Evaluation of stress distributions of polyether ether ketone and pure titanium plate materials in high and low level condylar neck fractures by finite element analysis

Objective: Mandibular condyle fractures often have a part in maxillofacial trauma. Due to their high incidence and complexity, various treatment options have been determined for these fractures. The surgeon needs to identify the aims of the treatment and choose the simplest and most effective method to reach them. A good reduction is the key to any fracture's successful treatment. Along with an appropriate manipulation, detailed information about the anatomy and position of the fracture provides an ideal anatomical reduction. Fixation to the appropriate spot with enough titanium plaque and screws has to be strong enough to endure functional load caused by the bone recovery. Fixation with mini plaque/screw is used considerably widespread at the present time. Despite having long-term reliability and biocompatibility, titanium plaques are associated with failure and tissue reactions that entail removal. The intention of eliminating these risks have led the researchers to seek a new material. The aim of this study is to shed a light on clinical applications by examining stress and relocation of plaque and screws in cortical bones as a result of 2 mini plaque and rhomboid plaque's fixation with PEEK and pure titanium materials in high- and low-level condyle fractures with finite element analysis. Equipment and Method: 3D modeled subcondylar fractures in mandibula has been simulated in two different levels. Fixation units have been designed as titanium alloys and PEEK, and fitted to mandibula using Rhinoceros version 4.0 software (Rhinoceros, Seattle, WA). Used compatibly with rhomboid plaque (Titanium and PEEK osteosynthesis mandibula; KLS Martin, Tuttlingen, Germany) and 2 mini plaque (AO Compact MF Lock System Implant; Johnson & Johnson) system. In 4 different scenario that has been created, the stress in cortical bones and plaque/screw systems has been examined and evaluated with finite element analysis. Findings: In high-level condylar neck fracture, the stress taking place in cortical bone and plaque/screw system by rhomboid plaque has been observed to be higher than that of 2 mini plaque's. However, stress distribution has been observed to be more balanced with rhomboid plaque. Rhomboid plaque has given more advantageous results in terms of stress and relocation than PEEK due to being made of titanium material. In low-level condylar neck fracture, the stress caused by 2 mini plaque to the bone and plaque/screw system has been observed to be lower than that of rhomboid plaque. PEEK has been observed to show more superior features in scenarios created with low-level condylar neck fractures. Conclusion: In accordance with the findings, rhomboid plaque has shown more advantageous usage than the 2 mini plaque design in high-level condylar neck fractures. However, there needs to be more clinical trials and long-term studies in order to use PEEK material and rhomboid plaque design together. On the other hand, fixation with 2 mini plaque in low-level condylar neck fractures has given more stable and biomechanically suitable results. PEEK as a material has shown results that could be an alternative to titanium. There needs to be conducted more studies in order for PEEK material to become a routine in clinical practice.