Comparison of Reconstruction Plates and Miniplates in Mandibular Defect Reconstruction with Free Iliac Flap

Comparison of Reconstruction Plates and Miniplates in Mandibular Defect Reconstruction with Free Iliac Flap | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Reconstruction Plates and Miniplates in Mandibular Defect Reconstruction with Free Iliac Flap Yifan Wang, Xinmiao Wang, Junqiang Bai, Shutian Guo, Zhengjun Shang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4756879/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Oct, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted 9 You are reading this latest preprint version Abstract Objective Given the increasing demand for precise and reliable reconstructive techniques in maxillofacial surgery, we try to offer valuable insights for clinicians in selecting optimal fixation methods. Materials and Methods Patients were categorized into miniplate and reconstruction plate groups for accuracy and bone healing comparison. We measured gonial angle, intercondylar, intergonial and anterior-posterior distance for general accuracy and distance of segmental endpoint to the sagittal plane for partial accuracy. The bone healing rate of the two groups was compared with CT images at 3, 6 and 12 months after operation. Result Considering directional indicators, the miniplate group exhibited a wider intercondylar distance than the reconstruction plate group (p = 0.029). At 6 months postoperatively, the miniplate group demonstrated a higher bone healing rate compared to the reconstruction plate group, with no significant differences at other time points. Conclusion Over a nearly 5-year review, mandibular reconstruction with vascularized iliac bone flaps showed that reconstruction plates better maintained condylar position accuracy, while miniplates had superior bone healing rates at 6 months. No significant differences were found in other accuracy indices between the two plates. Clinical Relevance: Clinicians' selection of fixation plates frequently depends on personal preference rather than evidence-based criteria. This study compares the precision and postoperative osseous healing outcomes of miniplates and reconstruction plates to provide a more scientifically grounded basis for clinical decision-making. Reconstruction plate Miniplate Reconstruction of mandibular defect Accuracy of reconstruction Bone union Figures Figure 1 1 Introduction Reconstruction of mandibular defects have long been pivotal in the field of oral and maxillofacial surgery. As early as the last century, various bone graft techniques have been continuously explored and developed. With the introduction of perforator flaps [ 1 , 2 ] and the study of the applied anatomy focus on the blood supply of the iliac flap [ 3 , 4 ], vascularized free iliac bone flaps are now widely utilized for mandibular defect reconstruction. The unique contour of the iliac bone graft matches the natural morphology of the mandible. Also, ample cortical and cancellous bone provide optimal conditions in later occlusal reconstruction. With a focus on restoring occlusal function, the prospects for using vascularized free iliac bone flaps are promising. As computer-assisted surgery (CAS) advances and the concept of functional reconstruction surgery expands, precision in bone graft transplantation is increasingly emphasized to restore the continuous contour of mandible and establish a solid foundation for subsequent occlusal reconstruction. Along with a variety of bone flaps, the fixation system of osseous graft has emerged and developed. From the extraoral fixation system, interosseous wires and the plating system in the last century, fixation systems are also the concerned field to explore. Because it is believed that the fixation system itself is often directly related to the outcome and prognosis of bone transplantation [ 5 – 7 ]. Titanium plate fixation systems, widely employed today for their convenience and reliable fixation effects, mainly include reconstruction plates and miniplates. Miniplates are often considered as stress-sharing, beneficial for graft survival and easier to shape [ 8 – 10 ], but they are also more prone to fracture [ 11 , 12 ]. Reconstruction plates, on the other hand, are regarded as stress-bearing, offering robust mechanical performance and secure fixation, albeit potentially interfering with ideal bone healing due to stress shielding and possibly affecting aesthetics with their larger size [ 13 – 15 ]. Some studies have discussed the complications of reconstruction plates and mini plates in the reconstruction of mandibular defects with free fibular flap [ 15 , 16 ]. However, there is limited published research comparing these systems specifically in free iliac bone flap transplantation for mandibular defect reconstruction, particularly regarding postoperative complications and precision of mandibular reconstruction. 2 Patients and Methods 2.1 Patient Inclusion and Data Collection Ethical approval was granted by Medical Ethics Committee of Wuhan University’s Stomatology Hospital (Ethical Approval No. B52, 2023). Patients included in this study underwent simultaneous free iliac bone flap reconstruction of mandibular defects from January 2019 to June 2023 in Oral and Maxillofacial-Head and Neck Oncology Surgery department. Inclusion criteria required patients to undergo CAS and have available postoperative CT scan data within 2 weeks and/or at 3, 6, and/or 12 months postoperatively. Patients unable to meet criteria were excluded. Additionally, patients diagnosed with osteomyelitis, underlying conditions affecting bone healing (such as osteoporosis), long-term use of medications impacting bone healing, or a history of preoperative radiotherapy were excluded. Considering potential age-related effects on bone healing, patients aged 20–65 years were selected for bone healing analysis. Patients were categorized into two groups based on the type of titanium plates used: the miniplate group (Group A) and the reconstruction plate group (Group B). Patients using both types of plates simultaneously were excluded. The reconstruction plates used in this study were Stryker 2.3 reconstruction plates or Martin 2.0 reconstruction plates, each using only 1 plate. The miniplates included Stryker 2.0 miniplates or Martin 2.0 miniplates, used in quantities of 4 or 6 plates. Subgroup classification was further based on the number of bone segments transplanted: single-segment miniplate group (Group A1), double-segment miniplate group (Group A2), single-segment reconstruction plate group (Group B1), and double-segment reconstruction plate group (Group B2). Patients with three or more bone segments were excluded due to their rarity, ensuring analytical accuracy. Demographic and clinical characteristics of included patients, such as age, gender, smoking history, alcohol history, diagnosis (classified as benign or malignant), type of titanium plate, number of bone segments transplanted, surgical duration, and mandibular defect classification according to the Brown classification system (which categorizes involvement of unilateral/bilateral mandibular angles, premolars, and condyles, limited to types I-III in this study) [ 17 ], were collected from the electronic medical records system and imaging center. 2.2 Accuracy Analysis All patients involved in the accuracy analysis underwent preoperative CBCT or CT scans conducted by the same specialized team for computer-assisted design. During surgery, the choice between reconstruction plates and miniplates was at the discretion of the operating surgeon. CBCT or CT scan data obtained within 2 weeks postoperatively were utilized for three-dimensional mandibular modeling. The postoperative models were aligned with the preoperative design models using the unaffected side as a reference to measure accuracy indicators (Fig. 1 ) (Mimics Research 21.0, 3-matic Research 13.0). Accuracy measurements (Fig. 1 ) in this study were divided into two parts: 1. General mandibular accuracy measurement: intercondylar distance (IC, mm), intergonial distance (IG, mm), anterior-posterior distance (AP, mm) and gonial angle (GA, degrees). Analysis of intergonial distance and gonial angle excluded patients where the mandibular angle was resected. Patients where condyles were not preserved were also excluded from accuracy measurement. 2. Partial accuracy measurement of bone segments for reconstruction of the mandibular lower border contour: distance from the anterior, posterior endpoint and midpoint (for patients with two bone segments) of the bone segment to the sagittal plane (mm). Endpoint measurements were taken from the outermost and lowermost points of the bone segments. All accuracy indicators were measured by the same specialized personnel, calculating the difference between postoperative and preoperative models. Additionally, postoperative reconstruction model 3D measurements were utilized to assess the defect area length (Defect size, DS, mm). 2.3 Bone Healing Analysis Patients included in the bone healing analysis were scheduled for postoperative CBCT or CT scans at 3 months, 6 months, and/or 12 months. Postoperative imaging was retrieved to assess bone healing using a scoring system [ 18 ], which evaluates the extent of bone union at bone-to-bone contact surfaces: Score 1: New bone callus absent with visible transplant interface present. Score 2: New bone callus present with visible transplant interface present. Score 3: New bone callus present without visible transplant interface. The percentage of bone contact surfaces achieving a score of 3 was calculated as the bone healing rate, relative to the total number of bone contact surfaces assessed. Bone healing rates were calculated separately for each group at 3 months, 6 months, and 12 months postoperatively. These bone healing scores were consistently evaluated by the same specialized personnel. 2.4 Statistical Analysis Statistical analysis was performed using SPSS software (IBM SPSS Statistics 26.0). The t-test was employed to compare continuous data that followed a normal distribution. The Mann-Whitney test was used for comparing non-normally distributed continuous data. Normality of continuous data was assessed using the Shapiro-Wilk test. Chi-square test and Fisher’s exact test were utilized for comparing categorical data. Normally distributed data are presented as "mean ± standard deviation," while non-normally distributed numerical data are presented as "median and interquartile range." A significance level of p < 0.05 was considered indicative of statistical significance between groups. 3 Results We collected patients undergoing simultaneous free iliac flap reconstruction for mandibular defects from January 2019 to June 2023. According to inclusion and extraction criteria, a total of 158 patients were finally enrolled, with 98 meeting the criteria for accuracy analysis and 113 meeting criteria for bone healing analysis. Include the demographic characteristics and clinical features of the patients as shown in Tables 1 a and 1 b. The proportion of reconstruction plates used in malignant tumor patients (39.3%) was significantly higher than that in the miniplate group (10.9%) ( p < 0.01). The mean defect length in the Group A1 was 52.82 mm, significantly less than 61.27 mm in the Group B1. However, there was no significant difference in the defect length between Group A2 and B2. The duration of surgery in the miniplate group was significantly shorter than in the reconstruction plate group ( p < 0.01). This may be due to a higher proportion of malignant tumor cases in the reconstruction plate group, which often involve more complex and time-consuming procedures such as neck lymph node dissection. Additionally, larger defects of reconstruction plate group may also increase the complexity and duration of reconstruction surgery. Table 1 a Patient demographic characteristics Item Miniplates group Reconstruction plates group A1(N = 39) A2(N = 7) A (N = 46) B1(N = 78) B2(N = 34) B (N = 112) Age (years) 37.1 ± 15.0 53.0(37.0–69.0) 39.5(13.25, 65.75) 45.6 ± 15.2 54.5(29.0–80.0) 50.0(25.25, 74.75) Gender Male 20(51.3%) 4(57.1%) 24(52.2%) 54(69.2%) 20(58.8%) 74(66.1%) Female 19(48.7%) 3(42.9%) 22(47.8%) 24(30.8%) 14(41.2%) 38(33.9%) Social history Alcohol 2(5.1%) 3(42.9%) 5(10.9%) 17(21.8%) 8(23.5%) 25(22.3%) Cigarette 11(28.2%) 2(28.6%) 13(28.3%) 28(35.9%) 10(29.4%) 38(33.9%) Table 1 b Patient clinical characteristics Item Miniplates group Reconstruction plates group p value A1(N = 39) A2(N = 7) A Total(N = 46) B1(N = 78) B2(N = 34) B Total(N = 112) A1/B1 A2/B2 A/B Diagnosis 0.001 * 0.844 0.001 * Malignancy 3(7.7%) 2(28.6%) 5(10.9%) 33(42.3%) 11(32.4%) 44(39.3%) Benign 36(92.3%) 5(71.4%) 41(89.1%) 45(57.7%) 23(67.6%) 68(60.7%) Brown classification 0.933 0.046 * 0.967 Ⅰ 25(64.1%) 0 25(54.3%) 50(64.1%) 13(38.2%) 63(56.3%) Ⅱ 13(33.3%) 3(42.9%) 16(34.8%) 25(32.1%) 11(32.4%) 36(32.1%) Ⅲ 1(2.6%) 4(57.1%) 5(10.9%) 3(3.8%) 10(29.4%) 13(11.6%) Bone segments 0.047 * 1 / / 39(84.8%) / / 78(69.6%) 2 / / 7(15.2%) / / 34(30.4%) Duration of surgery(h) 5.1(3.8, 6.4) 6.8 ± 1.8 5.3(3.7, 6.8) 6.7(4.7, 8.8) 7.0 ± 1.2 7(5.1, 8.9) 0.001 * 0.687 0.001 * Segment Length (mm) 51.94 ± 10.16 60.09 ± 6.50 52.82 ± 10.10 59.11 ± 11.90 66.87 ± 10.60 61.27 ± 12.00 0.007 * 0.241 0.001 * * p < 0.05 The accuracy analysis results are shown in Table 2 and Table 3 . When analyzing only the absolute values of accuracy indicators, there were no significant differences in general mandibular accuracy (Table 2 a) or the partial accuracy (Table 2 b) between the two titanium plates ( p > 0.05). However, when considering the direction of relevant indicators (Table 3 ), it was found that the intercondylar distance after surgery was significantly wider in the miniplate group compared to preoperative levels, with a statistical difference ( p = 0.029). This indicates that reconstruction plates may maintain better accuracy of the position of the condyles in mandibular reconstruction. The accuracy of reconstructing the lower mandibular margin did not significantly differ between the two titanium plates. Table 2 a Comparison of general accuracy (absolute value) Item Miniplates group Reconstruction plates group p value A1(N = 33) A2(N = 4) A Total(N = 37) B1(N = 44) B2(N = 17) B Total(N = 61) A1/B1 A2/B2 A/B IC (mm) 1.61 (0.13, 3.09) 3.53 (1.16, 5.90) 1.62 (-0.51, 3.75) 1.29 (-0.71, 3.29) 1.55 (-2.23, 5.33) 1.41 (-1.05, 3.87) 0.283 0.508 0.294 AP (mm) 0.91 (0.02, 1.80) 2.54 (-1.03, 6.11) 0.95 (-0.13, 2.03) 0.86 (0.00, 1.72) 1.08 (-0.13, 2.29) 1.03 (0.08, 1.98) 0.800 0.246 0.674 IG (mm) 1.61 (-2.04, 5.26) 3.74 ± 2.42 1.62 (-2.22, 5.46) 2.51 (-0.54, 5.56) 2.31 ± 1.77 2.34 (-0.73, 5.41) 0.443 0.206 0.844 GA (°) 1.70 (-0.34, 3.74) 2.22 ± 1.77 1.70 (-0.41, 3.81) 1.42 (-0.70, 3.54) 2.63 ± 1.83 2.03 (-0.48, 4.54) 0.610 0.696 0.987 Table 2 b Comparison of partial accuracy (absolute value) Item Miniplates group Reconstruction plates group p value A1(N = 33) A2(N = 4) A Total(N = 37) B1(N = 44) B2(N = 17) B Total(N = 61) A1/B1 A2/B2 A/B Anterior endpoint (mm) 1.28 (-0.75, 3.31) 1.06 (-2.44, 4.56) 1.26 (-0.77, 3.29) 2.06 (-0.36, 4.48) 2.76 (-0.34, 5.86) 2.37 (-0.53, 5.27) 0.208 0.232 0.054 Midpoint (mm) / 0.88 (-3.23, 4.99) / / 1.68 (-0.04, 3.40) / / 0.402 / Posterior endpoint (mm) 1.98 (-1.83, 5.79) 1.80 ± 1.93 1.98 (-1.97, 5.93) 2.03 (-0.17, 4.23) 2.40 ± 1.72 2.03 (-0.34, 4.40) 0.921 0.508 0.744 Total (mm) 2.28 (0.13, 4.43) 1.04 (-2.63, 4.71) 1.67 (-0.58, 3.92) 2.13 (0.06, 4.20) 2.46 (1.08, 3.84) 2.26 (0.49, 4.03) 0.776 0.229 0.442 Table 3 Comparison of accuracy Item Miniplates group Reconstruction plates group p value A Total(N = 37) B Total(N = 61) A/B IC (mm) + 1.61(-0.10, 3.32), (56.8%) 0.84(-0.72, 2.40), (34.4%) 0.029 * - -1.65(-4.04, 0.74), (43.2%) -1.61(-4.37, 1.15), (65.6%) 1.000 AP (mm) + 0.99(0.22, 1.76), (59.5%) 1.07(-0.07, 1.07), (72.1%) 0.847 - -0.75(-2.42, 0.92), (40.5%) -0.86(-1.55, -0.17), (27.9%) 0.702 IG (mm) + 1.80(-2.25, 5.85), (74.2%) 3.16(0.72, 5.60), (60.0%) 0.131 - -1.62(-5.40, 2.16), (25.8%) -1.25(-3.04, 0.54), (40.0%) 0.120 GA (°) + 1.19(-1.21, 3.59), (48.4%) 2.19(-1.12, 5.50), (54.0%) 0.380 - -2.15 ± 1.29, (51.6%) -1.83 ± 1.48, (46.0%) 0.482 Anterior endpoint (mm) + 1.30(-1.81, 4.41), (70.3%) 2.46(-0.44, 5.36), (78.7%) 0.147 - -1.26 ± 0.91, (29.7%) -1.83 ± 1.42, (21.3%) 0.261 Posterior endpoint (mm) + 0.90(-1.37, 3.17), (37.8%) 1.55(-0.98, 4.08), (52.5%) 0.089 - -2.98 ± 2.21, (62.2%) -2.48 ± 1.73, (47.5%) 0.370 * p < 0.05 The results of bone healing are shown in Table 4 . Due to potential age-related influences on bone healing, analysis was performed on patients aged 20–65 years. There were no statistical differences in age or gender between the groups and subgroups compared (A/B, A1/B1, A2/B2) ( p > 0.05). There were no significant differences in bone union rates between the two plates, and their respective subgroups at the third and twelfth months postoperatively. However, at six months postoperatively, regardless of single or double bone segment numbers, the bone healing rate was higher in the miniplate group compared to the corresponding reconstruction plate group ( p < 0.05). Nonetheless, high bone healing rates (94.4%-100.0%) were achieved in both plates by one year postoperatively. Table 4 Comparison of bone union at different postoperative timepoint Item Miniplates group Reconstruction plates group p valu e A1(n = 73) A2(n = 17) A (n = 90) B1(n = 126) B2(n = 81) B (n = 207) A1/B1 A2/B2 A/B 3m 33.3% 33.3% 33.3% 23.9% 39.5% 31.5% 0.553 1.000 0.861 6m 71.8% 100.0% 76.6% 49.1% 54.3% 51.5% 0.027 * 0.040 * 0.004 * 12m 95.1% 100.0% 96.6% 94.9% 93.8% 94.4% 1.000 0.561 0.813 * p < 0.05 4 Discussion Vascularized iliac flap is one of the main bone flaps used for segmental mandibular defect reconstruction. To explore the optimal fixation method is essential. However, existing literature predominantly compares common fixation plate systems in vascularized fibular flaps. Therefore, this study focuses on comparing the application of reconstruction plates and miniplates in vascularized iliac flaps. Previous studies have focused on complications following mandibular reconstruction with reconstruction plates and miniplates. Robey et al. found no statistically significant differences in cumulative incidence rates of postoperative complications such as plate removal, plate fracture, malunion or nonunion between the two types of plates [ 19 – 21 ]. A meta-analysis also indicated higher rates of plate extrusion and fracture in the miniplate group compared to the reconstruction plate group, with no significant differences in rates of surgical site infection, malunion or nonunion, though heterogeneity limited reliable conclusions, necessitating further comprehensive research [ 22 ]. When selecting internal fixation plates, consideration should extend beyond the potential plate-related complications to include their impact on the accuracy of mandibular reconstruction. The clinical significance of mandibular reconstruction accuracy has yet to be sufficiently studied [ 23 ]. However, different levels of accuracy may lead to varied aesthetic outcomes. For instance, Sun et al. found that bone deviations in the midface less than 1.6 mm were clinically acceptable in orthognathic surgery [ 24 ]. Given that midfacial soft tissue is relatively abundant compared to thin soft tissue covering the lower border of the mandible, greater precision is required in mandibular reconstruction to achieve satisfactory aesthetic results. However, further research is needed to conclusively determine the impact of specific deviation values on aesthetic outcomes. Additionally, studies suggest that changes in mandibular dimensions post-reconstruction may be implicated in certain neuro-muscular functional impairments, such as craniomandibular dysfunction. In this study, the median general deviation values for mandibular reconstruction of the lower border were 1.67 mm for the miniplate group and 2.26 mm for the reconstruction plate group, with no statistically significant difference. The spatial deviation of the condyle after mandibular reconstruction plays a significant role in both aesthetics and mandibular function [ 25 ]. Anomalies in the temporomandibular joint (TMJ) can lead to malocclusion, chewing difficulties, facial contour deformities, or pain. Condylar displacement is primarily influenced by the location and extent of the mandibular defect [ 26 , 27 ]. For instance, in cases where the ascending mandibular ramus is preserved, the deviation of the TMJ is smaller due to the preservation of the joint capsule and disc structure compared to cases where the condyle is resected. While the TMJ has better stability when both the ascending ramus and condyle are preserved. In our study, regardless of whether the ascending ramus was preserved, the absolute deviation value of the intercondylar distance between the miniplate and reconstruction plate groups showed no statistical significance. Results in this paper suggest that reconstruction plates offer better accuracy in maintaining condylar position. This may be attributed to the ability of reconstruction plates to span the bone defect area, thereby better controlling the overall shape of the mandible. Additionally, reconstruction plates, guided by screw hole positioning, possess characteristics that restore the pre-displacement relationship of mandibular segment positions. Miniplates, on the other hand, often require multiple plates to be used in tandem at both ends of the segmental defect, providing greater flexibility but potentially compromising the precision of mandibular overall shape reconstruction, especially in achieving precise fixation of deep condyles. Further research is needed to determine whether patients with reconstruction plates experience better restoration of TMJ function postoperatively. Since its introduction in 2009, CAS has been integrated into the surgical procedures for mandibular defect reconstruction in many hospitals [ 28 , 29 ]. The advent of CAS, including virtual surgical planning (VSP) and the application of cutting guides and forth on, has enhanced the accuracy of mandibular defect reconstruction [ 30 ]. In this study, both types of titanium plates used were prefabricated and manually pre-bent based on preoperative models. Besides possibly affecting accuracy, repeated deformation of titanium plates in the same position during pre-bending could lead to metal fatigue, potentially increasing the risk of plate fracture postoperatively. In recent years, with the development of CAS and computer-assisted design and manufacturing (CAD/CAM), personalized titanium plates for patients have been developed and applied, offering higher accuracy in mandibular reconstruction and improving postoperative quality of life compared to traditional manually pre-bent titanium plates [ 31 – 34 ]. However, due to longer production times and higher costs, personalized titanium plates have not yet been widely used in clinical applications in China. In comparing the applications of reconstruction plates and miniplates in mandibular reconstruction, in addition to accuracy, consideration should also be given to their long-term effects. This study focuses on the postoperative bone healing of the two types of plates. In this study, the miniplate group showed higher healing rates at the sixth month postoperative compared to the reconstruction plate group, but there was no difference at the twelfth month, possibly due to faster bone healing in the miniplate group. However, uncertainties in patient follow-up visits and poor compliance among some patients led to longer intervals between imaging data collection points, preventing capture of bone healing conditions over shorter intervals in both groups. Further research may be needed to reveal the bone healing rates after iliac bone graft transplantation using different titanium plates. Reconstruction plates are often considered to bear stress due to their higher mechanical performance, sometimes causing stress shielding leading to graft atrophy or osteoporosis, which is detrimental to bone healing. Miniplates are generally considered to share stress, promoting bone healing [ 15 , 35 ]. The results of this study confirm this pattern. Additionally, studies have shown that radiotherapy has a certain impact on bone healing, with a history of radiotherapy being an independent risk factor for non-union [ 14 ]. In this study, the proportion of patients with malignant tumors was significantly higher in the reconstruction plate group than in the miniplate group, suggesting that more patients in the reconstruction plate group might have been exposed to radiotherapy after reconstruction surgery, possibly leading to significantly lower bone healing rates at six months postoperatively in the reconstruction plate group. There is limited research on the selection of internal fixation plates for pediatric patients. Pediatric mandibular defect reconstruction is particularly complex, with some scholars suggesting personalized titanium implantation for children under 2 years of age and recommending free bone flap transplantation for children over 5 years of age [ 36 , 37 ]. Both reconstruction plates and miniplates have been reported for use in pediatric mandibular reconstruction surgeries, but there have been no studies comparing the application of the two[ 38 , 39 ]. This study included a total of 7 pediatric patients, with 4 using miniplates and 3 using reconstruction plates. However, the small sample size precludes drawing reliable conclusions, necessitating further research into the selection of internal fixation plates for pediatric mandibular reconstruction. 5 Conclusion This study reviewed data from patients undergoing vascularized iliac crest flap mandibular reconstruction over a period of approximately 4.5 years. It compared the accuracy of mandibular reconstruction using miniplates versus reconstruction plates. Reconstruction plates demonstrated superior accuracy in maintaining condylar positioning compared to miniplates, with no significant difference observed in overall accuracy between the two titanium plates. The study also investigated bone healing rates at 3, 6, and 12 months post-reconstruction with both types of titanium plates. It found a significantly higher bone healing rate in the miniplate group at 6 months compared to the reconstruction plate group, although both groups achieved similarly high bone healing rates at 12 months (94.4–100.0%). Declarations Author contributions: Conceptualization: Zhe Shao and Yifan Wang; Methodology: Zhe Shao and Yifan Wang; Formal analysis and investigation: Yifan Wang, Xinmiao Wang, Junqiang Bai, and Shutian Guo; Writing – original draft preparation: Yifan Wang; Writing – review and editing: Zhe Shao and Zhengjun Shang. Ethics Approval and Consent: This study was approved by the Ethics Committee of School & Hospital of Stomatology, Wuhan University (Ethical Approval No. B52, 2023) and followed the Declaration of Helsinki. Due to the retrospective observational nature of this study and the large number of subjects included, we requested and received approval for a waiver of informed consent from the Ethics Committee of School & Hospital of Stomatology, Wuhan University. Funding: This work was supported by the National Nature Science Foundation of China (Grant No.82373093). Competing Interests: The authors have no relevant financial or non-financial interests to disclose. References Koshima I, Moriguchi T, Fukuda H, Yoshikawa Y, Soeda S (1991) Free, thinned, paraumbilical perforator-based flaps. J Reconstr Microsurg 7:313–316 Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N (1992) Free thin paraumbilical perforator-based flaps. Ann Plast Surg 29:12–17. https://doi.org/10.1097/00000637-199207000-00004 Taylor GI, Corlett RJ, Ashton MW (2016) The Evolution of Free Vascularized Bone Transfer: A 40-Year Experience. Plast Reconstr Surg 137:1292–1305. https://doi.org/10.1097/PRS.0000000000002040 Huang GK, Liu ZZ, Shen YL, Hu RQ, Miao H, Yin ZY (1980) Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels. J Microsurg 2:113–120. https://doi.org/10.1002/micr.1920020207 Shaw RJ, Kanatas AN, Lowe D, Brown JS, Rogers SN, Vaughan ED (2004) Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck 26:456–463. https://doi.org/10.1002/hed.10343 Gielisch MW, Siegberg F, Thiem DGE, Blatt S, Heimes D, Kämmerer PW (2023) A novel alloplastic grid reconstruction plate for the mandible - Retrospective comparative clinical analysis of failure rates and specific complications. J Craniomaxillofac Surg 51:448–453. https://doi.org/10.1016/j.jcms.2023.07.005 Sobti N, Ahmed KS, Polanco T, Chilov M, Cohen MA, Boyle J, Shahzad F, Matros E, Nelson JA, Allen RJ (2022) Mini-plate versus reconstruction bar fixation for oncologic mandibular reconstruction with free fibula flaps: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 75:2691–2701. https://doi.org/10.1016/j.bjps.2022.04.097 Malata CM, McLean NR, Alvi R, McKiernan MV, Milner RH, Piggot TA (1997) An evaluation of the Würzburg titanium miniplate osteosynthesis system for mandibular fixation. Br J Plast Surg 50:26–32. https://doi.org/10.1016/s0007-1226(97)91279-0 Steffen C, Sellenschloh K, Vollmer M, Morlock MM, Heiland M, Huber G, Rendenbach C (2020) Biomechanical comparison of titanium miniplates versus a variety of CAD/CAM plates in mandibular reconstruction. J Mech Behav Biomed Mater 111:104007. https://doi.org/10.1016/j.jmbbm.2020.104007 Hidalgo DA (1989) Titanium miniplate fixation in free flap mandible reconstruction. Ann Plast Surg 23:498–507. https://doi.org/10.1097/00000637-198912000-00005 Evans GR, Clark N, Manson PN, Leipziger LS (1995) Role of mini- and microplate fixation in fractures of the midface and mandible. Ann Plast Surg 34:453–456. https://doi.org/10.1097/00000637-199505000-00001 Chang T-Y, Lai Y-S, Lin C-Y, Wang J-D, Pan S-C, Shieh S-J, Lee J-W, Lee Y-C (2023) Plate-related complication and health-related quality of life after mandibular reconstruction by fibula flap with reconstruction plate or miniplate versus anterolateral thigh flap with reconstruction plate. Microsurgery 43:131–141. https://doi.org/10.1002/micr.30893 Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, Biller HF (1998) Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg 124:46–55. https://doi.org/10.1001/archotol.124.1.46 Knitschke M, Yonan M, Roller FC, Pons-Kühnemann J, Attia S, Howaldt H-P, Streckbein P, Böttger S (2022) Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants. Cancers (Basel) 14:5774. https://doi.org/10.3390/cancers14235774 Robey AB, Spann ML, McAuliff TM, Meza JL, Hollins RR, Johnson PJ (2008) Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible. Plast Reconstr Surg 122:1733–1738. https://doi.org/10.1097/PRS.0b013e31818a9ac5 Shaw RJ, Kanatas AN, Lowe D, Brown JS, Rogers SN, Vaughan ED (2004) Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck 26:456–463. https://doi.org/10.1002/hed.10343 Brown JS, Barry C, Ho M, Shaw R (2016) A new classification for mandibular defects after oncological resection. Lancet Oncol 17:e23-30. https://doi.org/10.1016/S1470-2045(15)00310-1 May MM, Howe BM, O’Byrne TJ, Alexander AE, Morris JM, Moore EJ, Kasperbauer JL, Janus JR, Van Abel KM, Dickens HJ, Price DL (2021) Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck 43:2342–2352. https://doi.org/10.1002/hed.26688 Robey AB, Spann ML, McAuliff TM, Meza JL, Hollins RR, Johnson PJ (2008) Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible. Plast Reconstr Surg 122:1733–1738. https://doi.org/10.1097/PRS.0b013e31818a9ac5 Shaw RJ, Kanatas AN, Lowe D, Brown JS, Rogers SN, Vaughan ED (2004) Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck 26:456–463. https://doi.org/10.1002/hed.10343 López-Arcas JM, Arias J, Del Castillo JL, Burgueño M, Navarro I, Morán MJ, Chamorro M, Martorell V (2010) The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg 68:2377–2384. https://doi.org/10.1016/j.joms.2009.09.027 Sobti N, Ahmed KS, Polanco T, Chilov M, Cohen MA, Boyle J, Shahzad F, Matros E, Nelson JA, Allen RJ (2022) Mini-plate versus reconstruction bar fixation for oncologic mandibular reconstruction with free fibula flaps: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 75:2691–2701. https://doi.org/10.1016/j.bjps.2022.04.097 Goormans F, Sun Y, Bila M, Schoenaers J, Geusens J, Lübbers H-T, Coucke W, Politis C (2019) Accuracy of computer-assisted mandibular reconstructions with free fibula flap: Results of a single-center series. Oral Oncol 97:69–75. https://doi.org/10.1016/j.oraloncology.2019.07.022 Sun Y, Luebbers H-T, Agbaje JO, Schepers S, Vrielinck L, Lambrichts I, Politis C (2013) Validation of anatomical landmarks-based registration for image-guided surgery: an in-vitro study. J Craniomaxillofac Surg 41:522–526. https://doi.org/10.1016/j.jcms.2012.11.017 Möllmann HL, Apeltrath L, Karnatz N, Wilkat M, Riedel E, Singh DD, Rana M (2021) Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction. Front Oncol 11:719028. https://doi.org/10.3389/fonc.2021.719028 Brown JS, Barry C, Ho M, Shaw R (2016) A new classification for mandibular defects after oncological resection. Lancet Oncol 17:e23-30. https://doi.org/10.1016/S1470-2045(15)00310-1 Wang L, Liu K, Shao Z, Shang Z-J (2017) Management of the condyle following the resection of tumours of the mandible. Int J Oral Maxillofac Surg 46:1252–1256. https://doi.org/10.1016/j.ijom.2017.04.029 Zeiderman MR, Pu LLQ (2020) Contemporary reconstruction after complex facial trauma. Burns Trauma 8:tkaa003. https://doi.org/10.1093/burnst/tkaa003 Hirsch DL, Garfein ES, Christensen AM, Weimer KA, Saddeh PB, Levine JP (2009) Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg 67:2115–2122. https://doi.org/10.1016/j.joms.2009.02.007 Zhang L, Liu Z, Li B, Yu H, Shen SG, Wang X (2016) Evaluation of computer-assisted mandibular reconstruction with vascularized fibular flap compared to conventional surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 121:139–148. https://doi.org/10.1016/j.oooo.2015.10.005 Raghoebar II, Dubois L, de Lange J, Schepers T, Don Griot P, Essig H, Rozema F (2023) The Effectiveness of Three-Dimensional Osteosynthesis Plates versus Conventional Plates for the Treatment of Skeletal Fractures: A Systematic Review and Meta-Analysis. J Clin Med 12:4661. https://doi.org/10.3390/jcm12144661 Möllmann HL, Apeltrath L, Karnatz N, Wilkat M, Riedel E, Singh DD, Rana M (2021) Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction. Front Oncol 11:719028. https://doi.org/10.3389/fonc.2021.719028 Pamias-Romero J, Saez-Barba M, de-Pablo-García-Cuenca A, Vaquero-Martínez P, Masnou-Pratdesaba J, Bescós-Atín C (2023) Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature. Cancers (Basel) 15:2582. https://doi.org/10.3390/cancers15092582 Ong HS, Liu JN, Ahmed A, Qu XZ, Wan K, Xie DP, Zhang CP (2019) Improved accuracy of hemimandibular reconstructions involving the condyle by utilizing hydroformed reconstruction plates rather than hand-bent stock plates. Head Neck 41:3168–3176. https://doi.org/10.1002/hed.25809 Steffen C, Sellenschloh K, Willsch M, Soares AP, Morlock MM, Heiland M, Kreutzer K, Huber G, Rendenbach C (2023) Patient-specific miniplates versus patient-specific reconstruction plate: A biomechanical comparison with 3D-printed plates in mandibular reconstruction. J Mech Behav Biomed Mater 140:105742. https://doi.org/10.1016/j.jmbbm.2023.105742 Guo L, Ferraro NF, Padwa BL, Kaban LB, Upton J (2008) Vascularized fibular graft for pediatric mandibular reconstruction. Plast Reconstr Surg 121:2095–2105. https://doi.org/10.1097/PRS.0b013e3181712399 Valentini V, Califano L, Cassoni A, Marco DM, Raponi I, Priore P, Fadda MT, Dell’Aversana Orabona G, Terenzi V (2018) Maxillo-Mandibular Reconstruction in Pediatric Patients: How To Do It? J Craniofac Surg 29:761–766. https://doi.org/10.1097/SCS.0000000000004380 Innocenti M, Mori F, Raffaini M, Lucattelli E, Innocenti A (2020) Mandibular ramus and condyle reconstruction with vascularized proximal fibular epiphyseal transfer in the pediatric patient: A case report. Microsurgery 40:818–822. https://doi.org/10.1002/micr.30589 Nkenke E, Agaimy A, St Pierre M, Gratzki N, Stockmann P, von Wilmowsky C (2013) Intraoral microvascular anastomosis for segmental mandibular reconstruction following removal of an ameloblastoma. J Craniofac Surg 24:e265-270. https://doi.org/10.1097/SCS.0b013e31828cbe80 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Oct, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted Editorial decision: Accepted 01 Oct, 2024 Reviews received at journal 26 Sep, 2024 Reviewers agreed at journal 24 Sep, 2024 Reviews received at journal 22 Sep, 2024 Reviewers agreed at journal 23 Aug, 2024 Reviewers invited by journal 28 Jul, 2024 Editor assigned by journal 18 Jul, 2024 Submission checks completed at journal 18 Jul, 2024 First submitted to journal 17 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4756879","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335425864,"identity":"927514aa-5cd8-4cfe-9b24-98692361bd5f","order_by":0,"name":"Yifan Wang","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Yifan","middleName":"","lastName":"Wang","suffix":""},{"id":335425865,"identity":"6240ec06-bf7d-4d4e-8106-ff95eb023049","order_by":1,"name":"Xinmiao Wang","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Xinmiao","middleName":"","lastName":"Wang","suffix":""},{"id":335425866,"identity":"a6520b53-7e4e-4831-bb43-e9aeebbe18b8","order_by":2,"name":"Junqiang Bai","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Junqiang","middleName":"","lastName":"Bai","suffix":""},{"id":335425867,"identity":"2ea4d17b-e2b9-466d-87d1-a875d362f853","order_by":3,"name":"Shutian Guo","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Shutian","middleName":"","lastName":"Guo","suffix":""},{"id":335425868,"identity":"daf7f62b-631e-48c2-bc44-9984b1f95a06","order_by":4,"name":"Zhengjun Shang","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Zhengjun","middleName":"","lastName":"Shang","suffix":""},{"id":335425869,"identity":"e9059912-27c9-4363-8bc6-73eaa0c314e5","order_by":5,"name":"Zhe Shao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDACCSBmbGCQAzMY2EjQYky6lsQGorXIz25++PDnDpv0Dbd7DBg+lB1m4J/dgF+LwZ1jxgaSZ9JyN9w5Y8A449xhBok7BwhokUgwkzBsO5y77UaOATNv22GQCAGHzUj/JpHY9j/dDKTlLzFaGG7kmEkcbDuQANbCSIwWgxs5xYaNbcmG+2+kFRzsOZfOI3GDsMM2PvzZZicvOSN544MfZdZy/DMIOQwZHABiHhLUj4JRMApGwSjABQDCRUUVIWyrIwAAAABJRU5ErkJggg==","orcid":"","institution":"Wuhan University","correspondingAuthor":true,"prefix":"","firstName":"Zhe","middleName":"","lastName":"Shao","suffix":""}],"badges":[],"createdAt":"2024-07-17 14:21:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4756879/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4756879/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00784-024-05985-9","type":"published","date":"2024-10-10T15:57:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62657093,"identity":"b56e9d99-c2d6-43a9-8b0d-aae18a8c5265","added_by":"auto","created_at":"2024-08-17 02:06:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1700316,"visible":true,"origin":"","legend":"\u003cp\u003eMethod for accuracy analysis of segmental mandibular defect reconstruction. A: Firstly, the postoperative and preoperative three-dimensional mandibular models are aligned with the healthy side as the reference. The postoperative model is shown in blue, and the preoperative model is shown in magenta. For clarity, this figure illustrates the measurement of accuracy indicators using the postoperative model as an example. B-E: Overall accuracy measurements of the mandible: intercondylar distance (IC, mm), intergonial distance (IG, mm), anterior-posterior distance (AP, mm), gonial angle (GA, degrees). F: Partial accuracy measurement of bone segments for reconstruction of the mandibular lower border contour: distance from the anterior, posterior endpoint of the bone segment to the sagittal plane (mm).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4756879/v1/2b3606b7edf5509ae7baf895.png"},{"id":66597193,"identity":"19ebca4a-5993-4586-af17-959e9b415978","added_by":"auto","created_at":"2024-10-14 16:08:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3391768,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4756879/v1/91a22fa9-2a1f-4870-8cbd-3f08e3d90767.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Reconstruction Plates and Miniplates in Mandibular Defect Reconstruction with Free Iliac Flap","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eReconstruction of mandibular defects have long been pivotal in the field of oral and maxillofacial surgery. As early as the last century, various bone graft techniques have been continuously explored and developed. With the introduction of perforator flaps [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and the study of the applied anatomy focus on the blood supply of the iliac flap [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], vascularized free iliac bone flaps are now widely utilized for mandibular defect reconstruction. The unique contour of the iliac bone graft matches the natural morphology of the mandible. Also, ample cortical and cancellous bone provide optimal conditions in later occlusal reconstruction. With a focus on restoring occlusal function, the prospects for using vascularized free iliac bone flaps are promising. As computer-assisted surgery (CAS) advances and the concept of functional reconstruction surgery expands, precision in bone graft transplantation is increasingly emphasized to restore the continuous contour of mandible and establish a solid foundation for subsequent occlusal reconstruction.\u003c/p\u003e \u003cp\u003eAlong with a variety of bone flaps, the fixation system of osseous graft has emerged and developed. From the extraoral fixation system, interosseous wires and the plating system in the last century, fixation systems are also the concerned field to explore. Because it is believed that the fixation system itself is often directly related to the outcome and prognosis of bone transplantation [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Titanium plate fixation systems, widely employed today for their convenience and reliable fixation effects, mainly include reconstruction plates and miniplates. Miniplates are often considered as stress-sharing, beneficial for graft survival and easier to shape [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], but they are also more prone to fracture [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Reconstruction plates, on the other hand, are regarded as stress-bearing, offering robust mechanical performance and secure fixation, albeit potentially interfering with ideal bone healing due to stress shielding and possibly affecting aesthetics with their larger size [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome studies have discussed the complications of reconstruction plates and mini plates in the reconstruction of mandibular defects with free fibular flap [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, there is limited published research comparing these systems specifically in free iliac bone flap transplantation for mandibular defect reconstruction, particularly regarding postoperative complications and precision of mandibular reconstruction.\u003c/p\u003e"},{"header":"2 Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patient Inclusion and Data Collection\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was granted by Medical Ethics Committee of Wuhan University\u0026rsquo;s Stomatology Hospital (Ethical Approval No. B52, 2023). Patients included in this study underwent simultaneous free iliac bone flap reconstruction of mandibular defects from January 2019 to June 2023 in Oral and Maxillofacial-Head and Neck Oncology Surgery department. Inclusion criteria required patients to undergo CAS and have available postoperative CT scan data within 2 weeks and/or at 3, 6, and/or 12 months postoperatively. Patients unable to meet criteria were excluded. Additionally, patients diagnosed with osteomyelitis, underlying conditions affecting bone healing (such as osteoporosis), long-term use of medications impacting bone healing, or a history of preoperative radiotherapy were excluded. Considering potential age-related effects on bone healing, patients aged 20\u0026ndash;65 years were selected for bone healing analysis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePatients were categorized into two groups based on the type of titanium plates used: the miniplate group (Group A) and the reconstruction plate group (Group B). Patients using both types of plates simultaneously were excluded. The reconstruction plates used in this study were Stryker 2.3 reconstruction plates or Martin 2.0 reconstruction plates, each using only 1 plate. The miniplates included Stryker 2.0 miniplates or Martin 2.0 miniplates, used in quantities of 4 or 6 plates. Subgroup classification was further based on the number of bone segments transplanted: single-segment miniplate group (Group A1), double-segment miniplate group (Group A2), single-segment reconstruction plate group (Group B1), and double-segment reconstruction plate group (Group B2). Patients with three or more bone segments were excluded due to their rarity, ensuring analytical accuracy.\u003c/p\u003e \u003cp\u003eDemographic and clinical characteristics of included patients, such as age, gender, smoking history, alcohol history, diagnosis (classified as benign or malignant), type of titanium plate, number of bone segments transplanted, surgical duration, and mandibular defect classification according to the Brown classification system (which categorizes involvement of unilateral/bilateral mandibular angles, premolars, and condyles, limited to types I-III in this study) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], were collected from the electronic medical records system and imaging center.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Accuracy Analysis\u003c/h2\u003e \u003cp\u003eAll patients involved in the accuracy analysis underwent preoperative CBCT or CT scans conducted by the same specialized team for computer-assisted design. During surgery, the choice between reconstruction plates and miniplates was at the discretion of the operating surgeon. CBCT or CT scan data obtained within 2 weeks postoperatively were utilized for three-dimensional mandibular modeling. The postoperative models were aligned with the preoperative design models using the unaffected side as a reference to measure accuracy indicators (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e) (Mimics Research 21.0, 3-matic Research 13.0).\u003c/p\u003e \u003cp\u003eAccuracy measurements (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e) in this study were divided into two parts: 1. General mandibular accuracy measurement: intercondylar distance (IC, mm), intergonial distance (IG, mm), anterior-posterior distance (AP, mm) and gonial angle (GA, degrees). Analysis of intergonial distance and gonial angle excluded patients where the mandibular angle was resected. Patients where condyles were not preserved were also excluded from accuracy measurement. 2. Partial accuracy measurement of bone segments for reconstruction of the mandibular lower border contour: distance from the anterior, posterior endpoint and midpoint (for patients with two bone segments) of the bone segment to the sagittal plane (mm). Endpoint measurements were taken from the outermost and lowermost points of the bone segments.\u003c/p\u003e \u003cp\u003eAll accuracy indicators were measured by the same specialized personnel, calculating the difference between postoperative and preoperative models. Additionally, postoperative reconstruction model 3D measurements were utilized to assess the defect area length (Defect size, DS, mm).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Bone Healing Analysis\u003c/h2\u003e \u003cp\u003ePatients included in the bone healing analysis were scheduled for postoperative CBCT or CT scans at 3 months, 6 months, and/or 12 months. Postoperative imaging was retrieved to assess bone healing using a scoring system [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which evaluates the extent of bone union at bone-to-bone contact surfaces: Score 1: New bone callus absent with visible transplant interface present. Score 2: New bone callus present with visible transplant interface present. Score 3: New bone callus present without visible transplant interface. The percentage of bone contact surfaces achieving a score of 3 was calculated as the bone healing rate, relative to the total number of bone contact surfaces assessed. Bone healing rates were calculated separately for each group at 3 months, 6 months, and 12 months postoperatively. These bone healing scores were consistently evaluated by the same specialized personnel.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS software (IBM SPSS Statistics 26.0). The t-test was employed to compare continuous data that followed a normal distribution. The Mann-Whitney test was used for comparing non-normally distributed continuous data. Normality of continuous data was assessed using the Shapiro-Wilk test. Chi-square test and Fisher\u0026rsquo;s exact test were utilized for comparing categorical data. Normally distributed data are presented as \"mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation,\" while non-normally distributed numerical data are presented as \"median and interquartile range.\" A significance level of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered indicative of statistical significance between groups.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eWe collected patients undergoing simultaneous free iliac flap reconstruction for mandibular defects from January 2019 to June 2023. According to inclusion and extraction criteria, a total of 158 patients were finally enrolled, with 98 meeting the criteria for accuracy analysis and 113 meeting criteria for bone healing analysis.\u003c/p\u003e \u003cp\u003eInclude the demographic characteristics and clinical features of the patients as shown in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eb. The proportion of reconstruction plates used in malignant tumor patients (39.3%) was significantly higher than that in the miniplate group (10.9%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The mean defect length in the Group A1 was 52.82 mm, significantly less than 61.27 mm in the Group B1. However, there was no significant difference in the defect length between Group A2 and B2. The duration of surgery in the miniplate group was significantly shorter than in the reconstruction plate group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). This may be due to a higher proportion of malignant tumor cases in the reconstruction plate group, which often involve more complex and time-consuming procedures such as neck lymph node dissection. Additionally, larger defects of reconstruction plate group may also increase the complexity and duration of reconstruction surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003ea\u003c/b\u003e Patient demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMiniplates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eReconstruction plates group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA1(N\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA2(N\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA (N\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB1(N\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB2(N\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB (N\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.0(37.0\u0026ndash;69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.5(13.25, 65.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e54.5(29.0\u0026ndash;80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e50.0(25.25, 74.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(52.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54(69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20(58.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e74(66.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(48.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(47.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14(41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38(33.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17(21.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8(23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25(22.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCigarette\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(28.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28(35.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10(29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38(33.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eb\u003c/b\u003e Patient clinical characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMiniplates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eReconstruction plates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA1(N\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA2(N\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA Total(N\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB1(N\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB2(N\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB Total(N\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eA1/B1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA2/B2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eA/B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33(42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44(39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36(92.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41(89.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23(67.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e68(60.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBrown classification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.046\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.967\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(64.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50(64.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13(38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e63(56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e36(32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBone segments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.047\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39(84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e78(69.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e34(30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of surgery(h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1(3.8, 6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.3(3.7, 6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.7(4.7, 8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7(5.1, 8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSegment Length (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.94\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.11\u0026thinsp;\u0026plusmn;\u0026thinsp;11.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.87\u0026thinsp;\u0026plusmn;\u0026thinsp;10.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e61.27\u0026thinsp;\u0026plusmn;\u0026thinsp;12.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe accuracy analysis results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e. When analyzing only the absolute values of accuracy indicators, there were no significant differences in general mandibular accuracy (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003ea) or the partial accuracy (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003eb) between the two titanium plates (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, when considering the direction of relevant indicators (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e), it was found that the intercondylar distance after surgery was significantly wider in the miniplate group compared to preoperative levels, with a statistical difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029). This indicates that reconstruction plates may maintain better accuracy of the position of the condyles in mandibular reconstruction. The accuracy of reconstructing the lower mandibular margin did not significantly differ between the two titanium plates.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003ea\u003c/b\u003e Comparison of general accuracy (absolute value)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMiniplates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eReconstruction plates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA1(N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA2(N\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA Total(N\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB1(N\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB2(N\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB Total(N\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eA1/B1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA2/B2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eA/B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIC (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003cp\u003e(0.13, 3.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003cp\u003e(1.16, 5.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003cp\u003e(-0.51, 3.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003cp\u003e(-0.71, 3.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003cp\u003e(-2.23, 5.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003cp\u003e(-1.05, 3.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAP (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003cp\u003e(0.02, 1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.54\u003c/p\u003e \u003cp\u003e(-1.03, 6.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003cp\u003e(-0.13, 2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003cp\u003e(0.00, 1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003cp\u003e(-0.13, 2.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003cp\u003e(0.08, 1.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.674\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIG (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003cp\u003e(-2.04, 5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003cp\u003e(-2.22, 5.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003cp\u003e(-0.54, 5.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003cp\u003e(-0.73, 5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGA (\u0026deg;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003cp\u003e(-0.34, 3.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003cp\u003e(-0.41, 3.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003cp\u003e(-0.70, 3.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003cp\u003e(-0.48, 4.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.696\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eb\u003c/b\u003e Comparison of partial accuracy (absolute value)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMiniplates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eReconstruction plates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA1(N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA2(N\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA Total(N\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB1(N\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB2(N\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB Total(N\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eA1/B1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA2/B2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eA/B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnterior endpoint (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003cp\u003e(-0.75, 3.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003cp\u003e(-2.44, 4.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003cp\u003e(-0.77, 3.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.06\u003c/p\u003e \u003cp\u003e(-0.36, 4.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.76\u003c/p\u003e \u003cp\u003e(-0.34, 5.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003cp\u003e(-0.53, 5.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMidpoint (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003cp\u003e(-3.23, 4.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003cp\u003e(-0.04, 3.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePosterior endpoint (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003cp\u003e(-1.83, 5.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003cp\u003e(-1.97, 5.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003cp\u003e(-0.17, 4.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003cp\u003e(-0.34, 4.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003cp\u003e(0.13, 4.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003cp\u003e(-2.63, 4.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003cp\u003e(-0.58, 3.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003cp\u003e(0.06, 4.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.46\u003c/p\u003e \u003cp\u003e(1.08, 3.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003cp\u003e(0.49, 4.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of accuracy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiniplates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReconstruction plates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA Total(N\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB Total(N\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA/B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIC (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61(-0.10, 3.32), (56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84(-0.72, 2.40), (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.65(-4.04, 0.74), (43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.61(-4.37, 1.15), (65.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAP (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99(0.22, 1.76), (59.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07(-0.07, 1.07), (72.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.75(-2.42, 0.92), (40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.86(-1.55, -0.17), (27.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIG (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.80(-2.25, 5.85), (74.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.16(0.72, 5.60), (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.62(-5.40, 2.16), (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.25(-3.04, 0.54), (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGA (\u0026deg;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19(-1.21, 3.59), (48.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.19(-1.12, 5.50), (54.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29, (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48, (46.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnterior endpoint (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30(-1.81, 4.41), (70.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.46(-0.44, 5.36), (78.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91, (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42, (21.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePosterior endpoint (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90(-1.37, 3.17), (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.55(-0.98, 4.08), (52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21, (62.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73, (47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of bone healing are shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Due to potential age-related influences on bone healing, analysis was performed on patients aged 20\u0026ndash;65 years. There were no statistical differences in age or gender between the groups and subgroups compared (A/B, A1/B1, A2/B2) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There were no significant differences in bone union rates between the two plates, and their respective subgroups at the third and twelfth months postoperatively. However, at six months postoperatively, regardless of single or double bone segment numbers, the bone healing rate was higher in the miniplate group compared to the corresponding reconstruction plate group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Nonetheless, high bone healing rates (94.4%-100.0%) were achieved in both plates by one year postoperatively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of bone union at different postoperative timepoint\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMiniplates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eReconstruction plates group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e valu\u003cem\u003ee\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA1(n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA2(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB1(n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB2(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;207)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eA1/B1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA2/B2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eA/B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3m\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e31.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6m\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e54.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e51.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.027\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.040\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.004\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12m\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e93.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e94.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eVascularized iliac flap is one of the main bone flaps used for segmental mandibular defect reconstruction. To explore the optimal fixation method is essential. However, existing literature predominantly compares common fixation plate systems in vascularized fibular flaps. Therefore, this study focuses on comparing the application of reconstruction plates and miniplates in vascularized iliac flaps.\u003c/p\u003e \u003cp\u003ePrevious studies have focused on complications following mandibular reconstruction with reconstruction plates and miniplates. Robey et al. found no statistically significant differences in cumulative incidence rates of postoperative complications such as plate removal, plate fracture, malunion or nonunion between the two types of plates [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A meta-analysis also indicated higher rates of plate extrusion and fracture in the miniplate group compared to the reconstruction plate group, with no significant differences in rates of surgical site infection, malunion or nonunion, though heterogeneity limited reliable conclusions, necessitating further comprehensive research [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. When selecting internal fixation plates, consideration should extend beyond the potential plate-related complications to include their impact on the accuracy of mandibular reconstruction.\u003c/p\u003e \u003cp\u003eThe clinical significance of mandibular reconstruction accuracy has yet to be sufficiently studied [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, different levels of accuracy may lead to varied aesthetic outcomes. For instance, Sun et al. found that bone deviations in the midface less than 1.6 mm were clinically acceptable in orthognathic surgery [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Given that midfacial soft tissue is relatively abundant compared to thin soft tissue covering the lower border of the mandible, greater precision is required in mandibular reconstruction to achieve satisfactory aesthetic results. However, further research is needed to conclusively determine the impact of specific deviation values on aesthetic outcomes. Additionally, studies suggest that changes in mandibular dimensions post-reconstruction may be implicated in certain neuro-muscular functional impairments, such as craniomandibular dysfunction. In this study, the median general deviation values for mandibular reconstruction of the lower border were 1.67 mm for the miniplate group and 2.26 mm for the reconstruction plate group, with no statistically significant difference.\u003c/p\u003e \u003cp\u003eThe spatial deviation of the condyle after mandibular reconstruction plays a significant role in both aesthetics and mandibular function [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Anomalies in the temporomandibular joint (TMJ) can lead to malocclusion, chewing difficulties, facial contour deformities, or pain. Condylar displacement is primarily influenced by the location and extent of the mandibular defect [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For instance, in cases where the ascending mandibular ramus is preserved, the deviation of the TMJ is smaller due to the preservation of the joint capsule and disc structure compared to cases where the condyle is resected. While the TMJ has better stability when both the ascending ramus and condyle are preserved. In our study, regardless of whether the ascending ramus was preserved, the absolute deviation value of the intercondylar distance between the miniplate and reconstruction plate groups showed no statistical significance. Results in this paper suggest that reconstruction plates offer better accuracy in maintaining condylar position. This may be attributed to the ability of reconstruction plates to span the bone defect area, thereby better controlling the overall shape of the mandible. Additionally, reconstruction plates, guided by screw hole positioning, possess characteristics that restore the pre-displacement relationship of mandibular segment positions. Miniplates, on the other hand, often require multiple plates to be used in tandem at both ends of the segmental defect, providing greater flexibility but potentially compromising the precision of mandibular overall shape reconstruction, especially in achieving precise fixation of deep condyles. Further research is needed to determine whether patients with reconstruction plates experience better restoration of TMJ function postoperatively.\u003c/p\u003e \u003cp\u003eSince its introduction in 2009, CAS has been integrated into the surgical procedures for mandibular defect reconstruction in many hospitals [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The advent of CAS, including virtual surgical planning (VSP) and the application of cutting guides and forth on, has enhanced the accuracy of mandibular defect reconstruction [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In this study, both types of titanium plates used were prefabricated and manually pre-bent based on preoperative models. Besides possibly affecting accuracy, repeated deformation of titanium plates in the same position during pre-bending could lead to metal fatigue, potentially increasing the risk of plate fracture postoperatively. In recent years, with the development of CAS and computer-assisted design and manufacturing (CAD/CAM), personalized titanium plates for patients have been developed and applied, offering higher accuracy in mandibular reconstruction and improving postoperative quality of life compared to traditional manually pre-bent titanium plates [\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, due to longer production times and higher costs, personalized titanium plates have not yet been widely used in clinical applications in China.\u003c/p\u003e \u003cp\u003eIn comparing the applications of reconstruction plates and miniplates in mandibular reconstruction, in addition to accuracy, consideration should also be given to their long-term effects. This study focuses on the postoperative bone healing of the two types of plates. In this study, the miniplate group showed higher healing rates at the sixth month postoperative compared to the reconstruction plate group, but there was no difference at the twelfth month, possibly due to faster bone healing in the miniplate group. However, uncertainties in patient follow-up visits and poor compliance among some patients led to longer intervals between imaging data collection points, preventing capture of bone healing conditions over shorter intervals in both groups. Further research may be needed to reveal the bone healing rates after iliac bone graft transplantation using different titanium plates.\u003c/p\u003e \u003cp\u003eReconstruction plates are often considered to bear stress due to their higher mechanical performance, sometimes causing stress shielding leading to graft atrophy or osteoporosis, which is detrimental to bone healing. Miniplates are generally considered to share stress, promoting bone healing [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The results of this study confirm this pattern. Additionally, studies have shown that radiotherapy has a certain impact on bone healing, with a history of radiotherapy being an independent risk factor for non-union [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this study, the proportion of patients with malignant tumors was significantly higher in the reconstruction plate group than in the miniplate group, suggesting that more patients in the reconstruction plate group might have been exposed to radiotherapy after reconstruction surgery, possibly leading to significantly lower bone healing rates at six months postoperatively in the reconstruction plate group.\u003c/p\u003e \u003cp\u003eThere is limited research on the selection of internal fixation plates for pediatric patients. Pediatric mandibular defect reconstruction is particularly complex, with some scholars suggesting personalized titanium implantation for children under 2 years of age and recommending free bone flap transplantation for children over 5 years of age [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Both reconstruction plates and miniplates have been reported for use in pediatric mandibular reconstruction surgeries, but there have been no studies comparing the application of the two[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This study included a total of 7 pediatric patients, with 4 using miniplates and 3 using reconstruction plates. However, the small sample size precludes drawing reliable conclusions, necessitating further research into the selection of internal fixation plates for pediatric mandibular reconstruction.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis study reviewed data from patients undergoing vascularized iliac crest flap mandibular reconstruction over a period of approximately 4.5 years. It compared the accuracy of mandibular reconstruction using miniplates versus reconstruction plates. Reconstruction plates demonstrated superior accuracy in maintaining condylar positioning compared to miniplates, with no significant difference observed in overall accuracy between the two titanium plates. The study also investigated bone healing rates at 3, 6, and 12 months post-reconstruction with both types of titanium plates. It found a significantly higher bone healing rate in the miniplate group at 6 months compared to the reconstruction plate group, although both groups achieved similarly high bone healing rates at 12 months (94.4\u0026ndash;100.0%).\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eConceptualization: Zhe Shao and Yifan Wang; Methodology: Zhe Shao and Yifan Wang; Formal analysis and investigation: Yifan Wang, Xinmiao Wang, Junqiang Bai, and Shutian Guo; Writing \u0026ndash; original draft preparation: Yifan Wang; Writing \u0026ndash; review and editing: Zhe Shao and Zhengjun Shang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthics Approval and Consent:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Ethics Committee of School \u0026amp; Hospital of Stomatology, Wuhan University (Ethical Approval No. B52, 2023) and followed the Declaration of Helsinki.\u0026nbsp;Due to the retrospective observational nature of this study and the large number of subjects included, we requested and received approval for a waiver of informed consent from the Ethics Committee of School \u0026amp; Hospital of Stomatology, Wuhan University.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis work was supported by the National Nature Science Foundation of China (Grant No.82373093).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKoshima I, Moriguchi T, Fukuda H, Yoshikawa Y, Soeda S (1991) Free, thinned, paraumbilical perforator-based flaps. J Reconstr Microsurg 7:313\u0026ndash;316\u003c/li\u003e\n\u003cli\u003eKoshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N (1992) Free thin paraumbilical perforator-based flaps. Ann Plast Surg 29:12\u0026ndash;17. https://doi.org/10.1097/00000637-199207000-00004\u003c/li\u003e\n\u003cli\u003eTaylor GI, Corlett RJ, Ashton MW (2016) The Evolution of Free Vascularized Bone Transfer: A 40-Year Experience. Plast Reconstr Surg 137:1292\u0026ndash;1305. https://doi.org/10.1097/PRS.0000000000002040\u003c/li\u003e\n\u003cli\u003eHuang GK, Liu ZZ, Shen YL, Hu RQ, Miao H, Yin ZY (1980) Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels. J Microsurg 2:113\u0026ndash;120. https://doi.org/10.1002/micr.1920020207\u003c/li\u003e\n\u003cli\u003eShaw RJ, Kanatas AN, Lowe D, Brown JS, Rogers SN, Vaughan ED (2004) Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck 26:456\u0026ndash;463. https://doi.org/10.1002/hed.10343\u003c/li\u003e\n\u003cli\u003eGielisch MW, Siegberg F, Thiem DGE, Blatt S, Heimes D, K\u0026auml;mmerer PW (2023) A novel alloplastic grid reconstruction plate for the mandible - Retrospective comparative clinical analysis of failure rates and specific complications. J Craniomaxillofac Surg 51:448\u0026ndash;453. https://doi.org/10.1016/j.jcms.2023.07.005\u003c/li\u003e\n\u003cli\u003eSobti N, Ahmed KS, Polanco T, Chilov M, Cohen MA, Boyle J, Shahzad F, Matros E, Nelson JA, Allen RJ (2022) Mini-plate versus reconstruction bar fixation for oncologic mandibular reconstruction with free fibula flaps: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 75:2691\u0026ndash;2701. https://doi.org/10.1016/j.bjps.2022.04.097\u003c/li\u003e\n\u003cli\u003eMalata CM, McLean NR, Alvi R, McKiernan MV, Milner RH, Piggot TA (1997) An evaluation of the W\u0026uuml;rzburg titanium miniplate osteosynthesis system for mandibular fixation. Br J Plast Surg 50:26\u0026ndash;32. https://doi.org/10.1016/s0007-1226(97)91279-0\u003c/li\u003e\n\u003cli\u003eSteffen C, Sellenschloh K, Vollmer M, Morlock MM, Heiland M, Huber G, Rendenbach C (2020) Biomechanical comparison of titanium miniplates versus a variety of CAD/CAM plates in mandibular reconstruction. J Mech Behav Biomed Mater 111:104007. https://doi.org/10.1016/j.jmbbm.2020.104007\u003c/li\u003e\n\u003cli\u003eHidalgo DA (1989) Titanium miniplate fixation in free flap mandible reconstruction. Ann Plast Surg 23:498\u0026ndash;507. https://doi.org/10.1097/00000637-198912000-00005\u003c/li\u003e\n\u003cli\u003eEvans GR, Clark N, Manson PN, Leipziger LS (1995) Role of mini- and microplate fixation in fractures of the midface and mandible. Ann Plast Surg 34:453\u0026ndash;456. https://doi.org/10.1097/00000637-199505000-00001\u003c/li\u003e\n\u003cli\u003eChang T-Y, Lai Y-S, Lin C-Y, Wang J-D, Pan S-C, Shieh S-J, Lee J-W, Lee Y-C (2023) Plate-related complication and health-related quality of life after mandibular reconstruction by fibula flap with reconstruction plate or miniplate versus anterolateral thigh flap with reconstruction plate. Microsurgery 43:131\u0026ndash;141. https://doi.org/10.1002/micr.30893\u003c/li\u003e\n\u003cli\u003eUrken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, Biller HF (1998) Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg 124:46\u0026ndash;55. https://doi.org/10.1001/archotol.124.1.46\u003c/li\u003e\n\u003cli\u003eKnitschke M, Yonan M, Roller FC, Pons-K\u0026uuml;hnemann J, Attia S, Howaldt H-P, Streckbein P, B\u0026ouml;ttger S (2022) Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants. Cancers (Basel) 14:5774. https://doi.org/10.3390/cancers14235774\u003c/li\u003e\n\u003cli\u003eRobey AB, Spann ML, McAuliff TM, Meza JL, Hollins RR, Johnson PJ (2008) Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible. Plast Reconstr Surg 122:1733\u0026ndash;1738. https://doi.org/10.1097/PRS.0b013e31818a9ac5\u003c/li\u003e\n\u003cli\u003eShaw RJ, Kanatas AN, Lowe D, Brown JS, Rogers SN, Vaughan ED (2004) Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck 26:456\u0026ndash;463. https://doi.org/10.1002/hed.10343\u003c/li\u003e\n\u003cli\u003eBrown JS, Barry C, Ho M, Shaw R (2016) A new classification for mandibular defects after oncological resection. Lancet Oncol 17:e23-30. https://doi.org/10.1016/S1470-2045(15)00310-1\u003c/li\u003e\n\u003cli\u003eMay MM, Howe BM, O\u0026rsquo;Byrne TJ, Alexander AE, Morris JM, Moore EJ, Kasperbauer JL, Janus JR, Van Abel KM, Dickens HJ, Price DL (2021) Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck 43:2342\u0026ndash;2352. https://doi.org/10.1002/hed.26688\u003c/li\u003e\n\u003cli\u003eRobey AB, Spann ML, McAuliff TM, Meza JL, Hollins RR, Johnson PJ (2008) Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible. Plast Reconstr Surg 122:1733\u0026ndash;1738. https://doi.org/10.1097/PRS.0b013e31818a9ac5\u003c/li\u003e\n\u003cli\u003eShaw RJ, Kanatas AN, Lowe D, Brown JS, Rogers SN, Vaughan ED (2004) Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck 26:456\u0026ndash;463. https://doi.org/10.1002/hed.10343\u003c/li\u003e\n\u003cli\u003eL\u0026oacute;pez-Arcas JM, Arias J, Del Castillo JL, Burgue\u0026ntilde;o M, Navarro I, Mor\u0026aacute;n MJ, Chamorro M, Martorell V (2010) The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg 68:2377\u0026ndash;2384. https://doi.org/10.1016/j.joms.2009.09.027\u003c/li\u003e\n\u003cli\u003eSobti N, Ahmed KS, Polanco T, Chilov M, Cohen MA, Boyle J, Shahzad F, Matros E, Nelson JA, Allen RJ (2022) Mini-plate versus reconstruction bar fixation for oncologic mandibular reconstruction with free fibula flaps: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 75:2691\u0026ndash;2701. https://doi.org/10.1016/j.bjps.2022.04.097\u003c/li\u003e\n\u003cli\u003eGoormans F, Sun Y, Bila M, Schoenaers J, Geusens J, L\u0026uuml;bbers H-T, Coucke W, Politis C (2019) Accuracy of computer-assisted mandibular reconstructions with free fibula flap: Results of a single-center series. Oral Oncol 97:69\u0026ndash;75. https://doi.org/10.1016/j.oraloncology.2019.07.022\u003c/li\u003e\n\u003cli\u003eSun Y, Luebbers H-T, Agbaje JO, Schepers S, Vrielinck L, Lambrichts I, Politis C (2013) Validation of anatomical landmarks-based registration for image-guided surgery: an in-vitro study. J Craniomaxillofac Surg 41:522\u0026ndash;526. https://doi.org/10.1016/j.jcms.2012.11.017\u003c/li\u003e\n\u003cli\u003eM\u0026ouml;llmann HL, Apeltrath L, Karnatz N, Wilkat M, Riedel E, Singh DD, Rana M (2021) Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction. Front Oncol 11:719028. https://doi.org/10.3389/fonc.2021.719028\u003c/li\u003e\n\u003cli\u003eBrown JS, Barry C, Ho M, Shaw R (2016) A new classification for mandibular defects after oncological resection. Lancet Oncol 17:e23-30. https://doi.org/10.1016/S1470-2045(15)00310-1\u003c/li\u003e\n\u003cli\u003eWang L, Liu K, Shao Z, Shang Z-J (2017) Management of the condyle following the resection of tumours of the mandible. Int J Oral Maxillofac Surg 46:1252\u0026ndash;1256. https://doi.org/10.1016/j.ijom.2017.04.029\u003c/li\u003e\n\u003cli\u003eZeiderman MR, Pu LLQ (2020) Contemporary reconstruction after complex facial trauma. Burns Trauma 8:tkaa003. https://doi.org/10.1093/burnst/tkaa003\u003c/li\u003e\n\u003cli\u003eHirsch DL, Garfein ES, Christensen AM, Weimer KA, Saddeh PB, Levine JP (2009) Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg 67:2115\u0026ndash;2122. https://doi.org/10.1016/j.joms.2009.02.007\u003c/li\u003e\n\u003cli\u003eZhang L, Liu Z, Li B, Yu H, Shen SG, Wang X (2016) Evaluation of computer-assisted mandibular reconstruction with vascularized fibular flap compared to conventional surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 121:139\u0026ndash;148. https://doi.org/10.1016/j.oooo.2015.10.005\u003c/li\u003e\n\u003cli\u003eRaghoebar II, Dubois L, de Lange J, Schepers T, Don Griot P, Essig H, Rozema F (2023) The Effectiveness of Three-Dimensional Osteosynthesis Plates versus Conventional Plates for the Treatment of Skeletal Fractures: A Systematic Review and Meta-Analysis. J Clin Med 12:4661. https://doi.org/10.3390/jcm12144661\u003c/li\u003e\n\u003cli\u003eM\u0026ouml;llmann HL, Apeltrath L, Karnatz N, Wilkat M, Riedel E, Singh DD, Rana M (2021) Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction. Front Oncol 11:719028. https://doi.org/10.3389/fonc.2021.719028\u003c/li\u003e\n\u003cli\u003ePamias-Romero J, Saez-Barba M, de-Pablo-Garc\u0026iacute;a-Cuenca A, Vaquero-Mart\u0026iacute;nez P, Masnou-Pratdesaba J, Besc\u0026oacute;s-At\u0026iacute;n C (2023) Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature. Cancers (Basel) 15:2582. https://doi.org/10.3390/cancers15092582\u003c/li\u003e\n\u003cli\u003eOng HS, Liu JN, Ahmed A, Qu XZ, Wan K, Xie DP, Zhang CP (2019) Improved accuracy of hemimandibular reconstructions involving the condyle by utilizing hydroformed reconstruction plates rather than hand-bent stock plates. Head Neck 41:3168\u0026ndash;3176. https://doi.org/10.1002/hed.25809\u003c/li\u003e\n\u003cli\u003eSteffen C, Sellenschloh K, Willsch M, Soares AP, Morlock MM, Heiland M, Kreutzer K, Huber G, Rendenbach C (2023) Patient-specific miniplates versus patient-specific reconstruction plate: A biomechanical comparison with 3D-printed plates in mandibular reconstruction. J Mech Behav Biomed Mater 140:105742. https://doi.org/10.1016/j.jmbbm.2023.105742\u003c/li\u003e\n\u003cli\u003eGuo L, Ferraro NF, Padwa BL, Kaban LB, Upton J (2008) Vascularized fibular graft for pediatric mandibular reconstruction. Plast Reconstr Surg 121:2095\u0026ndash;2105. https://doi.org/10.1097/PRS.0b013e3181712399\u003c/li\u003e\n\u003cli\u003eValentini V, Califano L, Cassoni A, Marco DM, Raponi I, Priore P, Fadda MT, Dell\u0026rsquo;Aversana Orabona G, Terenzi V (2018) Maxillo-Mandibular Reconstruction in Pediatric Patients: How To Do It? J Craniofac Surg 29:761\u0026ndash;766. https://doi.org/10.1097/SCS.0000000000004380\u003c/li\u003e\n\u003cli\u003eInnocenti M, Mori F, Raffaini M, Lucattelli E, Innocenti A (2020) Mandibular ramus and condyle reconstruction with vascularized proximal fibular epiphyseal transfer in the pediatric patient: A case report. Microsurgery 40:818\u0026ndash;822. https://doi.org/10.1002/micr.30589\u003c/li\u003e\n\u003cli\u003eNkenke E, Agaimy A, St Pierre M, Gratzki N, Stockmann P, von Wilmowsky C (2013) Intraoral microvascular anastomosis for segmental mandibular reconstruction following removal of an ameloblastoma. J Craniofac Surg 24:e265-270. https://doi.org/10.1097/SCS.0b013e31828cbe80\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Reconstruction plate, Miniplate, Reconstruction of mandibular defect, Accuracy of reconstruction, Bone union","lastPublishedDoi":"10.21203/rs.3.rs-4756879/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4756879/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eGiven the increasing demand for precise and reliable reconstructive techniques in maxillofacial surgery, we try to offer valuable insights for clinicians in selecting optimal fixation methods.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003ePatients were categorized into miniplate and reconstruction plate groups for accuracy and bone healing comparison. We measured gonial angle, intercondylar, intergonial and anterior-posterior distance for general accuracy and distance of segmental endpoint to the sagittal plane for partial accuracy. The bone healing rate of the two groups was compared with CT images at 3, 6 and 12 months after operation.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eConsidering directional indicators, the miniplate group exhibited a wider intercondylar distance than the reconstruction plate group (p\u0026thinsp;=\u0026thinsp;0.029). At 6 months postoperatively, the miniplate group demonstrated a higher bone healing rate compared to the reconstruction plate group, with no significant differences at other time points.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOver a nearly 5-year review, mandibular reconstruction with vascularized iliac bone flaps showed that reconstruction plates better maintained condylar position accuracy, while miniplates had superior bone healing rates at 6 months. No significant differences were found in other accuracy indices between the two plates.\u003c/p\u003e\u003ch2\u003eClinical Relevance:\u003c/h2\u003e \u003cp\u003eClinicians' selection of fixation plates frequently depends on personal preference rather than evidence-based criteria. This study compares the precision and postoperative osseous healing outcomes of miniplates and reconstruction plates to provide a more scientifically grounded basis for clinical decision-making.\u003c/p\u003e","manuscriptTitle":"Comparison of Reconstruction Plates and Miniplates in Mandibular Defect Reconstruction with Free Iliac Flap","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-17 02:06:26","doi":"10.21203/rs.3.rs-4756879/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2024-10-01T21:00:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-26T17:53:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29750776792546818689240428318130615611","date":"2024-09-24T19:22:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-22T18:17:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293760928170170368403672218042619269071","date":"2024-08-23T11:34:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-29T02:06:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-18T05:31:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-18T05:28:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2024-07-17T14:19:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cdb36104-7e75-4e64-9f4e-a696f664f635","owner":[],"postedDate":"August 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:02:06+00:00","versionOfRecord":{"articleIdentity":"rs-4756879","link":"https://doi.org/10.1007/s00784-024-05985-9","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2024-10-10 15:57:38","publishedOnDateReadable":"October 10th, 2024"},"versionCreatedAt":"2024-08-17 02:06:26","video":"","vorDoi":"10.1007/s00784-024-05985-9","vorDoiUrl":"https://doi.org/10.1007/s00784-024-05985-9","workflowStages":[]},"version":"v1","identity":"rs-4756879","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4756879","identity":"rs-4756879","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}