The Multipoint Contact Plate in Fracture Treatment of the Atrophied Mandible: Animal Study and Clinical Application

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Abstract
Rapid consolidation of osseous fractures requires stable immobilization of the fragments. In the atrophied mandible, the nutrient supply should be ensured by protecting the periosseous soft tissue, i.e., the periosteum. In the conventional placement of osteosynthesis plates, however, the subimplant nutrition is restricted because of the high surface pressure between the osteosynthesis plate and bone. In order to improve the subimplant nutrient supply, we designed a new osteosynthesis plate with a "knobbed" underside enabling multipoint contact. Histomorphologic comparative studies were conducted on 16 Göttingen minipigs with an average weight of 47.5 +/- 8 kg. In each minipig, one side of the mandible was fractured and one side was left intact. One side of each mandible was plated with a six-hole dynamic multipoint contact plate and the other side with a conventional plate. The plates were applied, either epiosseous or epiperiosteal, with bicortical screws under defined torque. The results demonstrate the advantages of multipoint contact plates over the conventional ones and create the clinical basis for a "bio-logical" plate design that allows callus to grow between the knobs and therefore provide adequate nutritional and vascular supply. The plate's knobbed profile also promotes extraosseous venous drainage without impeding intraosseous fluid flow. This plate is the logical choice for rapid fracture consolidation in the high-grade atrophied mandible.