Dear Bassam, thanks for sharing your thoughts.

My humble opinion is that we might need a broader approach to your question. Namely, I woud give three additional points some consideration:

After defining the type of fracture that is intriguing you, the scientific literature is prolific with studies from many centers and may put you in the right direction. The works of Edward Ellis, for their scope and sample sizes, are worth looking into.

Again in my opinion, three screws per fracture side may be the prevailing  option for complex fractures to which heavier, load-bearing plates are applied. For simpler, stable and favorable fractures, two screws per fracture side may suffice. The need for a second plate depends on several anatomic aspects, and may be highly influenced by surgeon's preference and good judgement. I'd usually apply a second plate following the same principles of the first (often two screws per fracture side).

In the end, it heavily depends on what type of fracture you have in mind and what is the fixation strategy you believe is more suitable. Let us know more about what you have in mind!

Regards,

Thank you, Dr. Paulo Henrique Luiz de Freitas

I agree with you that such a question needs more specification.

You have almost covered my thought and question, that in the simple, linear or diagonal fracture in the symphysis, parasymphysis, and body area when using the double plates, two-point screw fixation of each plate is enough.

My question was because I saw a lot of surgeons prefer or accustomed to do three points fixation with 2.0 miniplates even with simlple fractures in the anterior part of the mandible.

dear Bassam your question should be about 2 or 3 screws on either side of the fracture line.

two point fixation "term" mostly mean 2 dimensional fixation, a plate used to fix fracture body of mandible. while three point fixation mean when we add an arch bar (intermaxillary fixation) to the same example "3D fixation" ...... with best regards

Dear Bassam,

I suggest you to read the article bellow:

Ribeiro-Junior PD, Magro-Filho O, Shastri KA, Papageorge MB. In vitro evaluation of conventional and locking miniplate/screw systems for the treatment of mandibular angle fractures. Int J Oral Maxillofac Surgery 2010: 39: 1109–1114.

Bests,

Gustavo Grolli Klein

I think so far the most evidence exist for the fractures in angle as most of the research is  performed especially for this area.

 Biomechanical evaluation of plating techniques for fixing mandibular angle fractures: the introduction of a new 3D plate approach.

Kalfarentzos EF, Deligianni D, Mitros G, Tyllianakis M.

Oral Maxillofac Surg. 2009 Sep;13(3):139-44. doi: 10.1007/s10006-009-0163-7.

PMID: 19636597

this is a nice study

generaly though it is still missing a big comparative study retrospective or prospective in order to have safer results

Hi, you may have interest to read our paper. Thanks!

Article Evaluation of osteotomy fixation changing the number, the ex...

Dear bassam, in my experience it is the strength of the miniplate that matters and two screws on either side of fracture should suffice, and additional number of screws doesn't matter, along with this amount of displacement and mobility does matter, earlier in our center we were using only 2.5mm ,4 holed miniplates but now for most of mandibular fractures 2mm 4holed miniplates are sufficient.

It is important to note that arch bar splinting with proper reduction of fractures in place before fixation plays an key role.