J Stomatol Oral Maxillofac Surg 120 (2019) 390–396

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Original Article

Effect of pulsed electromagnetic field on mandibular fracture healing:

A randomized control trial, (RCT)
H. Mohajerani a, F. Tabeie b, F. Vossoughi c, E. Jafari d, M. Assadi d,*
a
Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
b
Department of Nuclear Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
c
Department of Oral and Maxillofacial Surgery, School of dentistry, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
d
The Persian Gulf Nuclear Medicine Research Center, Bushehr University Of Medical Sciences, Bushehr, Iran

A R T I C L E I N F O A B S T R A C T

Article history: Introduction: Currently, the pulsed electromagnetic field (PEMF) method is utilized for the treatment of
Received 12 February 2018 nonunion long bone fractures. Considering the established effect of the PEMF on the acceleration of the
Accepted 25 February 2019 bone healing process, we conducted this study to evaluate the effect of PEMF on the healing process in
Available online 2 March 2019
mandibular bone fractures.
Material and methods: : This research was a randomized control trial (RCT) study. The sample consisted of
Keywords: patients with a mandibular fracture who were hospitalized in order to receive closed reduction
Pulsed electromagnetic fields
treatment. The participants were randomly selected and then sequentially divided into two groups of
Bone density
Mandibular fracture
16 participants each (controls = 16, cases = 16). The patients in the control group received conventional
Bone healing therapy without any extra treatment, while the patients in the case group received PEMF therapy in
Pain management addition to conventional therapy. For the PEMF therapy, patients in the case group received immediate
post-surgery PEMF therapy for 6 h. Next, they received 3 h of exposure for the next 6 d, and finally, the
same process was repeated for 1.5 h for post-surgery days 8–13. The maxillomandibular fixation (MMF)
device was removed at post-surgery week 4. The patients in the control group, however, did not receive
any extra treatment. The efficiency of the treatment modalities was evaluated clinically and
radiographically. For the radiographical assessment, we employed a direct digital panoramic machine
to calculate the computerized density of the bone, and those measurements were used for comparison of
the results between the control group and the study patients.
Results: There was no significant difference in the mean bone density values between the two groups
(P > 0.05). However, the percentage of changes in bone density of the two groups revealed that the case
group had insignificant decreases at post-surgery day 14 and a significant increase at post-surgery day
28 compared with the control group (P < 0.05). After releasing the MMF, a bimanual mobility test of the
fractured segments showed the stability of the segments in all patients. In the case group, the mouth
opening was significantly more stable than that of the control group (P < 0.05).
Conclusion: PEMF therapy postoperatively leads to increased bone density, faster recovery, increased
formation of new bone, a further opening of the mouth, and decreased pain.
C 2019 Elsevier Masson SAS. All rights reserved.

1. Introduction The basic treatment principles for mandibular fracture include

The mandible is the most common bone in the jaw that is
injured in facial trauma. Although the mandible is the largest and
strongest facial bone, fractures are quite common, and in the
middle region of the face, they occur two to three times more often
than in other parts of the face [1].
* Corresponding author.
E-mail address: assadipoya@gmail.com (M. Assadi).
reduction, fixation, immobilization, and supportive therapies.
Reduction can be attained with two procedures, which include
the closed and open techniques. In the closed reduction technique,
the fracture site is not surgically exposed, and the reduction is
obtained with palpation of the bony fragments and restoration of
the dental occlusion. Open reduction includes exposure of the
fracture region to allow direct observation, validation of the
procedure, and direct insertion of a fixation device at the fracture
site [2].

https://doi.org/10.1016/j.jormas.2019.02.022
2468-7855/ C 2019 Elsevier Masson SAS. All rights reserved.
 H. Mohajerani et al. / J Stomatol Oral Maxillofac Surg 120 (2019) 390–396
Open reduction was found to be more popular than closed
reduction among surgeons. However, the closed technique is still a
valuable option when considering treatment of mandibular
fracture [3]. In closed reduction, there is no threat of surgical
morbidity, hospitalization, and the high cost of open reductions
[4]. However, the long period of immobilization required and the
subsequent delay of rehabilitation are significant limitations of the
closed technique [5].
In pharmacological studies, a range of items, such as the
regional use of growth factors, calcium sulfate, bone morphoge-
netic proteins [6], systemic reception of vitamin D, parathyroid
hormone, estrogen, and base phosphonates, were evaluated for
increasing the speed of fracture healing [7]. Other treatment
procedures, including electrical, mechanical, and magnetic stimu-
lation, the use of shock waves, hyperbaric oxygen treatment, and
noninvasive ultrasound, were also evaluated for increasing the
speed of fracture healing [8].
In the last decade, among the reported treatment procedures,
the use of the biophysical intervention of pulsed electromagnetic
field (PEMF) therapy was considered because it is a noninvasive,
convenient, and easy to use intervention [9,10]. In 1970, the pulsed
magnetic field was developed as a beneficial instrument for
fracture regeneration. Although the mechanism of its action was
unknown, it caused the effective regeneration of nonunion bone
fractures [11].
In theory, PEMF offers a number of advantages, such as
reactivation of the biological procedure of bone regeneration,
simplification of fracture regeneration, and a shortened duration of
treatment. In addition, some studies reported that PEMF has a
positive effect on bone regeneration with certain energy transmis-
sion settings. These studies were commonly performed on long
bones and vertebral bones [12]. However, PEMF is still not fully
understood; therefore, one of the aims of this study was evaluation
of the effect of the pulsed magnetic field on the regeneration
process in patients with mandibular fracture. Also, as mentioned,
since the most significant limitation of closed reduction is the need
for a long period of immobilization, an additional aim of this study
was the evaluation of the effect of PEMF on reducing this period.
2. Material and methods
2.1. Participants and study design
This study was a randomized clinical trial project conducted
among candidate patients for closed reduction treatment hospital-
ized with a mandibular fracture in the oral, jaw, and facial surgery
Fig. 1. A patient who underwent maxillary mandibular fixation (MMF) (A) and pulsed electromagnetic field (PEMF) therapy.
391
department of a tertiary university-affiliated hospital in Tehran, Iran.
The sampling method was by census. In the studied population,
16 patients were in the control group, and 16 patients underwent
PEMF treatment. Inclusion criteria included the patient’s consent to
participate in the study, a mandibular fracture in the dental region,
the possibility of the application of an arch bar and maxillary
mandibular fixation (MMF), absence of signs of infection in the
fracture region, lack of systemic diseases affecting favorable stages of
bone regeneration, and treatment indications of closed reduction.
Exclusion criteria included lack of consent to participate in the study
and contraindications of closed reduction treatment.
Postoperatively, all of the patients received 1 g cefazolin and
8 mg of dexamethasone intravenously and 5 mg of morphine
sulfate intramuscularly. For closed reduction, the region of the
mandibular fracture underwent reduction manually, and after
closing the arch bar, MMF was established in the patients with 24-
gauge wire (Fig. 1). Then, using the block randomization method in
the form of foursome block and non-blind, all the patients were
randomly divided into two groups, which included cases
(16 patients) and controls (16 patients). The case group was
exposed to PEMF, while the control group was not exposed to any
radiation, and the device was turned off for them.
The PEMF device was a portable unit that consisted of a coil and
a magnetic field generator source along with a power supply
source-generated PEMF with 1 millitesla (mT) intensity and 40 Hz
frequency. The coil was fixed in the fracture zone (Fig. 2).
The protocol for exposure to the PEMF was as follows:
 immediately post-surgery for 6 h with the intensity of 1 mT and
a frequency of 40 Hz;
 three hours daily for the next 6 d (days 2–7) post-surgery with
the intensity of 1 mT and a frequency of 40 Hz;
 1.5 hours daily for the next 6 d (days 8–13) after operation with
the intensity of 1 mT and a frequency of 40 Hz.
MMF was opened in the case group after 4 weeks and in the
control group after 6 weeks post-surgery. Patients were followed
up on the day of surgery, and 7, 14, and 28 d post-surgery. Patient
pain, sensory changes in the fracture region, the maximum amount
of mouth opening, displacement of the fracture region, infection,
and malocclusion of the fracture region were evaluated at each
visit. The Visual Analog Scale (VAS) was used for pain measure-
ment and rated from 1–10. On this scale, 0, 1–3, 4–7, and 8–10
were considered as no pain, slight pain, moderate pain, and severe
pain, respectively. Patient verbal affirmation of abnormal lip
sensation was used for evaluation of sensory changes along with a
questionnaire that had been completed by the patients. In this
392 H. Mohajerani et al. / J Stomatol Oral Maxillofac Surg 120 (2019) 390–396
Fig. 2. The electromagnetic pulse device.
questionnaire, sensory changes had been described as numbness,
pinching, tingling, painful, burning, and no sensory changes. Also,
the maximum amount of mouth opening determined by measur-
ing the distance between upper and lower anterior teeth with a
Vernier caliper. Displacement of the fracture region was assessed
bimanually after the MMF opening. Malocclusion was diagnosed
by evaluating the relationship between the anterior and posterior
teeth and noting signs of infection, such as erythema, edema, and
infectious drainage from the fracture region. In addition, bone
density was determined by computerized quantitative radio
densitometry (Fig. 3). Standardized digital panoramic radiographs
at days 0, 14, and 28 post-surgery were performed for each patient
with a digital panoramic and cephalometric imaging system
(Cranex D; Sorodex, Inc., Germany) using the following exposure
parameters; 57–85 kVp, ten mA, and exposure of the panoramic
program set at 11 s. The digital images were evaluated by Sorodex,
Inc.’s Digora for Windows 2.7 (DfW 2.7) software. On panoramic
Fig. 3. Bone density is determined by using quantitative radiodensitometry using X-ray.
images, Dfw 2.7 is capable of measuring the bone density in the
fracture site by measurement of the Pikel value as a grey level with
a score of 0 to 250.
This study complied with the Declaration of Helsinki and was
approved by the Ethics Committee of Shahid Beheshti University of
Medical Sciences. It was also registered with the Database for
Clinical Trials (Iranian Registry of Clinical Trials, reference no:
IRCT2016022526769N1).
2.2. Statistical analysis
Comparison of the average of quantitative variables between
groups was made by a t-test and repeated measurement analysis of
variation (ANOVA), and for quality variables, the chi-square test
was used. Also, P < 0.05 was considered as statistically significant.
3. Results
All 32 patients (24 males, 8 females) enrolled in this study had
been diagnosed with a mandibular fracture. The mean age of the
study patients was 37.03  10.5 (19–51) years (Table 1).
The mean bone density immediately after treatment was
130.6  18.6 gr/cm2 in the case group and 145.6  18.7 gr/cm2 in
the control group; at post-surgery week 2, it was 124.10  18.2 gr/
cm2 in the case group and 128.4  18.9 gr/cm2 in the control group;
at post-surgery week 4, it was 144.6  19.3 gr/cm2 in the case group
and 131  20 gr/cm2 in the control group. Mean of bone density
changes at various times in the different study groups is shown in
Figs. 4 and 5.
The instant mean pain score post-surgery in the case group was
6.7  1.4; at post-surgery day 1, it was 2.8  1.2; at post-surgery
week 1, it was 1.75  1.06; and at post-surgery week 2, it was
0.81  0.83. In the control group, it was 7.5  0.75 immediately post-
surgery; at post-surgery day 1, it was 5.6  1.01; at post-surgery
week 1, it was 3.85  0.9; and at post-surgery week 2, it was
 H. Mohajerani et al. / J Stomatol Oral Maxillofac Surg 120 (2019) 390–396 393

Table 1
Comparison of demographic data between two study groups.

All Case group Control group P-value

Age (year) 37.06  10.5 37.06  10.6 37  10.7 0.987

Male 24 (75%) 13 (81.3%) 11 (68.8%)
Sex Female 8 (25%) 3 (18.8%) 5 (31.3%) 0.414

Left angle 5 (15.6%) 3 (18.8%) 2 (12.5%)

Right angle 5 (15.6%) 3 (18.8%) 2 (12.5%)
Left body 4 (12.5%) 3 (18.8%) 1 (6.3%)
Fracture region Right body 8 (25%) 3 (18.8%) 5 (31.3%)
Symphysis 2 (6.3%) 1 (6.3%) 1 (6.3%) 0.672
Right parasymphysis 3 (9.4%) 2 (12.5%) 1 (6.3%)
Left parasymphysis 5 (15.6%) 1 (6.3%) 4 (25%)
Fracture etiology Accident 22 (68.8%) 10 (62.5%) 12 (75%)
Strife 5 (15.6%) 2 (12.5%) 3 (18.8%)
Sports injury 3 (9.4%) 2 (12.5%) 1 (6.3%) 0.438
Falling from height 2 (6.3%) 2 (12.5%) 0 (0%)

2.4  0.9. The mean of pain score changes at different times and in the
different study groups are shown in Figs. 6 and 7.
The maximum amount of mouth opening was 46.7  3.02 mm
in the case-control, and 34  5.4 mm in the control group was
statistically significant (P = 0.0001). Additionally, the comparison
between the number of sensory changes at different times for the two
study groups showed no significant difference (Table 2). Furthermore,
the malocclusion numbers between the two groups were not
significantly different (P > 0.05). None of the patients showed signs
of fracture displacement or infection.
4. Discussion
Recently, new methods have been used in the healing of
mandibular fractures. Therefore, for the prevention of side effects,
such as dental and periodontal problems, temporal joint disorder,
nutrition failure, and occupational disability, using a method
making the fixation course shorter is very important. In this
randomized controlled study, we investigated the clinical efficacy
of the PEMF in the post-surgery mandibular fracture. We followed
up relevant factors, including the amount of bone density, mouth
opening, pain, and malocclusion between the case and control
groups.
In this study, the use of a long period immobilization with MMF
was in accordance with other studies that showed clinical stability
of 75–80% of mandibular fractures by week 4 [13]. One study
reported that 4.67  0.72 weeks were required for mandibular
fracture healing when treated by MMF [14].
In the current study, bone density changes were measured with
a CADIA (computer-assisted densitometric image analysis) system.
Compared to the conventional method, this is a feasible, low-cost
method with the ability to measure quantitative changes of density
by consecutive radiographs; clinical studies also showed a
significant relationship between CADIA and conventional quanti-
tative measurements for measurement of bone mineralization
[15].
According to the CADIA bone density measurement results,
values of bone density had decreased at post-surgery day 14 in
both groups, which could have been due to start of the
regeneration stage. However, at post-surgery day 28, the value
of bone density had increased, possibly due to callus regeneration.
These findings generally agree with those in a study that reported a
decrease in mean bone densities at post-surgery day 15 and an
increase in these values at post-surgery day 30 [2]. These results
can be explained by the concept of fracture healing that secondary
bone healing using either biologic immobilization alone or medical
fixation is characterized by callus formation [16]. The bone healing
sequence can be summarized as follows:

 formation of inflammation and hematoma;

 interfragmentary stabilization by periosteal and endosteal callus
generation;
 restoration of continuity by membranous and endochondral
ossification;
 Haversian remodeling and functional adaption [17].

Another study showed that the largest decrease in optical

Fig. 4. Comparison of the mean bone density at different times in the groups.
density was seen at days 7–14, and the largest increase in optical
density was at weeks 6–8 after repositioning and fixation of the
fracture site [18]. In contrast, one study reported an unanticipated
increase in bone density at post-surgery day 15, and a more
significant decrease in optical density was seen at day 30 in the
MMF group because of callus formation [19]. It has been reported
that fracture healing goes through four phases in humans
including: hematoma formation; early inflammatory phase (weeks
2–4); repair (proliferation and differentiation within 1–2 months);
and the late remodeling phase, which lasts for months or even
years [20]. An animal model study reported that fracture healing is
394 H. Mohajerani et al. / J Stomatol Oral Maxillofac Surg 120 (2019) 390–396
Fig. 5. Comparison of bone density changes at several times between the two groups.
characterized by three overlapping phases: the initial inflamma-
tory response, callus generation, and initial bony union and bone
remodeling. Thus, the inflammatory phase by the end of post-
surgery week 4 leads to a decrease in the mean bone density values
[2].
Also, in this study, bone density changes showed no significant
difference between the two groups using CADIA at post-surgery
days 14 and 28. However, in the case group, the bone density value
was higher than in the control group at day 28. This result has also
been confirmed by other studies. In a related study, healing of a
nonunion fractured lateral condyle of the humerus was reported
by pulsed electromagnetic induction [21].
Probably, contact of bony cells with the PEMF immediately
leads to cross-induced intracellular signals and is related with an
anabolic bony cell response [22]. Also, the regenerative effect of the
PEMF can be due to an increase the growth factor in several stages
[23]. In some studies, effective therapeutic doses of the PEMF were
evaluated and showed that an increase of the value of contact with
the PEMF leads to an increase in treatment success [24]. In our
study, contact duration with radiation immediately post-surgery
Fig. 6. Comparison the mean pain score at different times in the groups.
was 6 h; at post-surgery day 2, it was 3 h daily; and from day
7 onwards, it was 1.5 hours daily for 6 d.
There was a significant difference in evaluation of pain changes
at days 1, 7, and 14 between the two groups in this study, as at
day14, the pain was slight in the case group and moderate in the
control group. It seems that systemic emission of the PEMF with its
anti-inflammatory, analgesic, and anti-nociceptive effects leads to
a reduction in pain, and by binding to anti-CD3 in lymphocyte
receptors, it leads to a reduction in inflammatory responses
[25]. The regenerative effect of this could be due to a decrease of
the inflammation during the regeneration phase, which has been
confirmed by some studies. Some studies showed that application
of PEMF for 20 min daily for 10 d decreases chronic pains which are
resistant to conventional treatments [26].
Most likely, the difference between this study and other studies
is due to differences in the strength points and frequency of the
PEMF used.
In the current study, all broken bones were stabilized, and no
symptoms of infection were observed in the patients. Sensory
changes showed no significant difference at post-surgery days
30 and 60 for either of the two groups. No malocclusion was
reported in any of the case group patients. The only reported
malocclusion was in one control group patient. Furthermore, the
amount of mouth opening showed a significant difference in the
case group.
In the natural process of ossification, the PEMF is induced by
electrical currents generated during bone mechanical leading,
which has led to research about PEMF effects on bone. In vitro
studies reported that several types of growth factors affected bone
metabolism with bone morphogenetic protein 2 (BMP-2), trans-
forming growth factor beta (TGF-b), and insulin-like growth factor
II (IGF-II), playing an important role in bone metabolism [27]. PEMF
results can provoke stimulatory effects on bone by the activation of
extracellular signal-regulated kinase (ERK), mitogen-activated
protein kinase (MAPK), and prostaglandin synthesis [22,28]. Thus,
PEMF has been widely used in the healing and regeneration of non-
union fractures [29].
Some clinical studies reported PEMF affects osteogenesis
stimulation in patients in the nonunion fractured region, reduces
delays in regeneration arthrodesis of the foot and ankle, increases
union speed of spinal cord fracture [30], and heals the head of the
femur osteonecrosis [31]. The stimulatory effect of the PEMF
stimulates an increase in limb length, increase in callus formation,
maturation of the distraction region, and more rapid evolution of
the external fixation instrument [32]. However, the mechanism of
the increase in osteogenesis the PEMF remains unknown.
 H. Mohajerani et al. / J Stomatol Oral Maxillofac Surg 120 (2019) 390–396 395

Fig. 7. Comparison of the pain changes at several times between the two groups.

Table 2
Comparison of amount of sensory changes at different times in the two groups.

Sensory All Case group Control group P-value

Before surgery Positive 19 (59.4%) 10 (62.5%) 9 (56.3%) 0.719

Negative 13 (40.6%) 6 (37.5%) 7 (43.8%)
30th postoperative day Positive 18 (56.3%) 9 (56.3%) 9 (56.3%) 1.0
Negative 14 (43.8%) 7 (43.8%) 7 (43.8%)
60th postoperative day Positive 16 (50%) 7 (43.8%) 9 (56.3%) 0.480
Negative 16 (50%) 9 (56.3%) 7 (43.8%)

In summary, this project was conducted because of the Acknowledgments

increasing prevalence of facial fractures, particularly of the
mandible, and the importance of faster healing and return of
normal jaw function by using an easy, inexpensive, non-invasive
method for accelerating bone regeneration. There are conflicting
opinions about the healing effect of magnetic fields in bone
regeneration, decreasing morbidity after surgery, importance of
the preservation of the beauty and function of the face, reducing
hospitalization time, reduction of treatment costs, temporoman-
dibular joint disorder due to prolonged intermaxillary fixation,
nutrition failure, and dental or periodontal problems following oral
health problems; however, the positive effect of magnetic fields on
the process of regeneration and healing of long bone fractures has
been substantiated by research. Moreover, there are a growing
number of studies on the effects of these fields on the mandible,
usability of research results, and cost-effectiveness of treatment.
5. Conclusion
According to this study, post-surgery PEMF leads to an increase
in bone density, faster recovery, an increase in the formation of
new bone, further opening of the mouth, and a decrease in pain.
The application of PEMF is uncomplicated, noninvasive, and easy to
apply. It is an acceptable and effective method for the initiation of
healing and increasing regeneration speed of the fracture region.
Therefore, using the PEMF as an adjuvant treatment according to
this study protocol can be suggested to oral, jaw, and face surgeons
for the healing of mandibular fractures. However, further well-
designed studies are needed to more comprehensibly evaluate this
treatment.
Declaration of interest
The authors declare that they have no competing interest.
This study was the postgraduate thesis of Dr. Farshad Vossoughi
and was supported by Shahid Beheshti University of Medical
Sciences (grant no. 689). We would like to express our sincere
thanks to colleagues for help in data acquisition. Clinical trial
registration number: IRCT2016022526769N1
References
[1] Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures
and concomitant injuries. Int J Oral Maxillofac Surg 1990;48(9):926–32.
[2] Refai H, Radwan D, Hassanien N. Radiodensitometric assessment of the effect
of pulsed electromagnetic field stimulation versus low intensity laser irradia-
tion on Mandibular fracture repair: a preliminary clinical trial. Int J Oral
Maxillofac Surg 2014;13(4):451–7.
[3] Hoffman WY, Barton RM, Price M, Mathes SJ. Rigid internal fixation vs.
traditional techniques for the treatment of mandible fractures. J Trauma
1990;30(8):1032–5 [discussion 5-6].
[4] Kromer H. Closed and open reduction of condylar fractures. Dent Rec
1953;73:569.
[5] Cawood J. Small plate osteosynthesis of mandibular fractures. Br J Oral Maxi-
llofac Surg 1985;23(2):77–91.
[6] Bertone A, Pittman D, Bouxsein M, Li J, Clancy B, Seeherman H. Adenoviral-
mediated transfer of human BMP-6 gene accelerates healing in a rabbit ulnar
osteotomy model. J Orthop Res 2004;22(6):1261–70.
[7] Doetsch A, Faber J, Lynnerup N, Wätjen I, Bliddal H, Danneskiold–Samsøe B.
The effect of calcium and vitamin D3 supplementation on the healing of the
proximal humerus fracture: a randomized placebo-controlled study. Calcif
Tissue Int 2004;75(3):183–8.
[8] Muhonen A, Haaparanta M, Grönroos T, Bergman J, Knuuti J, Hinkka S, et al.
Osteoblastic activity and neoangiogenesis in distracted bone of irradiated
rabbit mandible with or without hyperbaric oxygen treatment. Int J Oral
Maxillofac Surg 2004;33(2):173–8.
[9] Chao E, Inoue N. Biophysical stimulation of bone fracture repair, regeneration
and remodelling. Eur Cell Mater 2003;6:72–84.
[10] Shi H-F, Cheung W-H, Qin L, AH-C Leung, Leung K-S. Low-magnitude high-
frequency vibration treatment augments fracture healing in ovariectomy-
induced osteoporotic bone. Bone 2010;46(5):1299–305.
[11] Griffin XL, Costa ML, Parsons N, Smith N. Electromagnetic field stimulation for
treating delayed union or non-union of long bone fractures in adults. Cochrane
Library 2011.
396 H. Mohajerani et al. / J Stomatol Oral Maxillofac Surg 120 (2019) 390–396
[12] Simonis R, Parnell E, Ray P, Peacock J. Electrical treatment of tibial non-union:
a prospective, randomised, double-blind trial. Injury 2003;34(5):357–62.
[13] Juniper R, Awty M. The immobilization period for fractures of the mandibular
body. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1973;36(2):157–63.
[14] Al-Belasy FA. A short period of maxillomandibular fixation for treatment of
fractures of the mandibular tooth-bearing area. J Oral Maxillofac Surg
2005;63(7):953–6.
[15] Robertson DD, Mintzer CM, Weissman BN, Ewald FC, LeBoff M, Spector M.
Distal loss of femoral bone following total knee arthroplasty. Measurement
with visual and computer-processing of roentgenograms and dual-energy x-
ray absorptiometry. J Bone Jt Surg Am 1994;76(1):66–76.
[16] AS K, editor Healing of mandibular fractures in patients with parodontosis
according to the data of X-ray examination1978; 25th of June, Moscow.
[17] Yu JDR, Hebda PA, Gosain AK, Friedman CD. Essential tissue healing of the face
and neck. Shelton: People’s Medical Publishing House and BC Decker; 2009.
[18] Razukevicius D, Sabalys G, Kubilius R. Comparative analysis of the effective-
ness of the mandibular angle fracture treatment methods. Stomatologija
2005;7(2):35–9.
[19] Villarreal PM, Junquera LM, Martı́nez A, Garcı́a-Consuegra L. Study of man-
dibular fracture repair using quantitative radiodensitometry: a comparison
between maxillomandibular and rigid internal fixation. J Oral Maxillofac Surg
2000;58(7):776–81.
[20] Harwood PJ, Newman JB, Michael AL. An update on fracture healing and non-
union. Orthop Trauma 2010;24(1):9–23.
[21] Das SS, Bassett C. Healing of nonunion of a fractured lateral condyle of the
humerus by pulsing electromagnetic induction. Contemporary Orthop
1991;22(1):47.
[22] Schnoke M, Midura RJ. Pulsed electromagnetic fields rapidly modulate intra-
cellular signaling events in osteoblastic cells: comparison to parathyroid
hormone and insulin. J Orthop Res 2007;25(7):933–40.
[23] Aaron RK, Boyan BD, Ciombor DM, Schwartz Z, Simon BJ. Stimulation of growth
factor synthesis by electric and electromagnetic fields. Clin Orthop Relat Res
2004;419:30–7.
[24] Garland DE, Moses B, Salyer W. Long-term follow-up of fracture nonunions
treated with PEMFs. Contemporary Orthop 1991;22(3):295–302.
[25] Nindl G, Swez J, Miller J, Balcavage W. Growth stage dependent effects of
electromagnetic fields on DNA synthesis of Jurkat cells. FEBS Lett
1997;414(3):501–6.
[26] Lefaucheur J-P. New insights into the therapeutic potential of non-invasive
transcranial cortical stimulation in chronic neuropathic pain. LWW 2006.
[27] Hinsenkamp M, Collard J-F. Bone Morphogenic Protein–mRNA upregulation
after exposure to low frequency electric field. Intl Orthop 2011;35(10):1577–
81.
[28] Chang K, Chang WHS. Pulsed electromagnetic fields prevent osteoporosis in an
ovariectomized female rat model: a prostaglandin E2-associated process.
Bioelectromagnetics 2003;24(3):189–98.
[29] Mollon B, Da Silva V, Busse JW, Einhorn TA, Bhandari M. Electrical stimulation
for long-bone fracture-healing: a meta-analysis of randomized controlled
trials. J Bone Joint Surg Am 2008;90(11):2322–30.
[30] Mackenzie D, Veninga FD. Reversal of delayed union of anterior cervical fusion
treated with pulsed electromagnetic field stimulation: case report. South Med
J 2004;97(5):519–25.
[31] Gonzalez FL, Arevalo RL, Coretti SM, Labajos VU, Rufino BD. Pulsed electro-
magnetic stimulation of regenerate bone in lengthening procedures. Acta
Orthop Belg 2005;71(5):571.
[32] Seber S, Omeroğlu H, Cetinkanat H, Köse N. The efficacy of pulsed electromag-
netic fields used alone in the treatment of femoral head osteonecrosis: a report
of two cases. Acta Orthop Traumatol Turc 2002;37(5):410–3.