Accepted Manuscript

Titanium Lag Screw Versus Miniplate Fixation In The Treatment Of Anterior

Mandibular Fractures

Manish Tiwari, Vikas Meshram, Pravin Lambade, Gabriela Fernandes

PII: S0278-2391(19)30001-1
DOI: https://doi.org/10.1016/j.joms.2019.01.001
Reference: YJOMS 58586

To appear in: Journal of Oral and Maxillofacial Surgery

Received Date: 25 July 2018

Revised Date: 5 January 2019
Accepted Date: 5 January 2019

Please cite this article as: Tiwari M, Meshram V, Lambade P, Fernandes G, Titanium Lag Screw Versus
Miniplate Fixation In The Treatment Of Anterior Mandibular Fractures, Journal of Oral and Maxillofacial
Surgery (2019), doi: https://doi.org/10.1016/j.joms.2019.01.001.

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 ACCEPTED MANUSCRIPT

TITANIUM LAG SCREW VERSUS MINIPLATE FIXATION IN THE TREATMENT

OF ANTERIOR MANDIBULAR FRACTURES

Manish Tiwari *, Vikas Meshram2, Pravin Lambade3, Gabriela Fernandes4

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1
BDS,MDS Fellow Department of Oral and Maxillofacial Surgery, SDKS Dental College,
Nagpur
Fellow, Oral Oncology, Park Clinic, 4 Gorky Terrace Rd, Elgin, Kolkata, West Bengal, India.

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Email: drmanishstiwari@gmail.com
2
BDS, M.D.S., Associate Professor, Dept. of Oral and Maxillofacial Surgery,

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Government Dental College, Mumbai. Email: drvikasm@gmail.com
3
BDS,MDS Consultant oral and maxillofacial surgeon, Former Head of Department, Oral and

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Maxillofacial Surgery, SDKS Dental College, Nagpur. Email: drpravinlambade@gmail.com
4
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BDS, MS ,Resident and Postdoctoral Researcher, Department of Periodontics and Endodontics,
School of dental medicine, SUNY Buffalo, Buffalo, New York, USA
Department of Oral Biology, School of dental medicine, SUNY Buffalo, Buffalo, New York,
USA. Email: gfernand@buffalo.edu
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*Correspondence: Dr. Manish Tiwari, Fellow, Oral Oncology, Park Clinic, 4 Gorky Terrace Rd,
Elgin, Kolkata, West Bengal, India.
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Phone number: +918793116994

Email: drmanishstiwari@gmail.com
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TITANIUM LAG SCREW VERSUS MINIPLATE FIXATION IN THE TREATMENT

OF ANTERIOR MANDIBULAR FRACTURES

Abstract

Purpose

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The use of plates for open reduction and internal fixation of mandibular fractures has become

a widely accepted method in the past three decades. However, the anterior mandible is well

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suited to lag screw fixation owing to the thickness of its bony cortices. Hence, the purpose of

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the present study was to comparatively evaluate clinical outcomes of fixation using lag

screws and miniplates in anterior mandibular fractures.

Patients and Methods

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A total of 50 patients reporting to the Department of Oral and Maxillofacial Surgery with
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non-comminuted anterior mandibular fractures were randomly divided into two groups of 25

patients each. Group A patients were treated with 2.5 mm lag-screws of 22 to 26mm length
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and Group B patients were treated with 2.0 mm four hole miniplates with gap using
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monocortical screws. Subsequent follow-up was done at 3, 6, 12, 24 weeks postoperatively.

The primary determinants included radiographic analysis of the fracture gap and biting
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efficiency of the patients in two groups. The secondary determinants included evaluation of

duration of surgery, pre-injury and post-injury occlusion and postoperative complications.

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Results were evaluated using Chi square and the unpaired t test.

Results

The mean age of the patients in this study was 29.1±8.32 years, ranging between 18 to 67

years. The mean post-operative fracture gap was considerably greater in group B. The mean

duration of surgery (minutes) was 37.60 ± 9.30 for group A and 47 ± 6.55 for group B. The
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difference was found to be statistically significant (p = 0.001). The lag screw group showed

faster improvement in terms of biting efficiency as compared to mini-plate group.

Conclusions

Lag screw fixation was found to have good stability, rigidity, was inexpensive, and less time

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consuming in anterior mandibular fractures when compared with miniplates.

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Key words: lag screw, Miniplate, Mandibular fracture.

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Introduction

Among various maxillofacial injuries, mandibular fractures are the most encountered and are

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treated more commonly than any other fracture . The incidence of anterior mandibular
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fractures has been reported with a wide variance by several authors . An aggregate analysis
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places this at approximately 17% of all mandibular fractures .

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With rapid advancement in technology, the fixation techniques for mandibular fractures have
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greatly evolved . The methods employed for fixation of mandible fracture have greatly
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improved patient’s comfort, function and aesthetics. Historically, the fractures were treated
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with the closed technique such as intermaxillary fixation (IMF), splints and external fixation;

however, these methods involved a greater degree of discomfort due to their long course and
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restriction of mouth opening .

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The use of miniplates has been greatly revolutionized, ever since the introduction of

Champy’s ideal lines of osteosynthesis . The author advocated that the natural compression
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occurs along the lower border, thus there is no need for compression osteosynthesis but the

recent biomechanical studies are in contrast to the theory of natural compression at lower

border, tension at upper border in the anterior mandible .

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The advantages of using miniplates are, ease of handling, avoiding an external incision,

eliminating potential nerve damage, simultaneous surveillance of fractures line reduction and

occlusal relationships, thus eliminating the need for IMF and its complications . On the other
1,7

hand, various reported disadvantages of the miniplate system includes osteoradionecrosis,

plate exposure (external/intraoral), orocutaneous fistulae, plate infection, osteomyelitis,

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delayed union, nonunion, malunion, fracture of the mandible or vascularized bone graft, and

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inferior alveolar or marginal mandibular nerve injury due to surgical manipulation . 8

The lag screw technique was first described by Brons & Boering (1970) . He stated that lag

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screw system produces a constant pressure along the fracture fragment and immobilizes

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them. Niederdellmann (1976) reintroduced the lag screw technique and suggested that it
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can be an extremely useful alternative to plate osteosynthesis. Ellis (2012) carried out a
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study to compare lag screws with miniplates for symphysis fractures of mandible and found a
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decrease in number of complications with the use of the lag-screws.

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The objective of the present study was to evaluate and compare the treatment outcomes with
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the use of titanium lag screws and titanium miniplates for the management of anterior

mandibular fractures by open reduction internal fixation (ORIF). We hypothesized that lag
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screws would demonstrate better results than miniplates. The primary determinants included

radiographic analysis of the fracture gap and biting efficiency of the patients in two groups.
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The secondary determinants included evaluation of duration of surgery, pre-injury and post-
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injury occlusion and postoperative complications.

Patients and methods

All procedures performed in studies involving human participants were in accordance with

the ethical standards of the institutional and/or national research committee and with the 1964

Helsinki Declaration and its later amendments or comparable ethical standards. The
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randomised prospective study population was composed of all patients presenting to for

evaluation and management of non comminuted anterior mandibular fractures between

January 2014 to January 2016. An ethical approval for the study was obtained by the SDKS

dental college hospital institutional ethical committee. Once the patient reported to the

emergency department, a through history regarding the etiology, mechanism of injury, other

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fractures of mandible or midface, site of anterior mandibular fracture was obtained.

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In order to be included in the study, patients had to demonstrate non-comminuted

mandibular parasymphysis fractures with adequate mouth opening for intraoral procedures

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and those fit for surgery under general anaesthesia. Patients were excluded as study subjects

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were those with comminuted fractures as well as with uncontrolled systemic disease who
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were unfit to undergo surgery under general anaesthesia.

The fifty patients were randomly divided into two groups. Each group consisted of 25
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patients. Patients in group A (n=25) were treated with 2.5 mm lag-screws of 22mm to 26mm
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length. Patients in group B (n=25) were treated with 2.0 mm four-hole miniplates with gap
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using monocortical screws (6-8mm in length).

SURGICAL PROCEDURES
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Surgery for the subjects of both groups were performed under general anaesthesia with
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nasoendotracheal intubation, prepping and draping was done in standardized manner along
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with the preparation of the surgical site. An intraoral approach was used in all the patients.

The oral cavity was cleaned and irrigated with an antimicrobial solution (betadine solution),

and the surgical site was infiltrated with 2% lignocaine with adrenaline (1:100000 conc.), A

vestibular incision was made from 1 canine to the other. The incision was made 10 to 15mm

away from the attached gingiva. This unattached tissue below the mucogingival junction
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facilitates closure. Subperiosteal dissection was carried out and the surgical site was exposed.

After debridement of the fracture line, IMF was done. Fracture fragments were reduced and

fixed in position using a bone reduction forcep. Further fixation of the fracture was carried

out either by lag-screws or miniplates. If there were extensive areas of comminution, the lag

screw technique was abandoned, because it has little chance of success in cases where the

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continuity of the cortices is disturbed.

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Fixation using Lag-screws (fig 1):

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For Group A patients 2.5mm titanium lag-screw was used, a modification in the technique

described by Ellis and Ghali 12

was followed. The lingual cortex was reduced in an anatomic

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position by applying pressure at bilateral angle region. The screw was placed perpendicular,
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or nearly perpendicular, to the line of fracture. As medullary bone offers insufficient

resistance to bone screw fixation; therefore, a bony cortex must be engaged with the terminal
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threads of the screw.

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Use of a two-step drilling as described by Ellis and Ghali was not needed as standard lag-
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screws were used in the present study instead of cortical screws. The threaded portion was

only in the terminal half of the screw with a diameter of 2.5mm and the non-threaded portion
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had diameter of 1.8mm. A 2.0 mm drill bit was used for the drill into the near and the far
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fragment which would keep the screw engaged in the far fragment and glide through the near
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fragment (fig 2).

A countersinking tool was used at slow speed to provide a smooth platform for screw-head

seating. The lag screw was placed such that threaded half of the lag screw should be

completely in the far segment and the non-threaded part in near fragment. Thus, when

tightened, the screw would compress the two segments of bone together. A second screw was

then inserted in the same manner as previously described.

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Fixation using miniplate (fig 3):

In group B, two titanium miniplates 4-hole with gap, were used based of the Champy’s

principle of osteosynthesis. The inferior plate was fixed first followed by the subapical plate.

The plates were carefully contoured to the mandible’s surface. Screws of 6 to 8mm length

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were placed with two screws on either side of the fracture line. While placing the screws in

near fragment bilateral pressure was applied over the angle region in order to reduce the

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lingual plate sufficiently. The bone clamp was then removed and the second plate was

applied more superiorly on the buccal cortex, attempting to avoid the root apices by placing

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the plate beneath or between them.

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The IMF was released, occlusion checked, and the incisions were closed, taking care to
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suture together the incised mentalis muscle. In all cases, a self-adhesive elastic dressing was

applied around the chin/submental area to superiorly support the chin for 5 to 7 days.
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Postoperatively, routine antibiotics and analgesics were prescribed.

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FOLLOW UP
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Post operative Panaromic radiographs were taken within 1 day after the surgery; clinical data
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was collected through a questionnaire designed for the study on pre-operative, 3 , 6 , 12 &
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24 week.
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ASSESSMENT OF PARAMETERS
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Demographic variables like age, sex, gender, etiology of injury, occlusion, and fracture

patterns were recorded for all the patients. Evaluation of pre-operative and immediate post-

operative panoramic radiographs of all patients was done to measure the gap between fracture

segments.
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A method presented by Schaaf and Goel et al was modified in order to acquire accurate
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reproducible points on the fracture line. Here, a perpendicular line is drawn from the orbital

plane on a selected fractured segment, keeping a distance of 1cm from the most inferior point

on the fracture line. Four equidistance perpendicular lines are projected on the fracture line to

measure the gap. On the post-operative Panorex, lines are projected by using similar vertical

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and horizontal references and the gap is measured and compared using digital Vernier caliper

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device (fig 4).

The biting force test was performed in both the groups on three sites in the arch, i.e. in left

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and right posterior segments between upper and lower molars and anteriorly between incisors

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on each post-operative follow up appointments until 24 week. A customized laboratory
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calibrated gnathodynemometer was used for recording biting force, where the patient needs

to bite on a sensor and the amount of force applied is shown on screen in kilograms per
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square centimeter (Kg/cm ) (fig 5).

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All the measurements were made with the subject seating with head upright, looking forward,
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and in an unsupported natural head position. The instrument was conveniently placed

between a single pair of opposing cusps in region of molars and incisors. The patients were
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advised to bite four times as forcefully as possible and the average of all the readings was

recorded from each site. Healthy subjects without any injury to mandible, with age ranging
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from 18 to 60 years underwent a single session of bite force record to rule out average biting
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force in healthy individuals.

Operative time was measured from start of incision to closure of wound. Post-operative

complications like neurosensory disturbance, soft tissue infection, implant exposure, implant

breakage, occlusal discrepancy, segmental mobility and malunion were noted and compared

among two groups using chi – square test.

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Statistical analysis: The software used in the analysis was SPSS 17.0 and Graph Pad Prism

5.0 version and p<0.05 was considered significant. The statistical tests used for the analysis

of the result were Students unpaired t test, Student’s paired t test, One way ANOVA,

Multiple Comparison (Tukey) Test, chi-square test, Mann Whitney U Test and Wilcoxon

Signed Rank Test.

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Results

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The mean age of the patients in this study was 29.1±8.32 years, ranging between 18 to 67

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years, and the male to female ratio was 15:1. The most common etiology of mandibular

fracture in this study was found to be motor vehicle crash (MVC) (82%), followed by fall

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from height (16%) and interpersonal violence (2%). Out of total samples, isolated symphysis
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and parasymphysis fractures were found in 56% of the patients, 22% of the patients had

associated condyle fracture, 20% of the patients had associated angle fracture, and 2% of the
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patients had fracture associated with body fracture.

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There was no significant difference in the pre-operative gap between the fracture fragments
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in two groups (p < 0.05). The evaluation of preoperative fracture gap using multiple

comparison test in total patients (n=50) showed statically significant gap at lower border
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(point D) than the upper border (point A) (p=0.0001) (fig. 6).

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Mean post-operative gap in group A at point A - 0.45±0.27 mm, point B - 0.43±0.26 mm,
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point C- 0.52±0.31 mm, point D - 0.73±0.52 mm and in group B at point A - 0.90±0.66 mm,

point B - 1.11±0.72 mm, point C - 0.94±0.51 mm, point D - 1.11±0.57 mm. The mean post –

operative gap among the lag-screw and the miniplate group was compared using Students

unpaired t test, it was significantly less in group A. The difference was found to be statically

significant (p < 0.05) (Table 1).

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On comparing amount of reduction in gap at four points by using Tukey multiple comparison

test statistically significant difference was found between point A and point D (p<0.05) in

group A. There was no difference in the amount of reduction in group B at different points.

The comparison of mean biting force record at different post – operative weeks in two groups

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are shown in table 2 and fig 7, 8 and 9. The values were found to be significantly higher in

group A at anterior region on 6 , 12 , 24 week post-operative follow-up (p < 0.05). The

th th th

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difference at right and left molar region was statically insignificant (p > 0.05). To rule out

the normal biting force in the population, 50 healthy subjects without any injury to mandible

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underwent only single bite force recording. The mean maximal bite force of the healthy

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individuals in incisor region was 18.14 Kg/cm , on left side posterior region it was 32.52
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Kg/cm and at right posterior region it was 37.43 Kg/cm . These findings were used as
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baseline for the comparison of biting rehabilitation among two groups. The comparisons
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show the significant increase in bite force in group A in the anterior region at the 6 , 12 &
th th

24 week.
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The mean operating time in group A patients was 37.60±9.30 minutes and in group B it was

47±6.55 minutes. By using Student’s unpaired t test statistically significant difference was
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found in I-C interval in two groups (t=4.13, p=0.0001).

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Various post-operative complications noted were, neurosensory disturbance in 4% of the

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patients of group A, soft tissue infection in 4% of the patients in group A and 8% of patients

in group B. Implant exposure in 4% of the patients of group B, Occlusal discrepancy was

observed in 8% of the patients in group B. Implant breakage, segmental mobility and

malunion were not seen in any patients. By using chi-square test statistically, no significant

difference was found in complications in both the group of patients (2‫א‬-value=2.00, p=0.35)

(table 3).
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Discussion

The results of the present study showed that, in comparison to the miniplates, lag screws

showed better reduction of fracture fragments, thereby, better healing and early rehabilitation

of masticatory forces. Many choices for ORIF of symphysis fractures are available, including

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lag screws, geometric bone plates, double miniplates, and a single strong non-reconstruction

bone plate. The thickness of the bony cortices provides secure fixation when the screws are
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properly inserted. Also, there are no anatomic hazards below the apices of the teeth until the

mental foramina is encountered . This makes lag screw placement straightforward, safe and

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reliable in anterior mandibular fractures ; besides these advantages, lag–screws are not
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routinely used in practice.
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The predominance of mandibular fracture was more in male patients (94%) than the females

(6%), which is in accordance with the studies by Ellis , Prabhakar, et al , Goel et al . This
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can be justified by the fact that the males are more prone to outdoor situations like MVC,
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sport activities etc. The most common etiology of mandibular fracture in this study was
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found to be MVC (82%) followed by fall from height (16%) and interpersonal violence (2%).

The etiological factors are in accordance with Ellis , Prabhakar et al . Whereas, the results of
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present study are in contrast to study by Johansson where assault was reported as etiological
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factor in 70% cases and MVC was noted in only 16% of the cases of mandibular fracture.
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The most common type of fracture pattern was isolated symphysis or parasymphysis fracture
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(56%), followed by symphysis / parasymphysis fractures associated with condyle (22%),

angle (20%) and body (2%) fractures. Ellis 15

found more number of patients having

symphysis fractures associated with angle fractures, which could be because of assault being

most common cause of injury reported. The mean post- operative gap in the patients treated

with lag - screws was significantly less than the miniplate group (p value < 0.05). This

suggests the compression exerted by the lag-screw technique. Similar comparative studies by
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Goyal , Schaaff ,et al also found significantly less fracture gap in lag-screw group when
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compared to iniplate group. Dediol, et al, in their study, concluded that a lag-screw offers
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better healing due to compression of the fracture segments. Results of the present study also

shows that a lag screw corrects the lower border flaring better than miniplates i.e. the amount

of reduction in lag screw group was significantly higher at the point D when compared with

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the point A (P = 0.021) where, no such observations were obtained in the miniplate group (P

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> 0.05). To rule out the biting force in an average healthy individual, 20 healthy subjects

without mandible fracture underwent a session of bite force recording. The mean maximal

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bite force in healthy subjects in incisor region was found to be 18.14±2.16kg, on left side

posterior region it was 32.5±26.38 kg and at right posterior region it was 37.43±5.92 kg. The

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findings in healthy subjects were in accordance with the studies by Ellis , Gerlach, et al, and
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used as baseline for the comparison of biting rehabilitation among two groups. None of the
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subjects in present study achieved biting force as that of the healthy subjects; this could be

attributed to a neuromuscular protective mechanism called muscle splinting . Some selective

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components of neuromuscular system are activated and de-activated to take forces off the
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damaged bone. In the present study, there was an increase in the biting force at subsequent

follow ups in both the groups. The difference of bite force was statically insignificant in right
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and left molar region (P > 0.05) (fig. 6, 7) but it was significantly higher on anterior region in
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group A at 6 , 12 , 24 week follow-up (P < 0.05) (fig 8). In a comparative study by

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Bhatnagar et al , higher vertical bite forces after fixation of the anterior mandibular fractures
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was noted in the lag screw group when compared to miniplates (P < 0.01). A study done by

Mittal et al and Madsen and McDaniel shows statistically significant difference between the
21 2

lag screw and other techniques for both yield load and stiffness. They also stated that when

molar loading was considered, the lag screw technique performed more favorably than any

other fixation systems.

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The operating time was found to be 37.60±9.30 minutes in lag-screw group and 47±6.55

minutes in miniplates fixation. Student’s t- test was applied, the difference in the operating

time was found to be significantly less in lag-screw group (P < 0.05). The rapidity of the lag

screw fixation has also been demonstrated by Goel et al , Schaaf et al , Elhussein et al and
14 13 22

Ellis . The shorter duration of the surgery is associated with fewer post-operative
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complications, less hospitalization and thereby significant decrease in financial burden on

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patients . The longer duration with the use of miniplates is obvious because of the need to
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adopt and contour the plates adequately. Furthermore, in present study, two patients (8%) in

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the group B had post-operative occlusal discrepancy which was corrected using guiding

elastics. At the end of 24 week, all the patients had functional and anatomical occlusion.
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These results are consistence with the results of study carried out by Agnihotri et al . 24
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Cawood reported malocclusion in 6% of patients treated with miniplates in mandibular
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symphysis fractures. The intraoperative difficulty in fixation was encountered more in the

lag- screw group. In miniplate group screw loosening was encountered in two patients (8%),
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which were corrected by screws of larger diameter. In the lag-screw group screw head of lag-
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screw was broken in one patient (4%) while final tightening, the drill bits had broken at two

instances (8%) which were retrieved and other hole was drilled for the fixation of lag –
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screw. Tiwana et al encountered drill breakage in 5.9% of cases. Assael concluded that lag
26 27
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screw fixation of symphyseal fractures had a particularly high rate of technique related
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failures. Improper or inadequate counter-sinking was common reason for fractures of the

outer cortex or distraction of the fracture when the screw was tightened. Fracture of the

buccal cortex due to improper countersinking was observed in one case in the present study.

The incidence of post-operative complications was more frequent in miniplate group than

that lag screw group. A neurosensory deficit was observed in the 1 patient of the lag-screw
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group, probably due to the close approximation of the fracture line to the mental foramen
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leading to paraesthesia in the symphysis region postoperatively; sensation was recovered

within 6 weeks. As the loop of the mental nerve has variable anatomical locations from

patient to patient lying anterior to the mental foramen, carries risk of damage by lag screws.

Kallela et al reported paraesthesia in the region of the mental nerve distribution in 68% of
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cases, which recovered within an average of 5.4 weeks. The use of miniplates instead of lag

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screws in cases where fracture lines passes closure to the mental foramen has been advocated.

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The results of present study are also consistent with the similar studies carried out by

Emam , Goel et al . Moreover, we found soft tissue infection to be present in 4% cases of

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group A and 8% in group B (table 4). The possible reason for infection in symphysis region

could be pre-existing subclinical infection, loose implants, foreign body reaction,

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inappropriate sterilization, poor host defence and poor oral hygiene. The infected cases were
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managed by local curettage and debridement, and short-term antibiotic therapy. None of the
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patients required implant removal post-operatively. This is in contrast to study by Agnihotri

et al who reported plate removal secondary to infection in 10% of the cases.

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Conclusion
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Within the limitations of the study, lag screws proved better than the miniplates for the
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management of lower border distraction in symphyseal region. It takes lesser operating time

and is associated with minimal complications. Though it is technique sensitive, it shows a

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gradual learning curve; once mastered, it is one of the excellent treatment options for the
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sagittal anterior mandibular fractures. Further studies should be directed towards larger

sample groups.

Conflicts of interest: The authors report no conflict of interest

Sources of funding: Nil

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Mittal G, Aggrawal A, Garg R, Sharma S, Rathi A, Sharma V. A clinical prospective
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516.

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Figure legends:
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Figure 1: Intraoperative photograph demonstrating fixation of mandibular fracture using Lag

– screws.
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Figure 2: A. 2.0mm drill bit overlapped over a lag screw shows its ability to engage the screw
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in far segment and glide in near segment. B to D. shows movement of far fragment close to
near fragment as the screw is tightened.
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Figure 3: Intraoperative photograph demonstrating fixation of mandibular fracture using

mini-plates.

Figure 4: Measurement of fracture gap using digital Vernier caliper device.

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Figure 5: Assessment of biting force using customized laboratory calibrated

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Gnathodynemometer.

Figure 6: Comparison of post-operative gap between fracture segments in two groups

Figure 7: Comparison of biting force record in two groups at right posterior region

Figure 8: Comparison of biting force record in two groups at left posterior region

Figure 9: Comparison of biting force record in two groups at anterior region

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Tables:

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Table1: Comparison of post op gap in two groups at four points (Student’s unpaired t test); S –
statically significant

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t-test for Equality of Means

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Point Difference

Mean Std. Error

T df p-value Lower Upper
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Difference Difference

0.003,S
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Point A 3.189 48 0.45 0.14 0.16 0.74

p<0.05
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0.0001,S
Point B 4.425 48 0.67 0.15 0.37 0.98
p<0.05
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0.001,S
Point C 3.502 48 0.42 0.12 0.17 0.66
p<0.05
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0.021,S
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Point D 2.388 48 0.37 0.15 0.05 0.68

p<0.05
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Table 2: Comparison of biting force record in two groups (Student’s unpaired t test)

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SC
Group A Group B
t-value p-value
Mean SD Mean SD

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Right 7.33 1.43 7.20 1.58 0.30 0.76,NS
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3rd week Anterior 5.01 1.56 5.08 1.57 0.15 0.87,NS

Left 6.95 1.52 6.71 1.13 0.61 0.54,NS

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Right 11.92 1.19 11 2.53 1.63 0.10,NS

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6th week Anterior 9.49 1.97 6.99 1.69 4.79 0.001,S

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Left 10.85 2.31 10.04 1.57 1.45 0.15,NS

Right 14.61 1.40 14 2.59 1.03 0.30,NS

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12th week Anterior 12.32 1.02 8.90 1.67 8.74 0.001,S

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Left 14.07 1.56 14.21 1.49 0.31 0.75,NS

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Right 21.28 2.57 21.07 2.69 0.27 0.78,NS

24th week Anterior 13.43 1.28 11.44 1.50 5.04 0.001,S

Left 18.63 2.25 19.29 2.14 1.06 0.29,S

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Table 3: Comparison of Post-operative complications in two groups

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Group A
Group B
Complications (Lag Total ‫א‬2-value p-value
(miniplates)

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screws)
Neurosensory
1(4%) 0(0%) 1(2%)
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disturbance
Soft tissue infection 1(4%) 2(8%) 3(6%)
Implant Exposure 0(0%) 1(4%) 1(2%)
0.35, NS,
Implant Breakage 0(0%) 0(0%) 0(0%) 2.00
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p>0.05
Occlusal Discrepancy 0(0%) 2(8%) 2(4%)
Segmental Mobility 0(0%) 0(0%) 0(0%)
Malunion 0(0%) 0(0%) 0(0%)
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Total 2(8) 2(8%) 4(8%)

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