Three-dimensional finite element analysis for internal fixation of mandibular condylar fractures: a scoping review

Three-dimensional finite element analysis (3D-FEA) has emerged as an essential computational tool for evaluating the biomechanical behaviors of internal fixation systems for mandibular condylar fractures. This scoping review maps and synthesizes the existing literature on 3D-FEA studies investigating the internal fixation of mandibular condylar fractures and explores, in a descriptive manner, differences in methodological focus between European and non-European research centers.

PubMed and Cochrane Library databases were systematically searched following PRISMA-ScR guidelines. Original English-language research articles using 3D-FEA to evaluate internal fixation of mandibular condylar fractures were included. Data were extracted using a standardized charting form.

Thirty-six studies met the inclusion criteria. European studies (n = 12) predominantly focused on development of novel plate designs and mechanical testing protocols, whereas Asian and other nationality studies (n = 24) emphasized material comparisons between titanium and bioabsorbable systems, patient-specific modeling, and loading condition analysis. Consensus findings include: (1) double-plate fixation provides superior stability; (2) among 3D plate designs, trapezoid plates demonstrate the best performance for subcondylar and condylar base fractures, whereas alpha and lambda plates may be preferable for condylar neck fractures; (3) plate positioning along the posterolateral ramus border and anterolateral sigmoid notch (A+B configuration) offers optimal biomechanical performance; and (4) contralateral molar clenching produces the highest stress concentrations.

Across the included FEA studies, the A+B double-plate configuration was the most consistently reported biomechanically favorable approach for both titanium and bioabsorbable systems; the trapezoid plate performed best for subcondylar and condylar base fractures, and two-screw osteosynthesis was effective for condylar head fractures. As these findings derive from computational models, clinical validation remains necessary. Future research should focus on patient-specific modeling, clinical outcome validation, and standardization of methodological protocols.