, Heterogeneity was measured by the I ² index.The forest plots for the effect of the intervention were pooled, outcomes of the included studies were checked, and no clinical cases in the studies of osteomylitis, malunion, non-union, or bone gap between two fractured segments were reported. Aesthetic (asymmetry) outcome was not dealt with in any of the included studies. The following outcomes showed no significant difference: soft tissue infection, plate infection, swelling at three, six and twelve weeks, gross post-operative occlusal disturbance, plate fracture, bone Fragment mobility, wound dehiscence, sensory or motor nerve disturbances, pain and plate removal either due to infection or in patient's request.Locking miniplate/screw system shows significant less incidence in Occlusal disturbances, mild post-operative occlusal disturbance (OR 0.43, 95% CI 0.21 -0.87, P= 0.02, I²=0%) and overall occlusal disturbance post-operatively (OR 0.35, 95% CI 0.21 -0.58, p < 0.01, I²=0%), the need of use the IMF post-operatively in overall usage (OR 0.27, 95% CI 0.16- 0.43, P < 0.01, I²=0%), one week MMF (OR 0.33, 95% CI 0.19- 0.56, P< 0.01, I²=0%), two weeks MMF (OR 0.18, 95% CI 0.05- 0.60, P< 0.01, I²=4.18%) and overall complication rate outcome reported in Thirteen studies included a total 771 patients, meta-analysis showed significant difference between the two interventions in the favor locking miniplate (OR 0.54, 95% CI 0.33- 0.88, P=0.01, I²=8.27%).Conclusion:This review and meta-analysis show locking miniplate/screw system significantly less incidence in occlusal disturbance post-operatively, the need of use maxillary mandibular fixation and overall complication rate than the non-locking standard miniplate screw/system in the management of mandibular fractures. This result came to confirm the significant theoretical advantages of the locking miniplate screw/system that seen in biomechanical studies.

Issued

1 Jan 2017

DOI

http://dx.doi.org/10.21473/iknito-space/40059

Details

Type

Thesis

Created At

28 Jan 2023