Implant Design and Fixation Technique Influence Mandibular Fracture Stability, Suggests Study
Egypt: A biomechanical study has revealed that patient-specific and conventional fixation techniques demonstrate different mechanical characteristics under simulated loading conditions. The findings indicate that both implant design and fixation configuration significantly influence the stability and biomechanical performance of mandibular angle fracture fixation, supporting individualized approaches when selecting fixation methods.
The study was published in BMC Oral Health by Asmaa M. Abd Elfattah, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt, and colleagues.
Mandibular angle fractures are among the common maxillofacial injuries and present fixation challenges because of the complex forces generated during jaw function. Conventional treatment often uses two miniplates, while advances in computer-aided design and manufacturing have enabled patient-specific implants tailored to individual anatomy.
The researchers used finite element analysis (FEA) to compare the biomechanical behaviour of a customized 3D titanium plate with conventional two-miniplate fixation.
A three-dimensional mandibular model was reconstructed from CT data of a 25-year-old fully dentate man. Two fixation models were developed: one using conventional two-miniplate fixation and another using a patient-specific 3D titanium plate contoured along the mandibular tension zone. Both models were assessed under simulated unilateral clenching using identical loading and boundary conditions.
The analysis evaluated Von Mises stress, maximum principal stress, and total displacement to assess the mechanical response of each fixation technique.
The findings showed:
- The patient-specific 3D plate had lower maximum Von Mises stress than conventional fixation (326.19 MPa vs 417.48 MPa).
- Maximum principal stress in cortical bone was higher with the customized plate (121.03 MPa) than with conventional fixation (87.759 MPa).
- Total displacement was greater with the patient-specific plate (157.32 μm) compared with the conventional system (131.47 μm).
- Despite the difference in displacement, values for both techniques remained within ranges considered acceptable for fracture healing.
- The customized plate demonstrated a load-sharing fixation pattern, while the conventional two-miniplate technique provided relatively more rigid fixation and lower interfragmentary displacement.
The researchers noted that these differences demonstrate the influence of both plate design and fixation configuration on stress distribution and fracture stability.
The study had several limitations, including its single-patient model, differences in plate design and fixation configuration, and simplified static loading that did not account for fatigue, muscle activity, bone remodelling or biological healing.
The authors concluded that patient-specific and conventional fixation provide distinct biomechanical characteristics and that further experimental validation and prospective clinical studies are needed to determine the clinical relevance of these findings.
Reference:
Abd Elfattah, A.M., Eldibany, M.M., Hassan, R.S. et al. Finite element analysis of patient specific three-dimensional titanium plate versus conventional two miniplate fixation for mandibular angle fractures. BMC Oral Health 26, 1382 (2026). https://doi.org/10.1186/s12903-026-09471-4
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