Customized Titanium Plates for Preventing Mandibular Fractures in Lower Third Molar Extractions

Overview

Journal J Funct Biomater

Specialty Biomedical Engineering

Date 2025 Feb 25

PMID 39997598

Authors

Cezara Andreea Onica

Costin Iulian Lupu

Elena-Raluca Baciu

Gabriela Luminita Geletu

Alice Murariu

Dana Gabriela Budala

Ionut Luchian

Neculai Onica

Affiliations

Soon will be listed here.

Abstract

The extraction of deeply impacted lower third molars is a common yet challenging surgical procedure associated with complications such as mandibular fractures, pain, and swelling. This study evaluated the effectiveness of customized 3D-printed titanium plates in reducing the risk of intraoperative iatrogenic mandibular fractures. This innovative approach aims to improve surgical outcomes, enhance patient safety, and boost confidence for both surgeons and patients. Eighteen patients with Pell and Gregory class II/IIIC impacted lower third molars underwent preoperative CBCT scans, which facilitated the design and fabrication of customized plates and drilling guides. The surgical procedure involved incision, flap elevation, precise plate placement, osteotomy, odontotomy, extraction, and the postoperative assessment of pain, swelling, trismus, and anxiety using validated scales and facial scanning. The results show that customized titanium plates successfully prevented mandibular fractures in all cases. Although initial postoperative discomfort, including swelling, trismus, and pain, was observed, significant improvements occurred within one week. This technique provided structural reinforcement during surgery and healing without adverse events or fractures. Customized 3D-printed titanium plates represent a safe and effective solution for minimizing mandibular fractures, offering promising improvements in surgical outcomes.

References

Civak T, Ustun T, Yilmaz H, Gursoy B . Postoperative evaluation of Er:YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions. J Craniomaxillofac Surg. 2020; 49(1):64-69. DOI: 10.1016/j.jcms.2020.11.010. View

Ajith S, Shetty S, Hussain H, Nagaraj T, Srinath M . Management of multiple impacted teeth: a case report and review. J Int Oral Health. 2014; 6(3):93-8. PMC: 4109248. View

Majid O . Submucosal dexamethasone injection improves quality of life measures after third molar surgery: a comparative study. J Oral Maxillofac Surg. 2011; 69(9):2289-97. DOI: 10.1016/j.joms.2011.01.037. View

Di Spirito F, Giordano F, Di Palo M, Ferraro C, Cecere L, Frucci E . Customized 3D-Printed Mesh, Membrane, Bone Substitute, and Dental Implant Applied to Guided Bone Regeneration in Oral Implantology: A Narrative Review. Dent J (Basel). 2024; 12(10). PMC: 11506345. DOI: 10.3390/dj12100303. View

Ye Z, Qian W, Wu Y, Yang C . Pathologies associated with the mandibular third molar impaction. Sci Prog. 2021; 104(2):368504211013247. PMC: 10454952. DOI: 10.1177/00368504211013247. View

Passi D, Singh G, Dutta S, Srivastava D, Chandra L, Mishra S . Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study. Natl J Maxillofac Surg. 2019; 10(1):59-67. PMC: 6563636. DOI: 10.4103/njms.NJMS_70_17. View

Rizqiawan A, Lesmaya Y, Rasyida A, Amir M, Ono S, Kamadjaja D . Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient's Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study. Int J Dent. 2022; 2022:7239339. PMC: 8749374. DOI: 10.1155/2022/7239339. View

Onica N, Budala D, Baciu E, Onica C, Geletu G, Murariu A . Long-Term Clinical Outcomes of 3D-Printed Subperiosteal Titanium Implants: A 6-Year Follow-Up. J Pers Med. 2024; 14(5). PMC: 11122366. DOI: 10.3390/jpm14050541. View

Nyirjesy S, Heller M, von Windheim N, Gingras A, Kang S, Ozer E . The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol. 2022; 132:105976. DOI: 10.1016/j.oraloncology.2022.105976. View

10.

Geletu G, Burlacu A, Murariu A, Andrian S, Golovcencu L, Baciu E . Customized 3D-Printed Titanium Mesh Developed for an Aesthetic Zone to Regenerate a Complex Bone Defect Resulting after a Deficient Odontectomy: A Case Report. Medicina (Kaunas). 2022; 58(9). PMC: 9504411. DOI: 10.3390/medicina58091192. View

11.

Yuasa H, Sugiura M . Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables. Br J Oral Maxillofac Surg. 2004; 42(3):209-14. DOI: 10.1016/j.bjoms.2004.02.005. View

12.

van der Meer W, Dijkstra P, Visser A, Vissink A, Ren Y . Reliability and validity of measurements of facial swelling with a stereophotogrammetry optical three-dimensional scanner. Br J Oral Maxillofac Surg. 2014; 52(10):922-7. DOI: 10.1016/j.bjoms.2014.08.019. View

13.

Guillaumet-Claure M, Juiz-Camps A, Gay-Escoda C . Prevalence of intraoperative and postoperative iatrogenic mandibular fractures after lower third molar extraction: A systematic review. J Clin Exp Dent. 2022; 14(1):e85-e94. PMC: 8760961. DOI: 10.4317/jced.58390. View

14.

Uppada U, Sinha R . Iatrogenic Mandibular Ramus Fracture Following Surgical Removal of Impacted Third Molar. J Maxillofac Oral Surg. 2023; 22(1):46-48. PMC: 9871124. DOI: 10.1007/s12663-020-01382-3. View

15.

Barone S, Zaffino P, Salviati M, Destito M, Antonelli A, Bennardo F . Automated pipeline for linear and volumetric assessment of facial swelling after third molar surgery. BMC Oral Health. 2024; 24(1):1404. PMC: 11575084. DOI: 10.1186/s12903-024-05193-7. View

16.

Krimmel M, Reinert S . Mandibular fracture after third molar removal. J Oral Maxillofac Surg. 2000; 58(10):1110-2. DOI: 10.1053/joms.2000.9566. View

17.

Figueiredo C, Paranhos L, Silva R, Herval A, Blumenberg C, Zanetta-Barbosa D . Accuracy of orthognathic surgery with customized titanium plates-Systematic review. J Stomatol Oral Maxillofac Surg. 2020; 122(1):88-97. DOI: 10.1016/j.jormas.2020.06.011. View

18.

Melville J, Manis C, Shum J, Alsuwied D . Single-Unit 3D-Printed Titanium Reconstruction Plate for Maxillary Reconstruction: The Evolution of Surgical Reconstruction for Maxillary Defects-A Case Report and Review of Current Techniques. J Oral Maxillofac Surg. 2019; 77(4):874.e1-874.e13. DOI: 10.1016/j.joms.2018.11.030. View

19.

Kaplan V, Cigerim L, Feslihan E, Cinarsoy Cigerim S . Effect of a Single Dose of Deflazacort on Postoperative Pain, Swelling, and Trismus after Impacted Lower Third Molar Surgery: Randomised Clinical Trial. Medicina (Kaunas). 2024; 60(8. PMC: 11356159. DOI: 10.3390/medicina60081206. View

20.

Woldenberg Y, Gatot I, Bodner L . Iatrogenic mandibular fracture associated with third molar removal. Can it be prevented?. Med Oral Patol Oral Cir Bucal. 2007; 12(1):E70-2. View