Sweedan, A., Hassan, N., El-Sheikh, S., El-Dibany, R., Kawana, K. (2016). EVALUATION OF RESORBABLE PLATES WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MIDFACE FRACTURES (CLINICAL, HISTOLOGICAL, AND BIOMECHANICAL STUDY). Alexandria Dental Journal, 41(3), 269-276. doi: 10.21608/adjalexu.2016.58035
Ahmed O. Sweedan; Nagy E. Hassan; Samraa A. El-Sheikh; Riham M. El-Dibany; Khadiga Y. Kawana. "EVALUATION OF RESORBABLE PLATES WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MIDFACE FRACTURES (CLINICAL, HISTOLOGICAL, AND BIOMECHANICAL STUDY)". Alexandria Dental Journal, 41, 3, 2016, 269-276. doi: 10.21608/adjalexu.2016.58035
Sweedan, A., Hassan, N., El-Sheikh, S., El-Dibany, R., Kawana, K. (2016). 'EVALUATION OF RESORBABLE PLATES WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MIDFACE FRACTURES (CLINICAL, HISTOLOGICAL, AND BIOMECHANICAL STUDY)', Alexandria Dental Journal, 41(3), pp. 269-276. doi: 10.21608/adjalexu.2016.58035
Sweedan, A., Hassan, N., El-Sheikh, S., El-Dibany, R., Kawana, K. EVALUATION OF RESORBABLE PLATES WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MIDFACE FRACTURES (CLINICAL, HISTOLOGICAL, AND BIOMECHANICAL STUDY). Alexandria Dental Journal, 2016; 41(3): 269-276. doi: 10.21608/adjalexu.2016.58035
EVALUATION OF RESORBABLE PLATES WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MIDFACE FRACTURES (CLINICAL, HISTOLOGICAL, AND BIOMECHANICAL STUDY)
1- Assistant lecturer at Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University.
2Professor of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University
3Professor of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University.
4Professor of Oral Biology, Department of Oral Biology, Faculty of Dentistry, Alexandria University.
Abstract
INTRODUCTION: The use of biodegradable screws has a number of limiting factors including poor mechanical stability, difficult handling properties, and time-consuming fixation. A new application system by welding a special configured resorbable pin through ultrasound may overcome the disadvantages of thread tapping. OBJECTIVES: Was to evaluate resorbable plates with ultrasonic welded pins in management of midface fracture. MATERIALS AND METHODS: Was conducted clinically on 20 midface fracture cases fixed with resorbable plates with ultrasonic welded pins, histologically on 4 healthy adult mongrel dogs, and biomechanically on 15 specimens tested for tension, bending, and torsion stiffness of this system. RESULTS: Clinically intraoperative handling showed 13% failure rate for the total number of pins placed for all cases, with stability failure in 10% of cases, and mean time needed for fixation of each plate was 10.6 minutes, however postoperative clinical results were normal with no significant complications. Radiographically; adequate bone healing with delayed resorption of pins was observed during follow-up phase which was continued till 12th week postoperatively. Histological study revealed woven bone growing in the defect area and development of new bone, osteocytes and osteoblasts seen on bone surface. Biomechanical study showed mean tensile stiffness 498.982 N/mm while mean bending stiffness was 1.176 N/mm and mean torsion stiffness was 0.342 N/mm. CONCLUSIONS: This retrospective study shows the general feasibility, sufficient mechanical stability, and efficient intraoperative handling of resorbable plates with ultrasonic welded pins in management of midface fractures
1. Greenberg AM, Prein J. Craniomaxillofacial reconstructive and corrective bone surgery. First edition, Springer: New York. 2002. p. 317-26. 2. Pietrzak WS. Critical concepts of resorbable internal fixation. J Craniofac Surg.2000; 11:335-6. 3. UekiK,HashibaY,MarukawaK,OkabeK,NakagawaK, AlamS, et al. Evaluation of Bone Formation After Sagittal Split Ramus Osteotomy with Bent Plate Fixation Using Computed Tomography. J Oral Maxillofac Surg. 2009; 67:1062-8. 4. Barry L, Eppley M. Repair of midfacial fractures with resorbable plates and screws, Oper Techn Otolaryngology- Head Neck Surg. 2002;13:287-92. 5. David E, Vázquez M, Donita DS, Stewart K, Lazow T, Julius R. Treatment of mandible fractures using resorbable plates with a mean of 3 weeks maxillomandibular fixation: a prospective study. J O Surg O Med O Path O Rad Endon. 2013;115: 25-8.
6. Wood RJ, Petronio JA, Graupman PC, Shell CD, Gear AJ. New resorbable plate and screw system in pediatric craniofacial surgery. J Craniofac Surg. 2012;23(3):845-9. 7. Yerit KC, Enislidis G, Schopper C, Turhani D, Wanschitz F. Fixation of mandibular fractures with biodegradable plates and screws. J Oral Surg Oral Med Oral Pathol Oral Radiol. 2002; 94:294-300 8. Hammond D, Parmar S. A Review of the Use of Resorbable Plateing Systems in Cranio-Maxillofacial Surgery. J Trop Med Surg. 2013; 1:151-4. 9. Eppley BL, Morales L, Wood R. Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients. J Plast Reconstr Surg. 2004; 114:850–6. 10.Neff A, Muhlberger G, Karoglan M. Stability of osteosyntheses for condylar head fractures in the clinic and biomechanical simulation. J Mund Kiefer Gesichtschir. 2004; 8:63–74. 11.Ricalde P, Engroff SL, Von Fraunhofer JA, Posnick JC. Strength analysis of titanium and resorbable internal fixation in a mandibulotomy model. J Oral Maxillofac Surg. 2005; 63:1180–3. 12.Wittwer G, Adeyemo W L. An evaluation of the clinical application of three different biodegradable osteosynthesis materials for the fixation of zygomatic fractures. J O Surg O Med O Path O Rad Endon. 2005;100(6):656-60. 13. Carron M A, Zuliani G. Stability of midface fracture repair using absorbable plate and screw system pilot holes drilled and pin placement at angles other than 90°. J Facial Plast Surg. 2014;16(1):42-8. 14. Cho P, Burton R, Gratton D, Cho H. Biomechanical study of SonicWeld Rx pin in cortical bone graft layering technique. J Oral Maxillofac Surg. 2011; 69:1519-22. 15. Pilling E, Meissner H, Jung R, Kochd R, Loukota R, Maia R, Reitemeier B, Richter G, Stadlinger B, Stelnicki E, Eckelt U. An experimental study of the biomechanical stability of ultrasound-activated pinned (SonicWeld Rx® + Resorb-X®) and screwed fixed (Resorb-X®) resorbable materials for osteosynthesis in the treatment of simulated craniosynostosis in sheep. Br J Oral Maxillofac Surge.2007;45:451–6. 16. Cutright DE, Hunsuck EE, Beasley JD. Fracture reduction using a biodegradable material, polylactic acid. J Oral Surg. 1971; 29:393–7. Quoted from Kontakis G, Pagkalos J, Tosounidis T, Melissas J, Katonis P. Bioabsorbable materials in orthopaedics. Acta Orthop. 2007; 73:159-69. 17. Mc Leod N M, Saeed N R. Treatment of fractures of the mandibular condylar head with ultrasound-activated resorbable pins: early clinical experience. Br J Oral Maxillofac Surg. 2016; 54:872-7. 18. Buijs GJ, van der Houwen EB, Stegenga B, Verkerke GJ, Bos RR. Mechanical strength and stiffness of the biodegradable SonicWeld Rx Osteofixation System. J Oral Maxillofac Surg. 2009; 67:782-90. 19. Maia R., Lauera G, Pilling E, Jungc R, Leonhardta H, Proff P Et al. Bone welding – A histological evaluation in the jaw. Ann. Anatomy J. 2007;189(4):350-5. 20. Ogbemudia AO, Phillip FA. Umebese SA. Implant failure in osteosynthesis of fractures of long bones. J Medic Biomed Resear. 2006; 5:75-8. 21. Reichwein AM, Schicho KD, Moser DS, Seemann RO, Poeschl PA, Baumann SA et al. Clinical Experiences with Resorbable Ultrasonic-Guided, Angle-Stable Osteosynthesis in the Panfacial Region. J Oral Maxillofac Surg. 2009; 67:1211-7. 22. Bell RB, Kindsfater CS. The use of biodegradable plates and screws to stabilize facial fractures. J Oral Maxillofac Surg. 2006; 64:31–9. 23. Meara D, Knoll M, Holmes J, Clark M. Fixation of Le Fort I Osteotomies with Poly-DL-Lactic Acid Mesh and Ultrasonic Welding—A New Technique. J Oral Maxillofac Surg. 2014; 70:1139-44. 24. Eckelt U, Pilling E, Stelnicki E: A new resorbable fixation technique in craniofacial surgery. Int J Oral Maxillofac Surg. 2005; 34:84-90. 25. El-Saadany W H, Sadakah A A, Hussein M M, Saad K A. Evaluation of using ultrasound welding process of biodegradable plates for fixation of pediatric mandibular fractures. Tanta Dent J. 2015; 12:22-9.