Computer Guided Screw Holes Locating Guide and Custom-made Plates

* Preoperative CT.
* Virtual reduction of broken segments on software.
* Gain occlusion.
* Design surgical screw holes locating guide.
* Design the custom-made plates.
* Print the screw holes locating guide and the custom-made plate. under general anesthesia the parasymphseal fracture will be reduced using screw holes locating guide and the custom-made plates.

Interventions 26 patients involved in this study will be divided in to two different groups, first group will be reduced using patient computer guided specific screw holes locating guide and custom-made plates.

Second group fractures will be reduced by conventional work flow.

Clinical evaluation:

A through medical and dental history followed by clinical examination was carried out for all patients. Clinical measurements were taken to ensure patient adherence to our initial inclusion criteria prior to further investigations.

A preoperative digital panoramic radiograph with 1:1 magnification was taken for each patient as a primary survey in order to exclude the presence of any lesion at the area of interest nor segment loss followed by A pre-operative CT.

Virtual planning and guide fabrication for the study group:

* Preoperative CT.
* Virtual reduction of broken segments on software.
* Gain occlusion.
* Design surgical screw holes locating guide.
* Design the custom-made plates.
* Print the screw holes locating guide and the custom-made plate.
* Surgical guiding tools: screw holes locating guide and custom-made plates.

Intra operative procedures for both groups:

• In both group: the operation will under general anesthesia with nasal intubation and oral pack, Injection of 20 cc saline adrenaline 1:00000 to 0 in the sulcus for hemostasis, Vestibular mucosal incision followed by mentalis incision in 2 planes and ensure enough cough for latter muscle suturing, Reflect the flap to visualize the broken segments.

In first group:

Put the specific screw holes locating device in place and drill the screw holes, remove the screw holes locating device and mobilize the segments then apply the custom-made plates and fix it with screw for passive reduction of the segments. Then suture the mentalis muscle then the mucosa.

In second group:

mobilize the broken segment first, Arch bar was made to achieve proper occlusion put the compression plate on the inferior border and remove it for further bending using plate pliers for further accommodation of the plate on the inferior border the fix it in place using compression and tension plate.

Eligibility Criteria:
Inclusion Criteria:

* Patients with parasymphseal mandibular class fracture needs open reduction and internal fixation.
* Patients with medical history that did not hinder plate placement (uncontrolled diabetes) and adequate proper oral hygiene.
* Both genders males and females will be included.

Exclusion Criteria:

* • • General contraindications to surgery.

  * Patients with fresh fractures (mobile segments).
  * Patients with unfavourable nor comminuted fractures.
  * Subjected to irradiation in the head and neck area less than 1 year before fixation.
  * Untreated periodontitis.
  * Poor oral hygiene and motivation.
  * Uncontrolled diabetes.
  * Pregnant or nursing.
  * Substance abuse.
  * Psychiatric problems or unrealistic expectations.
  * Severe bruxism or clenching.
  * Immunosuppressed or immunocompromised.
  * Treated or under treatment with intravenous amino-bisphosphonates.
  * Patients participating in other studies, if the present protocol could not be properly followed.