Evaluation of Accuracy of Three-Dimensional Printing and Three- Dimensional Miniplates in Treatment of Anterior Mandibular Fractures: Clinical Study

doi:10.21203/rs.3.rs-4719269/v1

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Evaluation of Accuracy of Three-Dimensional Printing and Three- Dimensional Miniplates in Treatment of Anterior Mandibular Fractures: Clinical Study

https://doi.org/10.21203/rs.3.rs-4719269/v1

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Background

There are strong torsional forces acting on the anterior mandible fractures. Maxillofacial surgery makes extensive use of digital technology, and three-dimensional printing is now an integral element of the workflow in several areas of oral and maxillofacial surgery. Three-dimensional (3D) miniplates had been proposed by several researchers as a good option for mandibular fracture fixation.

Methods

15 Patients with anterior mandibular fractures were included in the study. All patients undergone computer tomography (CT) scan and the data were imported in Mimics software. The unaffected healthy side was mirrored to the fractured side. Bone fixation three-dimensional plates were prebent and adapted on the model printed by three-dimensional printing machine, submitted to sterilization, and were used for bone reduction and fixation. An immediate postoperative CT scan was taken to evaluate the accuracy of virtual planning and after 3 months for evaluation of bone healing.

Results

Clinical observation revealed good stable occlusion and there was no significant difference between the postoperative three-dimensional image of the mandible and the virtually reduced mandible in the preoperative plan. The Hounsfield units (HU) measured on CT images after 3 months revealed good bone healing.

Virtual reduction. 3D printing

3D miniplates

mandibular fracture

The mandible is the largest and most prominent bone in the maxillofacial region. Facial fractures frequently involve the mandible (1). Rigid internal fixation combined with maxillo- mandibular fixation is the standard surgical procedure for treating mandibular fractures (2). Maxillofacial surgery currently makes extensive use of digital technology in

areas like surgical navigation, titanium plate preforming technology, and 3D digital guide plate technology (3–5).

Monocortical miniplates that are easily adaptable are used in Champy's semi-rigid fixation technique, along with an "ideal osteosynthesis line"

to counteract the developing masticatory forces (6). The location of the bone plate fixation must provide the fixation method that is most stable in relation to the line of tension at the base of the alveolar process. One plate is often used for fractures that are posterior to the foramen and two plates are typically used for fractures anterior to the foramen (6, 7).

Due to muscles working against each other, the anterior mandible fractures

are subject to strong torsional forces. Some researchers have suggested using the three-dimensional (3D) miniplates as a good option for fixation (8).

Farmand has created three- dimensional titanium plates and screws. Their design is based on the idea that a quadrangle is a stable geometric structure for support. The cross bars are only 1 mm thick because, in contrast to ordinary miniplates,

stability is provided by the geometric design (9, 10). Only a few follow- up series are provided in the literature, and there is a restricted usage of three- dimensional plates for the treatment of mandibular fractures. In a prospective analysis, Wittenberg reported stabilizing 20 angle fractures, of which 12 were associated with additional fractures of the mandibular body (11).

There is growing desire in creating workflows that are easier to use so that

more medical professionals will include 3D printing into their current practice (12). Currently, 3D printing and computer- assisted surgery (CAS) are crucial

components of the workflow in a number of areas of maxillofacial and oral surgery, particularly in difficult reconstructive surgeries (13).

Technology for printing objects in three dimensions (3D), also known as additive manufacturing, rapid prototyping, or solid-freeform technology (14), Due to its remarkable capacity to manufacture complicated structures with great precision, this new approach got a lot of attention, particularly within the head and neck surgical specialties of maxillofacial, otorhinolaryngology, and plastic surgery (15).

The surgeon is now able to use 3D segmentation and mirroring methods, which are highly effective in simulating the pre- traumatized anatomy at a minimal cost, using advanced open-source software programs (16).

The idea behind 3D printing in the medical industry is to take anatomical scans utilising imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI). The images from these methods will be saved in a common format, such as the Digital Imaging and Communications in Medicine (DICOM) format, and then with the aid of computer- aided design (CAD) software, a virtual 3D prototype with Standard Tessellation Language (STL) format will be created to enable 3D printing and the deposition of the material layer by layer to achieve the final structure (17–19).

Thus, in the present study, the goal was to assess the accuracy of virtual reduction and prebending of 3D miniplates on printed models for fixation of anterior mandibular fractures and to evaluate the clinical outcomes and bone density after fixation.

Sample Size Estimation

Patients with anterior mandibular fractures were selected from the outpatient clinic of oral and maxillofacial surgery department and the surgical procedures were performed under general anesthesia. Sample size was estimated using G-Power version 3.1.9.2 (Faul, Erdfelder, Lang. & Buchner. 2007) (20). A minimal total hypothesized sample size of 15 patients with anterior mandibular fractures was needed.

This study was performed after gaining ethical approval from Research Ethics Committee, Faculty of Dentistry, Alexandria University with the number 0308-1012021. Before starting the study, objectives, risks, and benefits were explained to the patients, and they received both oral and written information about the benefits and risks of the interventions and signed, informed consent was obtained prior to treatment.

The participating patients in this study were chosen according to the following criteria:

Inclusion criteria

Recent anterior mandibular fractures (within one week).

Adult patients of both genders (18–50 years old).

Systematic healthy patients.

Radiographic evidence of anterior mandibular fracture.

Exclusion criteria

Medically compromised patients contraindicated for general anesthesia and bone surgery.

Comminuted fractures.

Bilateral anterior mandibular fractures.

Previously treated fractures.

Pathological fractures and bone diseases.

Plate specifications:

Three-dimensional miniplates were created by connecting two miniplates using vertical crossbars to reduce bending. The quadrangular plate's geometric shape, rather than its length or thickness, increased its stability (thickness 1 mm, length 20 mm, and width 12 mm). Four holes 3D titanium grade 4 miniplates with titanium self-tapping screws in sizes 2 × 8 mm and 2 × 10 mm were used to fix the plates (Fig. 1D).

Preoperative assessment:

Personal, past medical and dental history and chief complaints were taken. General examination, both extra oral and intra oral examinations and radiographic examinations were done. A computed tomography (CT) scan was performed.

Fabrication of 3D printed models

Every patient had a CT scan, and the data was imported into Mimics software (MIMICS). Axial section images were used to define image thresholds, removing all soft tissues, and highlighting bone and dental tissues. Mandibular bone and teeth were also chosen, and a three-dimensional reconstruction of the segmented mandible, as well as dental hard tissue, was created (Fig. 1A, B). The mandibular bone of the healthy side was mirrored to the fracture side by software to rebuild a perfect reduction model (Fig. 1C). The 3D model of the fractured mandible was printed using a 3D printer. Bone fixation 3D plates were pre-modeled and adapted on the three-dimensional printed model, submitted to sterilization, and were utilized during surgery for bone reduction and fixation (Fig. 1D) (21, 22).

Surgical phase

The fracture line was exposed through the standard mandibular vestibular approach. Vasoconstrictor injection was done in the submucosal plane to lessen bleeding during incision and dissection. The lower lip was everted, and an anterior incision was made from canine to canine. A scalpel or electrocautery was used to incise the mucosa. Curvilinear and anteriorly extending into the lip, the incision leaving 10 to 15 mm of mucosa still adhered to the gingiva. (23).

The underlying mentalis muscle fibers were incised sharply in an oblique direction to the mandible. It was crucial to keep the mental nerve out of the way. Maxillo-mandibular fixation was temporarily secured followed by bone reduction into proper anatomical position. The prebent 3D miniplates were fitted the contour of the anatomically repositioned bone fragments following reduction. Except for the anterior region, one layer of closure is sufficient. Three or more deep resorbable sutures must be inserted into the mentalis muscle. Then, a non-resorbable suture is inserted through origin and insertion of each mentalis, followed by another suture in the midline. Following that, a suture was used to seal the mucosa (Fig. 2).

Postoperative phase

Early postoperative care and Postoperative medication

Antibiotic (amoxicillin clavulanic acid) + analgesic (diclofenac K).
α-chemo-trypsin ampoules as anti-oedematous once daily for 5 days.
Cold fomentation for 24 hours.
Povidone Iodine mouth wash 4 times daily.
Continue oral hygiene measures.

Follow-up phase

Clinical evaluation

Postoperative occlusion

The maximal intercuspal position (centric occlusion) was examined to ensure proper occlusal relationship including molar relation, canine relation, and midline centralization. Any disruption of the occlusal plane, such as an open bite or incorrect tooth contact, was observed. The maximum mouth opening was also assessed.

Radiographic evaluation (24)

An immediate postoperative CT scan was performed after surgery using the same parameters as the preoperative scan. The DICOM-formatted CT images were imported into the MIMICS software. The mandible was segmented in a similar manner to the preoperative planning procedure.

To evaluate the accuracy of the reduction, the distance was measured between the tip of the coronoid and the most anterior part of the chin (pogonion) (Fig. 3A) and the distance between the mental foramina was also measured (Fig. 3B). The preoperative and postoperative measurements were obtained and statistically compared.

The patients were followed up and another CT scan was taken after 3 months to evaluate bone healing and to estimate the mean bone density at the fracture line. Bone mineral density was calculated in Hounsfield Unit (HU) using the RadiAnt DICOM Viewer. Three measurements were taken along the fracture line, then the mean was calculated per patient (Fig. 3C).

Statistical Analysis

Statistical analysis was carried out using SPSS statistics software version 29 (SPSS, Inc., Chicago, IL). Quantitative data were tested for normality using Kolmogorov-Smirnov and Shapiro test. They were not normally distributed, it was described in terms of median, interquartile range, minimum and maximum. A non-parametric statistical test of significance was applied; Mann Whitney test was used to compare the parameters between virtual planning group and postoperative group. Wilicoxon signed rank test was used to compare the bone density immediate postoperative and 3 months after. In all applied statistical tests of significance, P value (< 0.05) was considered significant.

All patients were able to achieve normal occlusion and intercuspal relations, and none of them had any occlusal deformities. There was inadequate mouth opening on the immediate postoperative day (< 30 mm) then the normal mean mouth opening was achieved by time. There was no requirement for any occlusal alteration, selective extraction or grinding during the follow-up period (Fig. 4A).

A good reduction of the fractures was seen in the three-dimensionally reconstructed jaw and the postoperative CT scan. Immediate postoperative and after 3 months CT scan showed good bone segments reduction in all cases and proper alignment of the osseous borders of the mandible (Fig. 4-B, C). Preoperative, immediate postoperative and 3 months postoperative axial cuts showing fixation and healing of the fracture line (Fig. 5A-C).

Fig .5

Statistical Results:

Linear measurement evaluation

There was no statistical significant difference in the distance between coronoid process to mandible pogonion (mm) between virtual planning group and postoperative group [(M1 = 47.41, ranging from 46.30 to 47.67, vs., M2 = 47.32, ranging from 45.66 to 64.40), U = 12.00, p > 0.05] as shown in table (2) and figure (2). Likewise, There was no statistical significant difference in the distance between mental foramina (mm) between virtual planning group and postoperative group [(M1 = 104.01, ranging from 103.49 to 104.04, vs., M2 = 103.90, ranging from 103.49 to 104.02), U = 11.50, p > 0.05] as shown in table (1) and figure (6–7).

Table (1): Comparison between virtual planning group and postoperative group

Groups

Statistical test

P value

Virtual Planning Group

Post Operative Group

Distance between coronoid process to mandible pogonion (mm)

Median (Q1- Q3)

Min. – Max.

47.41 (46.91–47.53)

46.30–47.67

47.32 (46.50–47.99)

45.66–64.40

12.00

0.917

Distance between mental foramina (mm)

Median (Q1- Q3)

Min. – Max.

104.01 (103.80–104.02)

103.49–104.04

103.90 (103.80–104.02)

103.49–104.29

11.50

0.834

P value (< 0.05) was considered significant using Mann-Whitney Test

Bone density evaluation:

There was statistical significant difference in the bone density immediate postoperative and 3 months after the operation [(M1 = 197.14, ranging from 124 to 438.4, vs., M2 = 680.55, ranging from 555.01 to 1007.39), Z=-2.201, p = 0.028] as shown in table (2) and figure (8).

Table (2): Comparing the bone density immediate postoperative and 3 months after

Groups

Statistical test

P value

Immediate Post Opervative

Post Operative Group

3 months

Bone Density

Median (Q1- Q3)

Min. – Max.

197.14 (157.5–276.5)

124.00–438.40

680.55 (617.8–974.9)

555.01–1007.39

− 2.201

0.028*

P value (< 0.05) was considered significant using Wilicoxon signed Rank Test

Mandibular fractures are among the most frequently encountered fractures by craniomaxillofacial surgeons. Although several techniques for treating these types of fractures have been reported, including various designs of prosthetic devices, accurate anatomical bone reduction cannot be guaranteed. As a result, open reduction and internal fixation is the preferred method for achieving perfect anatomical reduction, particularly in fractures with severely displaced bone segments (25).

The aim of this study was to assess the accuracy of virtual reduction and prebending of 3D miniplates on printed models for fixation of anterior mandibular fractures and to evaluate the clinical outcomes and bone density after fixation.

The results revealed no significant difference between the postoperative three-dimensional image of the mandible and the virtually reduced mandible in the preoperative plan and good bone healing.

In this study mirroring of the contralateral healthy side of mandible was done. Comparable studies using mirroring of the unaffected side, followed by printing of models, pre-bending of commercial plates or meshes or patient-specific implant design, reported enhanced accuracy and proven time-efficient (26–29). Ballard et al. reported that the application of 3D technologies in OMFS can save up to an average of 83 min per surgery when pre-designed surgical guides are used, and more than 60 dollars per minute of surgery (30).

The benefit of using virtual surgical planning before open reduction and internal fixation was reported by Maloney & Rutner. The shorter surgical time and duration of general anesthesia, as well as the more precise adaptation of the hardware to the bony topography of the mandible when compared to plate adaptation performed intraoperatively were reported (31). The placement of 3D miniplates was simple and easy for use in our study.

A patient-specific custom plate was not applied in this research because that the time required for production was not worth it when a prebent plate could be prepared in less time and provided comparable benefits. Case studies demonstrated the advantages of using virtual surgical planning preoperatively and having the hardware readily available at the time of fracture exposure (31).

Concerning accuracy, there was no significant difference between the preoperative and postoperative measurements and between Preoperative reduced mandible planning and postoperative three-dimensional mandible images. These results may be due to the plate's quadrangular geometry which ensures 3D stability of the fracture sites by providing good resistance to torque forces, avoiding the need for maxillomandibular fixation and ensuring early restoration of Parasymphyseal function (32).

When the occlusion was examined postoperatively, we discovered that there was no occlusal disturbance and no mobility of the fractured segments in all cases. Our findings were similar to those of Gear et al., and Alkan et al., who demonstrated that 3D strut plates have superior compression load resistance than the Champy's technique (33, 34). Also, Mohd et al., found that Patients treated with 3D plates had a lower incidence of occlusal discrepancy than Champy's miniplates, though the difference between groups was statistically insignificant (32).

Patients with comminuted fractures were excluded in this study and this considered a limitation for using 3D miniplates. Another study revealed that a limitation of 3D plates is their placement over comminuted and oblique fractures. As a result, Champy's miniplates have an advantage over 3D plates in these situations (32).

In the parasymphysis, angle region, 3D plates were found to be better than miniplates; however, in cases of oblique fractures and body fractures which is in and around the mental foramen, placement of these plates is not possible without injuring the neurovascular bundle (35). An indigenous custom made detachable 3D titanium plate was designed to overcome this limitation of 3D plates (36).

Despite their effectiveness, stereolithographic models can only provide indirect guidance and cannot confirm "real-time" fracture reduction. A revolutionary technique for transferring virtual planning to actual surgery, is the surgical guide which is the result of combining CAD/CAM and fast prototyping technology (37).

Although 3D printing technologies are used extensively, they have limitations in use. Despite the potential cost constraint, The cost of 3D technology, in terms of devices, materials, and software, is continuing to fall (38). Another potential limitation is the time required to create a 3D-printed model. This includes the time required to capture anatomical scans, create a virtual 3D prototype, layer by layer 3D print the material, and finally modify the final structure. This can also vary between 1 and 24 hours, depending on the size of the object and the printing resolution (14).

Based on the clinical and radiographic outcome of our study, it is concluded that digital workflow including virtual planning and 3D printing provides accurate method in reduction and fixation of anterior mandibular fractures. Also, 3D miniplates provide good option for symphyseal and parasymphyseal fractures despite their limitations as in some cases like comminuted fractures and fractures in and around mental foramen.

CAS

MRI

DICOM

STL

CAD

Three-dimensional

Computed tomography

Hounsfield Unit

Computer- assisted surgery

Magnetic resonance imaging

Digital Imaging and Communications in Medicine

Standard Tessellation Language

Computer- aided design

Millimeters

Ethical approval:

This study was performed after gaining ethical approval from Research Ethics Committee, Faculty of Dentistry, Alexandria University with the number 0308-1012021. It was set up and reported according to the CONSORT guidelines. Before starting the study, objectives, risks, and benefits were explained to the patients, and they received both oral and written information about the benefits and risks of the interventions and signed, informed consent was obtained prior to treatment.

Consent for publication: Not applicable.

Availability of data and materials: All data generated or analyzed during this study are included in this published article.

Competing interests: The authors declare that they have no competing interests.

Funding: Not applicable

Authors' contributions:

AM: Conceptualization, Writing- Original draft, Methodology, SM: Resources, Software, Writing- Review & editing, Formal analysis, SA: Data curation, Investigation, EA: Conceptualization, Investigation, Supervision. All authors read and approved the final manuscript.

Acknowledgements: Not applicable

Macdonald B, McAleer S, Kelly S, Chakraverty R, Johnston M, Pollock N. Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice. Br J Sports Med. 2019;53(23):1464-73.
Hoffmann J, Westendorff C, Leitner C, Bartz D, Reinert S. Validation of 3D-laser surface registration for image-guided cranio-maxillofacial surgery. Journal of Cranio-Maxillofacial Surgery. 2005;33(1):13-8.
Kraeima J, Glas H, Witjes M, Schepman K. Patient-specific pre-contouring of osteosynthesis plates for mandibular reconstruction: using a three-dimensional key printed solution. Journal of Cranio-Maxillofacial Surgery. 2018;46(6):1037-40.
Liu X-Z, Shu D-L, Ran W, Guo B, Liao X. Digital surgical templates for managing high-energy zygomaticomaxillary complex injuries associated with orbital volume change: a quantitative assessment. Journal of Oral and Maxillofacial Surgery. 2013;71(10):1712-23.
Gong X, He Y, An J, Yang Y, Huang X, Liu M, et al. Application of a computer-assisted navigation system (CANS) in the delayed treatment of zygomatic fractures: a randomized controlled trial. Journal of Oral and Maxillofacial Surgery. 2017;75(7):1450-63.
Sadhwani BS, Anchlia SJAoms. Conventional 2.0 mm miniplates versus 3-D plates in mandibular fractures. 2013;3(2):154.
Goyal M, Marya K, Chawla S, Pandey RJJom, surgery o. Mandibular osteosynthesis: a comparative evaluation of two different fixation systems using 2.0 mm titanium miniplates & 3-D locking plates. 2011;10(4):316-20.
Ponvel K, Panneerselvam E, Balasubramanian S, Raja VKK. Evaluation of labial versus labio-inferior lines of osteosynthesis using 3D miniplate for fractures of anterior mandible: A finite element analysis with a pilot clinical trial. Chinese Journal of Traumatology. 2019;22(5):261-9.
Mittal G, Dubbudu RR, Cariappa KJJom, surgery o. Three dimensional titanium mini plates in oral & maxillofacial surgery: a prospective clinical trial. 2012;11(2):152-9.
Farmand MJFdKuG. Erfahrungen mit der 3-D-Miniplattenosteosynthese bei Unterkieferfrakturen. 1996;41:85-7.
Wittenberg J, Smith B, Trigg DJJOMS. Treatment of mandibular angle fractures with 3-D titanium miniplates. 1994;52(106):90388-3.
Costan VV, Nicolau A, Sulea D, Ciofu ML, Boișteanu O, Popescu E. The Impact of 3D Technology in Optimizing Midface Fracture Treatment—Focus on the Zygomatic Bone. Journal of Oral and Maxillofacial Surgery. 2021;79(4):880-91.
Azuma M, Yanagawa T, Ishibashi–Kanno N, Uchida F, Ito T, Yamagata K, et al. Mandibular reconstruction using plates prebent to fit rapid prototyping 3-dimensional printing models ameliorates contour deformity. Head & face medicine. 2014;10(1):1-8.
Zhong N, Zhao XJEAoO-R-L. 3D printing for clinical application in otorhinolaryngology. 2017;274(12):4079-89.
Choi JW, Kim NJAops. Clinical application of three-dimensional printing technology in craniofacial plastic surgery. 2015;42(03):267-77.
Longeac M, Depeyre A, Pereira B, Barthelemy I, Dang NP. Virtual surgical planning and three-dimensional printing for the treatment of comminuted zygomaticomaxillary complex fracture. Journal of Stomatology, Oral and Maxillofacial Surgery. 2020.
Marro A, Bandukwala T, Mak WJCpidr. Three-dimensional printing and medical imaging: a review of the methods and applications. 2016;45(1):2-9.
Rengier F, Mehndiratta A, Von Tengg-Kobligk H, Zechmann CM, Unterhinninghofen R, Kauczor H-U, et al. 3D printing based on imaging data: review of medical applications. 2010;5(4):335-41.
Frame M, Huntley JSJTSWJ. Rapid prototyping in orthopaedic surgery: a user's guide. 2012;2012.
Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007;39(2):175-91.
Li L-F, Tu J-B, Hou C-Q, Hu X-Y, Zhao B-H. Application of 3D printing in the treatment of unilateral comminuted zygomatic bone fracture. Shanghai kou qiang yi xue= Shanghai journal of stomatology. 2019;28(2):154-7.
King BJ, Park EP, Christensen BJ, Danrad R. On-site 3-dimensional printing and preoperative adaptation decrease operative time for mandibular fracture repair. Journal of Oral and Maxillofacial Surgery. 2018;76(9):1950. e1-. e8.
Ellis E, Zide MF. Surgical approaches to the facial skeleton: Lippincott Williams & Wilkins; 2006.
Glória JCR, Fernandes IA, Silveira EMD, Souza GM, Rocha RL, Galvão EL, et al. Comparison of Bite Force with Locking Plates versus Non-Locking Plates in the Treatment of Mandibular Fractures: A Meta-Analysis. International archives of otorhinolaryngology. 2018;22(2):181-9.
el-Gengehi M, Seif SAJJoCS. Evaluation of the accuracy of computer-guided mandibular fracture reduction. 2015;26(5):1587-91.
Li J-p, Chen S-l, Zhang X, Chen X-y, Deng WJJoo, surgery m. Experimental research of accurate reduction of zygomatic-orbitomaxillary complex fractures with individual templates. 2011;69(6):1718-25.
Rana M, Chui CH, Wagner M, Zimmerer R, Rana M, Gellrich N-CJJoO, et al. Increasing the accuracy of orbital reconstruction with selective laser-melted patient-specific implants combined with intraoperative navigation. 2015;73(6):1113-8.
Jansen J, Schreurs R, Dubois L, Maal TJ, Gooris PJ, Becking AGJJoC-MS. The advantages of advanced computer-assisted diagnostics and three-dimensional preoperative planning on implant position in orbital reconstruction. 2018;46(4):715-21.
Essig H, Dressel L, Rana M, Rana M, Kokemueller H, Ruecker M, et al. Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study. 2013;9(1):1-7.
King BJ, Park EP, Christensen BJ, Danrad RJJoO, Surgery M. On-site 3-dimensional printing and preoperative adaptation decrease operative time for mandibular fracture repair. 2018;76(9):1950. e1-. e8.
Maloney K, Rutner TJCT, Reconstruction. Virtual surgical planning and hardware fabrication prior to open reduction and internal fixation of atrophic edentulous mandible fractures. 2019;12(2):156-62.
Mohd YQ, Reddy S, Sinha R, Agarwal A, Fatima U, Abidullah MJAoMS. Three-dimensional miniplate: For the management of mandibular parasymphysis fractures. 2019;9(2):333.
Gear AJ, Apasova E, Schmitz JP, Schubert WJJoo, surgery m. Treatment modalities for mandibular angle fractures. 2005;63(5):655-63.
Alkan A, Çelebi N, Özden B, Baş B, İnal SJOS, Oral Medicine, Oral Pathology, Oral Radiology,, Endodontology. Biomechanical comparison of different plating techniques in repair of mandibular angle fractures. 2007;104(6):752-6.
Mittal Y, Varghese KG, Mohan S, Jayakumar N, Chhag SJJom, surgery o. A comparative study of 3-dimensional titanium versus 2-dimensional titanium miniplates for open reduction and fixation of mandibular parasymphysis fracture. 2016;15(1):93-8.
Thapliyal S, Mowar A, Bansal VJJoM, Surgery O. Comparison Between Conventional Titanium Miniplates and Indigenous Detachable Custom made 3D Titanium Plates (VAS 3D Bone Plate) for Fixation of Mandibular Fracture in Mental Foramen Region: A Randomized Clinical Trial and Finite Element Analysis. 2020:1-8.
Graham RN, Perriss RW, Scarsbrook AFJCr. DICOM demystified: a review of digital file formats and their use in radiological practice. 2005;60(11):1133-40.
Tack P, Victor J, Gemmel P, Annemans LJBeo. 3D-printing techniques in a medical setting: a systematic literature review. 2016;15(1):1-21.

No competing interests reported.

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Evaluation of Accuracy of Three-Dimensional Printing and Three- Dimensional Miniplates in Treatment of Anterior Mandibular Fractures: Clinical Study

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Abstract

Background

Methods

Results

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1. Background

2. Materials and methods

3. Results

4. Discussion

5. Conclusion

Abbreviations

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