Palper, A.S. (2014) De toegevoegde waarde van locking plaatsystemen in de behandeling van mandibulafracturen. thesis, Dentistry.
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Abstract
Background Internal fixation with surgical plates is often considered the treatment of choice when treating fractures of the mandibula. But in some clinical situations the biomechanical properties of conventional plates aren‟t sufficient to use them as an internal fixator. Results of in vitro studies in the late 90s showed that locking plates do have the biomechanical properties necessary in these cases and could be used as an alternative for conventional plates. A systematic review and meta-analysis were performed to review the evidence for the use of locking plates as an internal fixator in the treatment of mandibular fractures. Methods PubMed, Cochrane and Embase were searched from inception until March 2014 for randomized controlled trials which compared locking plates with conventional plates as an internal fixator in the treatment of mandibular fractures. The primary outcome was defined as the number of complications that occurred after surgical treatment. Based on title and abstract the publications were reviewed for eligibility for full text analysis. The full texts were analyzed for relevance with predetermined inclusion and exclusion criteria. For quality assessment both the Jadad scale and the CONSORT checklist for randomized controlled trials have been used. Data extraction was performed with a modified version of the Data Collection Form from the Cochrane Group. Statistical analysis was performed with RevMan 5 (version 5.2.11). A meta-analysis yielded the Relative Risk, the Risk Difference and the Number Needed to Threat together with the corresponding 95% confidence intervals. Results The initial search yielded a total of 83 available publications. After analyzing and quality assessment, data was extracted out of 4 publications which were selected for meta-analysis. Meta-analysis revealed no statistical significant difference between locking plates and conventional plates as an internal fixator in the amount of complications that occurred after surgical treatment for mandibular fractures. Contrary to the primary outcome, the pooled data showed a statistical significant difference between the groups in the occurrence of occlusal discrepancies and need for postoperative MMF (p<0,05). Occlusal discrepancies occurred in 10,7% in the locking plate group and 30,7% in the control group. Postoperative MMF was necessary by 18,7% of the treated patients in the locking group and by 53,3% in the control group. Both the experimental as the control group consisted of the pooled data from 75 patients. Discussion Quality assessment of the full texts revealed that none of available publications meet the predetermined quality requirements. Moreover, full text analysis with the CONSORT checklist for randomized controlled trials showed that there was a high risk of bias. A lot of items of the CONSORT checklist were inadequately reported or were missing in the selected publications. After minor adjustments of the inclusion criteria and the quality requirements meta-analysis could be performed. Because the included publications didn‟t meet the predetermined requirements, the results from the meta-analysis reported in this systematic review shouldn‟t be considered as solid evidence but mere indicative. Conclusion Meta-analyses reveals that the use of locking plates as an internal fixator in the treatment of mandibular fractures results in less occlusal discrepancies and diminishes the need for postoperative MMF. However, in the view of the general poor quality of the included publications, these results should be viewed with caution. Further randomized controlled trials with adequate follow-up are required to determine the benefits of locking plates over conventional plates as an internal fixator in the treatment of mandibular fractures.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Minnen, Dr. B. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/553 |
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