Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

369 questions · 382 findings · 20 reviews · Oral and maxillofacial surgery

No studies found 92 · 24.1%GRADE not reported 239 · 62.6%Very low 42 · 11%Low 4 · 1%Moderate 5 · 1.3%High 0 · 0%

2 mm titanium plates vs 2.5 mm bioresorbable plates

Restoration of function (inability to chew hard food) · Adults (16 to 68 years) with mandibular fractures excluding condylar involvement

2 mm titanium plates showed no clear difference in restoration of function (inability to chew hard food) compared with 2.5 mm bioresorbable plates; GRADE not reported.

1 finding from 1 review

Transbuccal miniplate combined with intraoral approach vs Intraoral approach alone

Post-operative infection (persistent) · Adults with fractures of the mandibular angle

Transbuccal miniplate combined with intraoral approach showed no clear difference in post-operative infection (persistent) compared with intraoral approach alone; GRADE not reported.

1 finding from 1 review

Locking plate vs 2 mm non-locking titanium plates

Post-operative adverse events and complications (paraesthesia, swelling, segmental mobility) · Adults (16 to 68 years) with mandibular fractures excluding condylar involvement
1 finding from 1 review
  • Agarwal 2011: paraesthesia in one participant in the non-locking plate group (resolved by 3 months), none in the locking group; infection rates similar at 6 weeks and 3 months; post-operative swelling in 20% of both…
    1 study
    GRADE not reported

Two miniplates (transbuccal approach) vs One miniplate plus two screws (intraoral approach at external oblique ridge)

Post-operative adverse events and complications (lip numbness; overall) · Adults with fractures of the mandibular angle
1 finding from 1 review
  • Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes
    Angle of mandible only
    Siddiqui 2007: 22/36 (61%) single-miniplate vs 14/26 (54%) two-miniplate had one or more complications; subjective lip numbness 15/36 (41.7%) vs 10/26 (38.5%) (P=0.82), objective 16/36 (44.4%) vs 8/26 (31.7%) (P=0.29).…
    2 studies
    GRADE not reported

2 mm titanium plates vs 2.5 mm bioresorbable plates

Post-operative neurosensory disturbance (mental nerve paraesthesia) · Adults (16 to 68 years) with mandibular fractures excluding condylar involvement

2 mm titanium plates led to higher post-operative neurosensory disturbance (mental nerve paraesthesia) compared with 2.5 mm bioresorbable plates; GRADE not reported.

1 finding from 1 review

Two lag screws vs One lag screw (with arch bars and IMF)

Post-operative adverse events and complications · Adults (16 to 68 years) with mandibular fractures excluding condylar involvement
1 finding from 1 review
  • Three participants in the two-lag-screws group experienced complications: malocclusion (one) and mental-nerve paraesthesia (two, resolved after 3 months). There were no post-operative complications in the one-lag-screw…
    1 study
    GRADE not reported

3-dimensional (3D) miniplates vs Standard (Champy) plates

Post-operative adverse events and complications · Adults (16 to 68 years) with mandibular fractures excluding condylar involvement
1 finding from 1 review
  • Jain 2010 (3D group): segmental mobility (two), proximity to mental nerve or roots (two), radiologically unsatisfactory reduction (one) and unsatisfactory fixation (four) vs one (standard); only fixation differed…
    2 studies
    GRADE not reported

Two miniplates (transbuccal approach) vs One miniplate plus two screws (intraoral approach at external oblique ridge)

Restoration of function (malocclusion) · Adults with fractures of the mandibular angle

Two miniplates (transbuccal approach) showed no clear difference in restoration of function (malocclusion) compared with one miniplate plus two screws (intraoral approach at external…; GRADE not reported.

1 finding from 1 review

Immediate mobilization vs 2 weeks delayed mobilization (IMF)

Average pain scores (0-100 VAS) · Adults with mandibular fractures excluding condyles (fixed with 2 mm titanium miniplates)
1 finding from 1 review
  • Pain (scale 1 to 10) was minor in both groups with no significant differences (Table 4): 6 weeks 1.55 vs 1.20; 3 months 1.00 vs 2.64; 6 months 1.30 vs 2.71 (immediate release vs IMF). 95% confidence interval not…
    1 study
    GRADE not reported

Locking plate vs 2 mm non-locking titanium plates

Drop-out rate due to protocol deviation · Adults (16 to 68 years) with mandibular fractures excluding condylar involvement
1 finding from 1 review
  • Early premature removal of IMF (from hours up to 2 weeks) was reported in 13 of the 90 participants analysed (Collins 2004); participants released their own IMF or reported that "the wires fell off".
    1 study · 90 participants
    GRADE not reported

2 mm titanium plates vs 2.5 mm bioresorbable plates

Post-operative pain (residual pain, any severity) · Adults (16 to 68 years) with mandibular fractures excluding condylar involvement

2 mm titanium plates showed no clear difference in post-operative pain (residual pain, any severity) compared with 2.5 mm bioresorbable plates; GRADE not reported.

1 finding from 1 review

Immediate mobilization vs 2 weeks delayed mobilization (IMF)

Post-operative adverse events and complications · Adults with mandibular fractures excluding condyles (fixed with 2 mm titanium miniplates)
1 finding from 1 review
  • One wound separation and one infection in the immediate-mobilization group. Inferior alveolar nerve status (scale 1 to 3) showed no significant difference at 6 weeks (P=0.76), 3 months (P=0.87) or 6 months (P=0.99).…
    1 study
    GRADE not reported