MONOCORTICAL VS. BICORTICAL SCREW FIXATION IN SYMPHYSIS AND PARASYMPHYSIS FRACTURES WITH BILATERAL CONDYLAR FRACTURES: A PROSPECTIVE RANDOMIZED TRIAL

Abstract

Mandibular symphysis and parasymphysis fractures, particularly when associated with bilateral condylar fractures, present a surgical challenge due to the need to restore occlusion, maintain mandibular continuity, and prevent complications like lingual splaying. While monocortical screw fixation is commonly used for its ease and safety, bicortical screws may offer greater stability by engaging both buccal and lingual cortices. This prospective, single-blind randomized clinical trial compared monocortical and bicortical screw fixation in 60 patients with symphysis/parasymphysis fractures and conservatively managed bilateral condylar fractures. Postoperative CBCT measurements showed significantly smaller lingual gaps in the bicortical group (p < 0.05), with no hardware failures or complications reported. The results suggest that bicortical fixation provides superior stability and may promote better functional outcomes, highlighting the need for larger multicenter studies to validate these findings and optimize treatment protocols.