In our study, interpersonal violence accounted for 14.28% of the cases, fall injury accounts for 28.58% of cases of mandible fracture  road traffic accidents were responsible for the majority of cases (57.14%) of mandible fractures. This is in accordance with the study by Bormann et al
] . Out of 28 patients in our study, 18 were male (64.29%) and 10 (35.71%) were female . This male dominance was also reported by Haug et al
] The age group most commonly affected was 21-30 years (40%). Eight patients had bilateral mandible fracture and 12 had unilateral fracture. The most common site of mandible fracture was parasymphysis (35%) and angle (35%), followed by body (20%) and symphysis (10%) [, ].
Pattern of etiology of fracture in the present study
Gender distribution of patients
Distribution of fracture site, favorability of fracture site, methods of fixation of fracture site
(a, b) Distribution of fracture site, favorability of fracture site, and methods of fixation of fracture site
Among patients in Group II, in 1 patient, there was intraoral exposure of plate and intraoral pus discharge at left lower-third molar region. X-ray OPG of patient shows fractured 2-D miniplate at the left angle . This complication was treated by removal of implant, intraorally under higher antibiotic coverage. No incidence of plate failure was reported in Group I patients, which coincides with the report by Guimond et al
] on fixation of mandible angle fracture with 3-D plates . Fracture of mandibular angle is associated with highest incidence of postsurgical infection of all mandible fractures reported by Lizuka and Lindquist.[10
X-ray OPG shows fractured 2.0-mm conventional plate at left angle
Comparsion of complication between group I and group II
In the angle region where horizontal and vertical rami of mandible meet and where powerful elevator muscles are attached to the ramus, strong distractive forces are created; therefore, to counteract these forces, a strong fixation device is required. In this study, the advantage of 3-D plating system over conventional 2-D miniplates comes from the fact that the screws of the 3-D plates are placed in the box configuration on both sides of the fracture rather than on a single line. Also, a broad platform is created that may increase the resistance to the torsional forces along the axis of the plate. This theory coincides with the study of Alkan et al
One case of tooth damage at the symphysis region was reported among Group I patients. Vitality testing of the injured tooth was done. Endodontic treatment was carried out for the management of injured tooth. The damage occurred due to the larger size of 3-D plate and insufficient vertical height of anterior mandible. Advantage of conventional 2-D miniplates over 3-D miniplates is their small size and easy adaptability, which minimizes the chances of tooth damage .
The occlusion of patients was checked preoperatively and during the follow-up stages after surgery. Among Group II, 2 patients (both displaced parasymphysis + angle fractures) developed postoperative occlusal discrepancy, which was corrected by postoperative inter-maxillary fixation for 4 weeks. None of the patients of Group I developed occlusal discrepancy . According to Champy, when only one linear conventional plate is applied at the external oblique ridge in cases of mandibular angle fracture, torsional and bending forces usually cause movement along the axis of the plate with bucco-lingual splaying and gap formation at the inferior border, respectively. This coincides with the study of Gutwald et al
] on angle fracture using various fixation devices. Also, 3-D plates, because of a box-like configuration, provide rigid fixation of fractures that prevent bucco-lingual splaying and gap formation at the fracture site and subsequent occlusal discrepancy; this is the advantage of 3-D miniplates over 2-D miniplates.
Mobility of fractured segments was evaluated in both groups: In Group II, 2 patients (one symphysis and other angle + parasymphysis fracture) had immediate postoperative mobility present at the fracture site, which was corrected by postoperative inter-maxillary fixation for 4 weeks. In Group I, none of patients had immediate postoperative mobility present at the fracture site . According to Andrew et al., as 3-D plates are square or rectangular units, they provide increased torsional stability. Also, as the symphysis fractures are under greater degree of torsional strain than any other area of the mandible, 3-D plates provide higher stability in this region.
Duration of surgery was measured from incision to closure of wound. The operating time required for the placement of 3-D plates in the angle region was 20-min extra as compared to intraoral placement of single conventional 2-D miniplate. This finding coincides with the study of Feledy et al
] who conducted a study on the time taken for the treatment of angle fractures. In the body region, difference was not significant, average time of 7 min more was taken by 3-D plates; whereas, in the symphysis and parasymphysis region, 20 min more was taken for 3-D plate fixation than for 2-D miniplates.
In our study, not a single patient treated by 3-D plate developed infection or plate failure, which is not in accordance with Zix et al
] who reported 1 patient with fractured 3-D plate that occurred due to reduced inter-fragmentary cross-sectional bone surrounding the fracture site after extraction of molar tooth in angle region, leading to higher torsional forces. Also, an infection rate of 6.6% was reported by Parmar et al
] Implant failure (4.54%) and postoperative neurosensory deficit (4.54%) was recorded by Goyal et al
] Fixation of mandibular angle fractures with single conventional miniplates at the upper border is associated with complications like infection, malocclusion, and mobility of fracture segments, as studied by Singh et al
] Parallel reports has been found in literature in several type of clinical situation.[19