+ MODEL

Kaohsiung Journal of Medical Sciences (2017) xx, 1e9

Available online at www.sciencedirect.com

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journal homepage: http://www.kjms-online.com

Original Article

Three dimensional versus standard miniplate

fixation in the management of mandibular
fractures: A meta-analysis of randomized
controlled trials
Kubila Silajiding a,b, Patiguli Wusiman a,b, Bilikezi Yusufu c,
Adili Moming a,b,*

a
Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang
Medical University, Urumqi, Xinjiang, People’s Republic of China
b
Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi,
Xinjiang, People’s Republic of China
c
Department of Oral and Maxillofacial Surgery, The First People’s Hospital in Kashgar
Region, Kashgar, Xinjiang, People’s Republic of China

Received 4 August 2016; accepted 21 March 2017

KEYWORDS
3-Dimensional versus
standard miniplate;
Mandibular fractures;
Meta-analysis
Abstract The aim of this meta-analysis is to evaluate the efficacy of the 3-dimensional mini-
plate system in comparison with the standard miniplate system for the treatment of mandibular
fractures (MFs). A systematic review was conducted according to PRISMA guidelines, examining
Medline-Ovid, Embase, and PubMed databases. The primary search objective was to identify all
papers reporting the results of randomized control trials (RCTs) for the treatment of adults with
mandibular fractures, with the aim of comparing the different techniques. The incidence of com-
plications was evaluated; nine studies including 283 patients with different fracture sites were
enrolled in the analysis. The results showed no significant differences in overall complications
(odds ratio [OR], 0.92; 95% confidence interval [CI], 0.552e1.542; P Z 0.81), postoperative infec-
tions (OR, 0.99; 95% CI, 0.40e2.48; P Z 0.89), wound dehiscence (OR, 0.96; 95% CI, 0.13e7.37;
P Z 0.96), paresthesia (OR, 0.47; 95% CI, 0.20e1.07; P Z 0.11), or malocclusion (OR, 1.8; 95%
CI, 0.39e8.32; P Z 0.47) between standard miniplates and 3-dimensional miniplates for treating
mandibular fractures. Mandibular fractures treated with 3-dimensional miniplates and standard
miniplates presented similar short-term complication rates, and the low postoperative

Conflicts of interest: All authors declare no conflicts of interests.

* Corresponding author. Department of Oral & Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, No. 137
South Li YU-shan Road, New City District, 830054 Urumqi, Xinjiang Uyghur Autonomous Region, People’s Republic of China.
E-mail address: adili928@hotmail.com (A. Moming).

http://dx.doi.org/10.1016/j.kjms.2017.05.001
1607-551X/Copyright ª 2017, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
 + MODEL
2 K. Silajiding et al.

maxillomandibular fixation rate of using standard miniplates also indicated that the standard
miniplate has a promising application in the treatment of mandibular fractures.
Copyright ª 2017, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open ac-
cess article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction of the methods of fixation that has emerged as a challenge

Mandibular fractures are frequent in facial trauma. With the
increase in facial trauma in incidence due to automobile-
and industrial-related accidents, the treatment of mandib-
ular fractures has become important for the maxillofacial
surgeon [1]. During past decades, various types of tech-
niques have been developed to provide stable fixation for
mandibular fractures and osteotomies. Miniplate osteosyn-
thesis, first introduced by Michelet in 1973 [2] and further
developed by Champy et al. [3] in 1975, has become the
standard method for surgical treatment of mandibular
fractures [4e6]. Unlike conventional rigid fixation that pre-
vents micromotion of bony fragments, stable miniplates
allow bone alignment and permit healing during use [7].
Currently, 2 different types of miniplate systems are avail-
able: 3-dimensional miniplates and standard miniplates. The
ideal method of treatment of mandibular fractures should
aim for perfect anatomic reduction, stable fixation, and
painless mobilization of the injured region around its artic-
ulation [8]. The use of 3-dimensional (3D) strut plates is one
to the Champy technique for the fixation of mandibular
fractures and has been the topic of a growing number of
clinical studies [9]. The 3D plates can be considered as a
two-plate system, with two miniplates joined by inter-
connecting crossbars [10]. Their shape is based on the
principle of a quadrilateral as a geometrically stable
configuration for support [11]. Because the screws are ar-
ranged in the configuration of a box on both sides of the
fracture, a broadband platform is created, increasing the
resistance to twisting and bending the long axis of the plate.
There is a simultaneous stabilization of the tension and
compression over that of conventional miniplates [12].
Moreover, this system is simple to apply because of its
malleability, low profile (reduced palpability), and ease of
application (requiring little or no additional contouring) [12].
The treatment of MFs has evolved during the past
several decades, especially with the application of
different fixation techniques. The debate continues
regarding the ideal treatment method; thus, the aim of this
study is to answer the following question: What fixation

Fig. 1. Study screening process.

Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
 Three dimensional versus standard miniplate
10.1016/j.kjms.2017.05.001
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of

Table 1 Studies comparing three-dimensional and standard miniplate fixation techniques in the management of mandibular fractures.
Study Year Study Gender Mean age Patients Follow-up MF fixation methods Mean length MFs Region of MFs
published design (M/F) (Range) (y) (n) period of operation
(min)
Jain et al. 2010 RCT (G1): 17/3 (G1): 48 (G1): 20 1, 2, 4 6 wk G1: two 2.0-mm miniplates G1: 45 40 (G1): 13 symphyseal and
(G2): 18/2 (G2): 47 (G2): 20 2 month G2: 3D 2-mm stainless steel G2: 33 parasymphyseal 5 body,
plates 2 angle
(G2): 13 symphyseal and
parasymphyseal 5 body,
2 angle
Kumar et al. 2012 RCT (G1, G2): 20/0 (G1, G2): 33.9 (G1): 10 1, 2, 4 8 wk (G1): one 2-mm stainless steel (G1): 10.2 34 G1: 10 (symphyseal and
(19e63) (G2): 10 3 month (G2): 3D 2-mm stainless steel (G2): 6.3 parasymphyseal)
G2: 10 (symphyseal and
parasymphyseal)
(G1, G2): 2 body, 4
angle, 8 condyle
Malhotra et al. 2012 RCT (G1, G2): 20/5 (G1, G2): 29 (G1): 10 1, 3 6 wk (G1): two 2.0-mm miniplate NM 25 (G1): 10 (symphyseal and
(G2): 10 3 month (G2): 3D 2-mm stainless steel parasymphyseal)
plates (G2): 11 (symphyseal and

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MODEL
parasymphyseal)
(G1, G2): 1 body, 2 angle
Agarwal et al. 2014 RCT (G1): 37/3 (G1): 26.62 (G1): 40 1, 3 6 wk (G1): two 2.0-mm miniplates (G1): 38 NM NM
(G2): 39/1 (G2): 24.72 (G2): 40 3 month (G2): 3D 2-mm stainless steel (G2): 49
plates
Singh et al. 2012 RCT (G1, G2): 4/46 (G1, G2): 30.4 G1: 25 1, 4, 8, 12 wk (G1): single 2.0-mm 4-hole G1:49.57 56 Angle (n Z 20)
G2: 25 miniplate at the G2:43 Parasymphysis (n Z 35)
externaloblique line or on the Symphysis (n Z 1)
lateral cortex (n Z 10)
(G2): single rectangular 2.0-
mm 6-hole 3D miniplate
(n Z 10)
Jain et al. 2012 RCT NM (G1, G2): 16e60 G1: 10 1,2,4, 6 wk G1: 2 mm titanium locking G1:38 20 Inter mental foramina
G2: 10 2 months miniplates G2:17 region: 20
G2: 2 mm 4 holed 3-
dimensional (3D) locking
titanium miniplates
Vineeth et al. 2012 RCT NM (G1, G2): 19e51 G1: 10 1 day (G1): single 2.0-mm 4-hole NM 29 Angle (n Z 20)
G2: 10 1 wk miniplate at the Additional fractures
1 month externaloblique line (n Z 10) (n Z 9; G1, n Z 5; G2,
3 months (G2): single rectangular 2.0- n Z 4)
mm 6- or 8-hole 3D miniplate
(n Z 10)
(continued on next page)

3
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4 K. Silajiding et al.

method has the fewest complications in the treatment of

MFs? The study also provides clinical and scientific data to

Parasymphysis (n Z 8)
enable surgeons to make reliable decisions regarding the

Subcondylar (n Z 1)

NM, not mentioned; RCT, randomized controlled trial; MF, mandibular fracture; G1, group 1 (standard miniplates); G2, group 2 (3D miniplates); MMF, maxillomandibular fixation.
Region of MFs
best technique.

Angle (n Z 13) Materials and methods

Literature search

G1: 39.7  9.1 NM NM

A systematic review was conducted according to PRISMA
MFs

22

guidelines, examining Medline-Ovid, Embase, and PubMed

databases. The primary search objective was to identify all
of operation
Mean length

G2: 33  4.6
papers reporting the results of randomized controlled trials
(min)

(G2): 102

(RCTs) for the treatment of adults with mandibular angle

(G1): 42

fractures, with the aim of comparing different techniques.

The key words and combinations of the following search
terms were included: “3-dimensional versus standard min-
G2: 1.0-mm miniplate (n Z 73)
(G2): single curved 2.0-mm 10-

iplate,” “conventional versus 3-dimensional,” “standard

externaloblique line (n Z 7)

G1: single 2.0-mm standard

miniplate versus AND 3-dimensional fixation AND mandib-

(G1): single 2.0-mm 4-hole

hole 3D miniplate (n Z 6)
MF fixation methods

ular fracture,” “Champy technique versus 3-dimensional

miniplate AND fixation AND mandibular fracture,”
“mandibular fracture,” “three-dimensional, standard or
miniplate at the

conventional,” “rigid fixation,” “osteosynthesis,” “grid

miniplate,” “matrix miniplate,” “3D strut miniplate,” and
“Champy.”
miniplate

A manual search of oral and maxillofacial surgery-related

journals was also performed, including the International
Journal of Oral and Maxillofacial Surgery; British Journal of
Oral and Maxillofacial Surgery; Journal of Oral and Maxillo-
Follow-up

facial Surgery; Oral Surgery, Oral Medicine, Oral Pathology,

1,2, 3 and
period

6 months

Oral Radiology and Endodontology; Journal of Cranio-

6 month
1e2 wk
4e6 wk

Maxillo-Facial Surgery; Journal of Craniofacial Surgery;

1 wk

and Journal of Maxillofacial and Oral Surgery. Relevant re-

views on the subject and the reference lists of the studies
Patients

identified were also scanned for possible additional studies.

G1: 10
G2: 10
(n)

G1: 6
G2: 7

Moreover, online databases providing information on clinical

trials in progress were checked (http://clinical-trials.gov;
http://www.centerwatch.com/clinical-trials; http://www.
(G1, G2): 16/4 G1:25.5  6.8
(Range) (y)

clinicalconnec-tion.com). Any randomized or quasi-

Mean age

G2:27  0.9

randomized controlled trialsdcontrolled clinical trial

(G1, G2): 18/0 (G1): 28
(G2): 28

studies whose aim was the comparison of postoperative

complications between or among fixation techniques (e.g.,
3D plates, standard miniplates) in the management of
MFsdwere included. Case reports, technical reports,
animal studies, in vitro studies, review papers, and studies
Gender
(M/F)

that included infected and/or comminuted MFs and

fractures in edentulous mandibles were excluded.

Selection of relevant studies

published design
Study

RCT

RCT

We carefully assessed the eligibility of all studies retrieved

from the databases. From the included studies in the final
2013

2014
Year

analysis, the following data were extracted (when available):

authors, year of publication, study design, number of pa-
Table 1 (continued )

tients, gender, mean age in years, follow-up period, number

of MFs (mandibular fractures), region of MFs, fixation
Moraissi et al.

methods, length of operation, use of antibiotics and/or

Xue et al.

chlorhexidine, mouth opening, and postoperative complica-

tions (infection, postoperative occlusion, hardware failure,
Study

malunion, trismus, nonunion, wound dehiscence, pares-

thesia). Authors were contacted for possible missing data.

Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
 + MODEL
Three dimensional versus standard miniplate 5

Risk for bias in individual studies
A methodologic quality rating was performed by combining
the proposed criteria of the Meta-Analysis of Observational
Studies in Epidemiology statement [13], the Strengthening
the Reporting of Observational Studies in Epidemiology
statement [14], and the Preferred Reporting Items for
Systematic Reviews and Meta-analyses [15] to verify the
strength of scientific evidence in clinical decision-making.
The classification of the risk for bias potential for each
study was based on the following five criteria: random se-
lection in the population, definition of inclusion and
exclusion criteria, report of losses to follow up, validated
measurements, and statistical analysis.
A study that included all these criteria was classified as
having a low risk for bias, and a study that did not include
one of these criteria was classified as having a moderate
risk for bias. When two or more criteria were missing, a
study was considered to have a high risk for bias.
Meta-analysis
Meta-analyses were conducted only if there were studies of
similar comparisons, reporting the same outcome measures.
For binary outcomes, we calculated a standard estimation
of the odds ratio (OR) by the random-effects model if het-
erogeneity was detected; otherwise, a fixed-effect model
with a 95% confidence interval (CI) was used. Weighted
mean differences were used to construct forest plots of
continuous data. The data were analyzed using Review
Manager version 5.2.6 (The Nordic Cochrane Centre, The
Cochrane Collaboration, Copenhagen, Denmark).
Assessment of heterogeneity
is represented; and (4) from 75% to 100%, there is
considerable heterogeneity represented.
Investigation of publication bias
A funnel plot (plot of effect size versus standard error) was
drawn. Asymmetry of the funnel plot may indicate publi-
cation bias and other biases related to sample size,
although the asymmetry may also represent a true rela-
tionship between trial size and effect size.
Sensitivity analysis
If there were sufficient studies included, we planned to
conduct a sensitivity analysis to assess the robustness of the
review results by repeating the analysis with the following
adjustment: exclusion of studies with a high risk of bias.
Results
The study selection process is summarized in Fig. 1. The
electronic search resulted in 954 entries; six additional
articles were identified manually. After the initial screening
of the titles and abstracts, 860 articles were excluded
because they were cited in more than one search of terms.
Of the resulting 100 studies, 66 were excluded for not being
related to the topic. The full-text reports of the remaining
34 articles led to the exclusion of 17, because they did not
meet the inclusion criteria. In addition, 8 more records
were excluded because they were not considered RCTs and
clinical control trials. Thus, a total of 9 publications were
preliminarily included in the review. Detailed characteris-
tics of the included studies are shown in Table 1.

The significance of any discrepancies in the estimates of the Quality assessment

treatment effects of the different trials was assessed by the
Cochrane test for heterogeneity. Heterogeneity was consid-
ered statistically significant if P < 0.10. A rough guide to the
interpretation of I2, given in the Cochrane handbook (Higgins
et al., 2011. http://www.cochrane-handbook.org), is as
follows: (1) from 0% to 40%, heterogeneity might not be
important; (2) from 30% to 60%, moderate heterogeneity is
represented; (3) from 50% to 90%, substantial heterogeneity
Each trial was assessed for risk of bias; the scores are
summarized in Table 2. One was considered at moderate
risk of bias; three were considered at low risk.
Effect of intervention
The forest plots for the effect of intervention are shown in
Fig. 2.

Table 2 Results of the quality assessment.

Authors Published Random Defined Loss of Validated Statistical Estimated
selection in inclusion/exclusion follow-up measurement analysis potential
population criteria risk of bias
Jain et al.18 2010 Yes Yes Yes Yes Yes Low
Kumar et al.19 2012 Yes No Yes No Yes High
Malhotra et al.21 2012 Yes Yes Yes Yes Yes Low
Agarwal et al.1 2014 Yes Yes Yes Yes Yes Low
Singh et al.22 2012 Yes Yes Yes Yes Yes Low
Jain et al.20 2012 Yes Yes Yes Yes Yes Low
Vineeth et al.11 2013 Yes Yes Yes Yes Yes Low
Xue et al.23 2013 Yes Yes Yes Yes Yes Low
Moraissi et al.9 2014 Yes Yes Yes Yes Yes Low

Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
 + MODEL
6 K. Silajiding et al.

Fig. 2. Forest plots, 3D miniplate versus standard miniplate in MFs (postoperative complications). CI, confidence interval; M-H,
the Mantel-Haenszel.

Infection thus, the fixed-effects model was used. According to the

Infection rate is an important indicator to evaluate the analysis, the incidence of postoperative infection between
effects of surgery. Eight studies were enrolled in the anal- the standard miniplates group and 3-dimensional miniplates
ysis of postoperative infection. There was no heterogeneity group had no statistical difference (OR, 0.99; 95% CI,
among the studies (c2 Z 5.23, P Z 0.63, I2 Z 0%) (Fig. 2); 0.396e2.478; P Z 0.89) (Fig. 2).

Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
 + MODEL
Three dimensional versus standard miniplate 7

Wound dehiscence Malocclusion

The incidence of wound dehiscence was reported in
three studies. There was no statistically significant ef-
fect on the outcome of wound dehiscence favoring the
standard miniplate group (fixed: OR 0.96; 95% CI,
0.125e7.371; P Z 0.96). There was an absence of het-
erogeneity among the studies (c2 Z 1.16, df Z 7,
P Z 0.56; I2 Z 0%).
Paresthesia
The incidence of paresthesia was reported in 6 studies. The
cumulative analysis showed that there was no statistically
significant difference between the standard miniplate and
3D groups (fixed: OR 0.47; 95% CI, 0.204e1.071; P Z 0.11)
and no heterogeneity present among the studies
(c2 Z 3.20, df Z 5, P Z 0.67; I2 Z 0%).
Three studies evaluated malocclusion. The cumulative
analysis showed no statistically significant difference in the
outcome, favoring standard miniplates (fixed: OR 1.8; 95%
CI, 0.39e8.32; P Z 0.47). There was an absence of het-
erogeneity among the studies (c2 Z 3.17, df Z 2,
P Z 0.21; I2 Z 37%).
Overall complications
Nine studies showed the incidence of overall complications
in each group treated for mandibular fractures. Because
heterogeneity was not observed among the studies
(c2 Z 19.09, P Z 0.58, I2 Z 0%) (Fig. 2), the fixed-effects
model was used. The results showed no significant differ-
ence between 2 groups (OR, 0.92; 95% CI, 0.552e1.542;
P Z 0.81) (Fig. 2), suggesting that standard miniplates had

Fig. 3. Forest plots, 3D plate versus standard miniplate (operative time). CI, confidence interval; IV, inverse variance.

Fig. 4. Sentivity analysis.

Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
 + MODEL
8 K. Silajiding et al.
a similar overall complication rate to 3-dimensional mini-
plates in the treatment of mandible fractures.
Operative time
Seven studies reported the operating times and provided
information on the mean operation time. However, only
one study reported the standard deviation; therefore,
comparisons of continuous outcomes are necessary. The
standard miniplate groups had shorter operative time than
the 3-dimensional plate groups in the treatment of
mandibular fractures (Fig. 3).
Sensitivity analysis and publication bias
The cumulative analysis after the exclusion of studies with
a high risk for bias did not change the overall main results
(Fig. 4). The funnel plot showed no noticeable asymmetry,
indicating absence of publication bias (Fig. 5).
Discussion
Mandibular fractures are common. A variety of different
treatment methods for MFs have been described. The key to
successful management of these fractures is to understand
the principles of the accurate reestablishment of occlusion,
fracture reduction, and stable internal fixation [9].
The purpose of this review is to verify and evaluate
through meta-analysis the following: What is the best fix-
ation method with the fewest postoperative complications?
Is there a significant difference in the clinical outcomes
between standard and 3-dimensional miniplate fixation in
the treatment of MFs? In general, the results of the present
meta-analysis show mandibular fractures treated with 3-
dimensional miniplates and standard miniplates present
similar short-term complication rates. The low post-
operative maxillomandibular fixation rate of using standard
Fig. 5. Funnel plot e publication bias according to the reported.
Please cite this article in press as: Silajiding K, et al., Three dimensional versus standard miniplate fixation in the management of
mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
miniplates also indicates that the standard miniplate has a
promising application in the treatment of mandibular
fractures. Some of the trials included appear to be too
underpowered to detect a clinically significant difference
in some of the postoperative complications, although they
showed clear trends favoring the use of the 3-dimensional
miniplate. However, a statistically and clinically significant
difference in the incidence of complications was found
after the meta-analyses, stressing the importance of meta-
analyses to increase the sample size of individual trials to
reach more precise estimates of the effects of in-
terventions [9].
Interfragmentary stability is an important factor to be
considered, because it was shown that significant differ-
ences in the incidence of complications exist between the
two techniques. Successful treatment of mandibular frac-
tures depends on undisturbed healing in the correct
anatomical position under stable conditions. Failure to
achieve this leads to infection, malocclusion, or nonunion
[11]. When comparing differences between the techniques
concerning the incidence of infection (8.47% in the 3-
dimensional miniplate group, 8.55% in the standard mini-
plate group), the incidence of infection did not reach sta-
tistical significance (P Z 0.22). Studies have demonstrated
that the use of one standard miniplate leads to the opening
of the fracture line at the lower border, lateral displace-
ment of the fragments at the inferior border, and posterior
open bite on the fracture side [11].
No statistically significant difference in the incidence of
paresthesia was observed between the two techniques
(P Z 0.29). During surgery, aggressive manipulation due to
fracture replacement may cause additional nerve injury,
and sometimes drill-hole preparation near the mandibular
canal may also cause permanent alterations [16]. There-
fore, if paresthesia is not checked before surgery, it may
appear that all paresthesia present after surgery resulted
from the surgery. There is little information in the
 + MODEL
Three dimensional versus standard miniplate
literature concerning the incidence and natural history of
inferior alveolar sensory deficits as a consequence of the
fracture or as a complication of fracture fixation, as the
postinjury/pretreatment sensory status is often not recor-
ded [17].
The period of follow-up is also an important factor to be
considered, because three studies have not reported mean
periods of follow-up. The maximum follow-up period in the
included studies varied between 2 and 6 months. Many
minor complications such as fracture and exposure of the
bone plate may occur months or even years after successful
healing but must still be considered complications, as they
result in surgical intervention that would not otherwise
have been necessary. The complication rate, therefore,
may increase with the length of follow-up [9].
There is one general philosophy espoused that RCTs
provide more adequate and reliable data base for meta-
analysis. The present meta-analysis included only RCTs.
They are not only the gold standard for meta-analysis but
also provide true database. There is a need for prospective,
randomized studies comparing the two techniques. A large
sample size of patients and a long follow-up period to
evaluate whether one technique of fixation will result in
lower postoperative complication rates than the other
would be ideal.
In conclusion, this meta-analysis confirms that mandib-
ular fractures treated with standard miniplates and 3-
dimensional miniplates present similar short-term compli-
cation rates, which indicates that the complication rate is
more likely related to surgical technique rather than the
fixation system. In addition, the low postoperative max-
illomandibular fixation (MMF) rate of using standard mini-
plates also showed that the standard miniplate is a
prospective fixation system in the treatment of maxillofa-
cial fractures.
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mandibular fractures: A meta-analysis of randomized controlled trials, Kaohsiung Journal of Medical Sciences (2017), http://dx.doi.org/
10.1016/j.kjms.2017.05.001
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