An in vitro study of the effect of bony buttressing on fixation strength of a fractured atrophic edentulous mandible model.

PURPOSE: The purpose of this study was to measure the resistance to displacement in an adult bovine rib mandible model as the vertical dimension of the bone decreases, and to compare the fixation strength of titanium miniplates and reconstruction plates.

MATERIALS AND

METHODS

Five groups of 6 ribs each were tested based on the vertical dimension of the rib and method of fixation (group 1, 40 mm, miniplate), (group 2, 30 mm, miniplate), (group 3, 20 mm, miniplate), (group 4, 10 mm, miniplate), (group 5, 10 mm, reconstruction plate). In the 4 groups stabilized with a miniplate, a 3-hole-per-segment, 2.0-mm titanium miniplate and 6.0-mm monocortical titanium screws were used. In group 5, a 3-screw-per-segment, 2.4-mm titanium reconstruction plate and 2.4-mm bicortical titanium screws were used for fixation. A 2-dimensional beam model (Class III lever) was established, and an Instron machine was used initially to develop a load-displacement curve to 100 N for each specimen. An osteotomy was then created, and the segments were reduced without preload. The ribs were then loaded to failure in the Instron machine. The load-displacement curve and failure load were recorded.

RESULTS

There was no significant difference (P < or = .05) between any of the groups before the osteotomy. At 75 N, groups 1 and 2 were superior to group 5 in resistance to displacement. Group 4 showed significantly less (P < or = .05) resistance to displacement than the other experimental miniplated subgroups. As loads increased, groups 1 and 2 continued to show increased resistance to displacement when compared with groups 3, 4, and 5. Loads to failure for groups 1 and 2 were comparable to group 5.

CONCLUSIONS

Decreased resistance to displacement occurs with decreasing vertical dimension of the bovine rib. In fractures of the edentulous mandible, a miniplate is more likely to provide adequate fixation if the mandible is 30 to 40 mm in height (nonatrophic). At higher loads, groups with greater vertical height (30 mm and 40 mm) provided resistance to displacement equivalent to the 10-mm group repaired with a reconstruction plate. Therefore, fractures of the atrophic mandible may be better treated with more rigid techniques.