Management of mandibular angle fractures using 3- dimensional or standard miniplates: A systematic review and meta-analysis

Purpose This study proposed to compare clinical outcomes between three-dimensional (3D) plate and standard miniplate fixation systems for the management of mandibular angle fractures (MAFs). Methods A systematic review search of several databases, including MEDLINE-Ovid, Embase, Springer Link, and PubMed, for relevant articles in English and without date restrictions was performed in February 2018. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure postoperative complications. Results Eleven publications were enrolled in the analysis. The results showed that there were significant differences in overall complications (RR, 0.453; 95% CI, 0.311–0.660; P = 0.007). The incidence of hardware failure showed a statistically significant difference in the outcome, favoring 3D miniplates (fixed: RR 0.156; 95% CI, 0.042–0.581; P = 0.0006). Subgroup analyses indicated that the 3D miniplate caused a lower incidence rate of malunion and hardware failure than the standard miniplate with 8 or 10 holes (P = 0.006, P = 0.03, respectively). In addition, the use of standard miniplates had a shorter operation time than the use of 3D miniplates (P = 0.002). Conclusion The present study demonstrates that the three-dimensional miniplate was a better fixation system than the standard miniplate technique in reducing postoperative complications in the management of mandibular angle fracture (P = 0.007).