Comparative assessment of improvement in masticatory efficiency in patients with anterior mandibular fractures treated with four-hole versus six-hole mini plate fixation. A pilot randomized control trial.

The mandible is the second most common fractured bone over the facial region after the nose. Road traffic accidents, assaults, and falls from height are common causes of mandibular fractures. Of about 15.1% of reported cases of anterior mandibular fractures, symphysis and parasymphysis fractures account for 2.85% and 12.16%, respectively. A fractured mandible undergoes compression, tension, and torsion due to different muscle forces. Mandibular fracture treatment aims to restore anatomical form and function and re-establish the occlusion, thereby improving the bite force. According to AO (Arbeitsgemeinschaft für Osteosynthesefragen), sufficient internal fixation hardware must be applied to resist the maximum forces of mastication. Recommendations for the amount of fixation hardware necessary to treat fractures of the mandible vary widely—the size of plates (thickness, length, number of holes). The diameter and length of screws, and the number of plates used for anterior mandible fractures differ from surgeon to surgeon. Measuring bite force is an excellent assessment criterion for restoring bony architecture and healing of masticatory soft tissue. Champy and colleagues advocated a modification of Michelet’s miniplate osteosynthesis technique and described ideal lines of osteosynthesis. A standard protocol of osteosynthesis is to use two 4-hole mini plates in anterior inter-foraminal fractures. One at the tension zone and one at the compression zone. Disadvantages of miniplate usage include chances of buccolingual splaying and gap formation at the inferior border. Our study plans to assess the bite force primarily along with pain, swelling, stability and buccolingual splaying if one 4-hole plate was to be placed subapically and a 6-hole mini plate was placed at the inferior border.