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CAD-CAM Splints Versus Arch Bars for Management of Dentate Mandibular Fractures - A Randomized Control Study
Varad Rajendra Saptarshi1, Srivalli Natarajan2
1Former Resident, Department of Oral & Maxillofacial Surgery, MGM Dental College & Hospital, Navi Mumbai, India; Currently Pursuing Fellowship in Facial Plastic & Cosmetic Surgery, Mumbai, India.
Background:
Mandibular fractures are technically demanding because accurate restoration of occlusion is required and conventional maxillomandibular fixation (MMF) techniques have important limitations.
Purpose:
The purpose of this study was to measure and compare the clinical efficacy of CAD-CAM splints versus conventional arch bars as MMF techniques in subjects undergoing open reduction and internal fixation (ORIF) of mandibular fractures in the dentate region.
Study Design And Setting:
This single-blind randomized clinical study was conducted in the Department of Oral and Maxillofacial Surgery at a tertiary academic center between September 2022 and March 2024. Adult patients indicated for ORIF of mandibular fractures in the dentate region were eligible. Exclusion criteria were isolated condylar fractures, comminuted or edentulous mandibular fractures, and associated midface fractures affecting occlusion.
Predictor Variable:
The primary predictor variable was the MMF technique and subjects were randomly assigned to CAD-CAM splint or conventional arch bar groups.
Outcome Variables:
The primary outcome was clinical efficacy, assessed by postoperative occlusion, need for and duration of postoperative MMF, and operative time. Secondary outcomes included lower border step deformity, lingual cortical reduction, preparation time, and achievement of condylar pushback.
Covariates:
The covariates were demographics, fracture patterns, and presence of associated condylar fractures and their management.
Statistical Analysis:
Appropriate tests were used for analysis with significance set at P < .05.
Results:
The sample was composed of 32 subjects (16 in each group) with a mean age of 29.9 years (standard deviation [SD] 10.7); 28 (87.5%) were males. Normal occlusion at 4 weeks was achieved in 16 of 16 (100%) CAD-CAM subjects and 12 of 16 (75%) arch bar subjects (P = .02). The combined mean operative time was 50.4 minutes (SD 15.8) for CAD-CAM and 59.9 minutes (SD 18.1) for arch bars (P = .1). The combined mean preparation time was 90.9 minutes (SD 9.4) for CAD-CAM splints and 83.9 minutes (SD 10.5) for arch bars (P = .1).
Conclusion And Relevance:
CAD-CAM splints as an MMF technique are associated with improved occlusal outcomes, a lower need for postoperative MMF in complex fracture patterns, and shorter operative times in selected subgroups compared with conventional arch bars.
