Comparison of a 2.0-mm locking system with conventional
2.0- and 2.4-mm systems in the treatment of mandibular
fractures: a randomized controlled trial
Rubens Camino Junior
Rogério Bonfante Moraes
João Gualberto C. Luz
Received: 4 December 2016 /Accepted: 29 May 2017 /Published online: 12 June 2017
Springer-Verlag Berlin Heidelberg 2017
Purpose A comparative study of the use of the 2.0-mm
locking fixation system with conventional systems in the treat-
ment of mandibular fractures was performed.
Methods For this study, 87 consecutive patients with 112
mandibular fractures were randomized to receive either 2.0-
mm locking plates (n = 45) or conventional 2.0- or 2.4-mm
plates (n = 42) and had a minimum follow-up of 6 months.
Fractures were classified based on the degree of displacement
and complexity. Statistical analyses were used to verify pos-
sible differences between the groups when separately com-
pared unfavourable and favourable cases (p ≤ 0.050).
Results Despite randomization, systemic diseases were more
frequent in the 2.0-mm locking group in favourable cases.
Substance abuse occurred predominantly in the 2.0-mm
locking group, in unfavourable and favourable fractures.
There were more cases of complex fractures in the conven-
tional group in unfavourable cases. One case involving a ma-
jor postoperative complication occurred in the locking group
(2.2%) and three cases occurred in the conventional group
(7.1%) but with no significant difference between groups. In
this study, there were no major differences between conven-
tional and locking 2.0-mm locking systems with regard to the
outcome of treated mandibular fractures, showing that both
are adequate as long as the criteria of their indication and
requirements for installation are met.
Conclusions It was concluded that the 2.0-mm locking fixa-
tion system can replace conventional systems in the treatment
of mandibular fractures; in addition, this approach was effec-
tive in the treatment of unfavourable fractures that typically
require the 2.4-mm conventional system.
Keywords Mandibular fractures
Fracture fixation, internal
Miniplate fixation is the most widely used technique to treat
mandibular fractures. However, loosening of screws due to the
transmission of pressure to the underlying bone leads to a
reduction in fracture stability and subsequent fixation failure
[1–3]. Rigid fixation is considered a more cost-effective treat-
ment than non-rigid methods, which is partly due to the de-
creased probability of postoperative complications that may
necessitate further surgery .
The primary postoperative complications requiring surgical
retreatment are nonunion, soft tissue infection associated with
screw loosening, osteomyelitis and malunion [5, 6]. Some
factors related to the systemic condition and fracture charac-
teristics can contribute to the occurrence of such complica-
tions [7, 8]. One way to overcome these factors in the treat-
ment of mandibular fractures is the use of more rigid systems
The locking plating system acts as an internal-external
fixator, which results in better distribution of the load, decreas-
ing the risk of screw loosening and slipping . The advan-
tages of the locking systems include the following: greater
* João Gualberto C. Luz
Department of Oral and Maxillofacial Surgery, School of Dentistry,
University of São Paulo, Av. Prof. Lineu Prestes, 2227-Cidade
Universitária, São Paulo, SP 02036-021, Brazil
Department of Oral and Maxillofacial Surgery, Hospital M. Dr.
Arthur R. de Saboya, São Paulo, Brazil
Department of Oral, Craniomaxillofacial and Plastic Facial Surgery,
Sana Hospital Offenbach, Frankfurt Am Main, Germany
Oral Maxillofac Surg (2017) 21:327–334