Le Fort I İlerletme Osteotomisi Sonrası Farklı Fiksasyon Sistemlerinin Biyomekanik Olarak Karşılaştırması: İn Vitro Çalışma

Year 2021, Volume: 8 Issue: 3, 729 - 735, 31.12.2021

Mehmet Melih Ömezli , Ferhat Ayrancı , Damla Torul , Mustafa Ay

https://doi.org/10.15311/selcukdentj.783190

Abstract

Amaç: Bu çalışmanın amacı, poliüretan kafatası modellerinde Le Fort I osteotomisi sonrası beş farklı plak-vida sisteminin stabilite üzerindeki etkisini araştırmaktır. Ayrıca ikincil olarak mikro ve rezorbe olabilen fiksasyon sistemlerinin özellikle kasların kısmen ince olduğu bölgelerde yeterli stabilite sağlanmasındaki etkinliğini değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Poliüretan kafataslarında yapay olarak oluşturulan Le Fort I osteotomisinin sabit fiksasyonu için standart titanyum mini plaklar, titanyum mikroplaklar ve rezorbe olabilen plakalar uygulandı. Isırma kuvvetlerini simüle etmek için aşağı-yukarı yönde yük uygulandı. Kuvvet-yer değiştirme değerleri kaydedildi.
Bulgular: 120, 150, 180 ve 200 N yüklemede beş farklı fiksasyon sisteminin yer değiştirme değerleri arasında önemli farklılıklar gözlendi (p <0.05). En yüksek deplasman değerleri, artan yük ile 4RLt-Micro grubunda gözlendi. 4RLt-Mini ve 4LLt-Mini grupları en düşük yer değiştirme değerlerini gösterdi ve 4LLt-Mini grubu 4RLt-Mini grubundan daha az yer değiştirme gösterdi. 2Lt / 2It-Mini ve 2Lt / 2Ir-Mini grupları, 4RLt-Mini ve 4LLt-Mini grupları ile yaklaşık deplasman değerleri gösterdi.
Sonuçlar: Bu çalışmanın sonuçları, sol taraftaki L mini plakaların sağ tarafa göre daha stabil sonuçlar verdiğini göstermektedir. Ayrıca yeterli stabilite elde edilirken, ince kaslı bölgelerde rezorbe olabilen plakların standart titanyum mini plaklar ile kombine halde kullanılmasıyla palpabilite probleminin de ortadan kalktığı söylenebilir. Bununla birlikte, bu sonuçları doğrulamak için daha geniş ilerleme değerlerine sahip daha fazla in vitro ve in vivo çalışmaların yapılması gerekmektedir.

Keywords

Rezorbe olabilen sistem, mikroplak,, stabilite, ilerletme, Le Fort osteotomisi

Supporting Institution

Ordu Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi

Project Number

A-1815

Biomechanical Comparison of Different Fixation Systems after Le Fort I Advancement Osteotomy: An in Vitro Study

Abstract

Background: The aim of this study is to explore the effect of five different plate-screw systems on the stability after LeFort I osteotomy in polyurethane skull models. Also, we aimed secondarily to evaluate the efficiency of the use of micro and bioabsorbable fixation systems especially in the regions where the muscularity is relatively thin, in providing enough stability.
Methods: Standard titanium miniplates, titanium microplates and bioabsorbable plates were applied for the internal fixation of artificially created LeFort I osteotomy on polyurethane skulls. Load applied in inferior-superior direction to simulate bite forces. The load-displacement values were recorded.
Results: Significant differences were observed among the displacement values of five fixation systems at 120, 150, 180 and 200 N of loading (p< 0.05). The highest displacement values were observed in the 4RLt-Micro group with the increasing load. The 4RLt-Mini and 4LLt-Mini groups showed the least displacement values, and the 4LLt-Mini group showed less displacement than the 4RLt-Mini group. The 2Lt/2It- Mini and 2Lt/2Ir-Mini groups showed proximate displacement values with the 4RLt-Mini and 4LLt-Mini groups.
Conclusions: The results of this study show that the left sided L miniplates provide more stable results than the right sided ones. Also, it may be said that while sufficient stability can be obtained, the problem of palpability is also eliminated with the use of bioabsorbable plates in the regions with thin muscularity in combination with standard titanium miniplates. However, further in vitro and in vivo studies with wider advancement values needs to be conducted to confirm these results.

Keywords

Bioabsorbable system, microplate, stability, advancement, Le Fort osteotomy

Project Number

A-1815

References

• 1. Susarla SM, Ettinger R, Preston K, Kapadia H, Egbert MA. Two-point nasomaxillary fixation of the Le Fort I osteotomy: assessment of stability at one year postoperative. Int J Oral Maxillofac Surg. 2020;49(4):466-470.
• 2. Erkmen E, Atac MS, Yucel E, Kurt A. Comparison of biomechanical behaviour of maxilla following Le Fort I osteotomy with 2- versus 4-plate fixation using 3D-FEA: part 3: inferior and anterior repositioning surgery. Int J Oral Maxillofac Surg. 2009;38(2):173-179.
• 3. Coskunses FM, Kan B, Mutlu I, Cilasun U, Celik T. Evaluation of prebent miniplates in fixation of Le Fort I advancement osteotomy with the finite element method. J Craniomaxillofac Surg. 2015;43(8):1505-1510.
• 4. Uckan S, Veziroglu F, Soydan SS, Uckan E. Comparison of stability of resorbable and titanium fixation systems by finite element analysis after maxillary advancement surgery. J Craniofac Surg. 2009;20(3):775-779.
• 5. Huang SF, Lo LJ, Lin CL. Biomechanical interactions of different mini-plate fixations and maxilla advancements in the Le Fort I Osteotomy: a finite element analysis. Comput Methods Biomech Biomed Engin. 2016;19(16):1704-1713.
• 6. Araujo MM, Waite PD, Lemons JE. Strength analysis of Le Fort I osteotomy fixation: titanium versus resorbable plates. J Oral Maxillofac Surg. 2001;59(9):1034-1039; discussion 1039-1040.
• 7. Kim BC, Padwa BL, Park HS, Jung YS. Stability of maxillary position after Le Fort I osteotomy using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws. J Oral Maxillofac Surg. 2011;69(5):1442-1446.
• 8. Gupta A, Singh V, Mohammad S. Bite force evaluation of mandibular fractures treated with microplates and miniplates. J Oral Maxillofac Surg. 2012;70(8):1903-1908.
• 9. Farole A, Diecidue RJ. Microscrew and microplate systems for select osteotomies in orthognathic surgery. Oral Surg Oral Med Oral Pathol. 1993;75(3):276-279.
• 10. Pinto CM, Asprino L, de Moraes M. Chemical and structural analyses of titanium plates retrieved from patients. Int J Oral Maxillofac Surg. 2015;44(8):1005-1009.
• 11. Schmidt BL, Perrott DH, Mahan D, Kearns G. The removal of plates and screws after Le Fort I osteotomy. J Oral Maxillofac Surg. 1998;56(2):184-188.
• 12. Norholt SE, Pedersen TK, Jensen J. Le Fort I miniplate osteosynthesis: a randomized, prospective study comparing resorbable PLLA/PGA with titanium. Int J Oral Maxillofac Surg. 2004;33(3):245-252.
• 13. Schortinghuis J, Bos RR, Vissink A. Complications of internal fixation of maxillofacial fractures with microplates. J Oral Maxillofac Surg. 1999;57(2):130-134; discussion 135.
• 14. Xie ST, Singhal D, Chen CT, Chen YR. Functional and radiologic outcome of open reduction and internal fixation of condylar head and neck fractures using miniplate or microplate system. Ann Plast Surg. 2013;71 Suppl 1:S61-66.
• 15. Park JH, Kim M, Kim SY, Jung HD, Jung YS. Three-dimensional analysis of maxillary stability after Le Fort I osteotomy using hydroxyapatite/poly-L-lactide plate. J Craniomaxillofac Surg. 2016;44(4):421-426.
• 16. Cheung LK, Yip IH, Chow RL. Stability and morbidity of Le Fort I osteotomy with bioresorbable fixation: a randomized controlled trial. Int J Oral Maxillofac Surg. 2008;37(3):232-241.
• 17. Costa F, Robiony M, Zorzan E, Zerman N, Politi M. Stability of skeletal Class III malocclusion after combined maxillary and mandibular procedures: titanium versus resorbable plates and screws for maxillary fixation. J Oral Maxillofac Surg. 2006;64(4):642-651.
• 18. Dhol WS, Reyneke JP, Tompson B, Sandor GK. Comparison of titanium and resorbable copolymer fixation after Le Fort I maxillary impaction. Am J Orthod Dentofacial Orthop. 2008;134(1):67-73.
• 19. Eppley BL, Prevel CD. Nonmetallic fixation in traumatic midfacial fractures. J Craniofac Surg. 1997;8(2):103-109.
• 20. 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.
• 21. Ferretti C, Reyneke JP. Mandibular, sagittal split osteotomies fixed with biodegradable or titanium screws: a prospective, comparative study of postoperative stability. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(5):534-537.
• 22. Haers PE, Sailer HF. Biodegradable self-reinforced poly-L/DL-lactide plates and screws in bimaxillary orthognathic surgery: short term skeletal stability and material related failures. J Craniomaxillofac Surg. 1998;26(6):363-372.
• 23. Omezli MM, Torul D, Polat ME, Dayi E. Biomechanical comparison of osteosynthesis with poly-L-lactic acid and titanium screw in intracapsular condylar fracture fixation: An experimental study. Niger J Clin Pract. 2015;18(5):589-593.
• 24. Pozzer L, Olate S, Cavalieri-Pereira L, Navarro P, de Albergaria Barbosa JR. Mechanical stability of 2-plate versus 4-plate osteosynthesis in advancement Le Fort I osteotomy. An in vitro study. J Stomatol Oral Maxillofac Surg. 2017;118(1):2-4.
• 25. Murray RA, Upton LG, Rottman KR. Comparison of the postsurgical stability of the Le Fort I osteotomy using 2- and 4-plate fixation. J Oral Maxillofac Surg. 2003;61(5):574-579.
• 26. Ueki K, Okabe K, Moroi A, et al. Maxillary stability after Le Fort I osteotomy using three different plate systems. Int J Oral Maxillofac Surg. 2012;41(8):942-948.
• 27. Esen A, Isik K, Saglam H, Ozdemir YB, Dolanmaz D. Biomechanical evaluation of different fixation systems after Le Fort I osteotomy in polyurethane models of unilateral clefts. Br J Oral Maxillofac Surg. 2016;54(7):757-761.
• 28. Atac MS, Erkmen E, Yucel E, Kurt A. Comparison of biomechanical behaviour of maxilla following Le Fort I osteotomy with 2- versus 4-plate fixation using 3D-FEA Part 2: impaction surgery. Int J Oral Maxillofac Surg. 2009;38(1):58-63.
• 29. Stokbro K, Borg SW, Andersen MO, Thygesen T. Patient-specific 3D printed plates improve stability of Le Fort 1 osteotomies in vitro. J Craniomaxillofac Surg. 2019;47(3):394-399.
• 30. Passeri LA, Bento AM, Vanni T. Resorbable Versus Titanium Fixation of Le Fort I Osteotomy. J Craniofac Surg. 2020.
• 31. Ueki K, Marukawa K, Shimada M, Nakagawa K, Alam S, Yamamoto E. Maxillary stability following Le Fort I osteotomy in combination with sagittal split ramus osteotomy and intraoral vertical ramus osteotomy: a comparative study between titanium miniplate and poly-L-lactic acid plate. J Oral Maxillofac Surg. 2006;64(1):74-80.
• 32. Gareb B, van Bakelen NB, Buijs GJ, et al. Comparison of the long-term clinical performance of a biodegradable and a titanium fixation system in maxillofacial surgery: A multicenter randomized controlled trial. PLoS One. 2017;12(5):e0177152.
• 33. Choi TJ, Chung YH, Cho JY, Burm JS. The Use of Microplates for Internal Fixation of Comminuted Mandibular Fractures. Ann Plast Surg. 2019;82(1):55-61.
• 34. Kalfas IH. Principles of bone healing. Neurosurg Focus. 2001;10(4):E1.
• 35. Choi YJ, Lim H, Chung CJ, Park KH, Kim KH. Two-year follow-up of changes in bite force and occlusal contact area after intraoral vertical ramus osteotomy with and without Le Fort I osteotomy. Int J Oral Maxillofac Surg. 2014;43(6):742-747.
• 36. Song HC, Throckmorton GS, Ellis E, 3rd, Sinn DP. Functional and morphologic alterations after anterior or inferior repositioning of the maxilla. J Oral Maxillofac Surg. 1997;55(1):41-49; discussion 49-50.