Functional Reconstruction of the Mandible: Experimental Foundations and Clinical Experience

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Since 1958 the Association for the Study of Internal Fixation (ASIF) has worked to establish the experimental and biomechanical prin- ciples of the operative treatment of fractures. It has been proven that immediate, pain-free mobilization, made possible by stable internal fixation, is the key to restoring function in a fractured extremity. The same principles were applied in 1972173 by Roland Schmoker, who developed a universal plate and sophisticated instrument set designed initially for the treatment of comminuted fractures of the mandible. To extend the applications of his plate to reconstructions after ex- tensive tumor resections, he supplemented the device with tem- poromandibular joint prostheses and anchoring elements for the at- tachment of dentures. He first tested the functional stability of these implants experimentally in sheep. Later he found that the minipig had a more human-like jaw shape and masticatory action, and so he tested the implants in 37 mini pigs that underwent extensive mandibular re- sections without bone grafting, using sequential dye injections and postoperative weight gain to chart the progress of osseous regener- ation. Seven other animals were not operated and served as controls.