Radiodensitometric Assessment of the Effect of Pulsed Electromagnetic Field Stimulation Versus Low Intensity Laser Irradiation on Mandibular Fracture Repair: A Preliminary Clinical Trial.

Journal of maxillofacial and oral surgery · 2014 · Mixed · Low evidence

← Research stream

MixedLow evidencePaper 3011

Study snapshot

PublicationJournal of maxillofacial and oral surgery · 2014

Study typerandomized_trial

Reported directionMixed

Evidence ratingLow

Abstract

PURPOSE: Closed reduction of mandibular fractures usually entails a relatively long period of immobilization, with the subsequent delay of rehabilitation. Therefore, shorter immobilization period with various approaches to protect or enhance bone healing have been investigated. The aim of this study was to analyze the effects of pulsed electromagnetic field (PEMF) and low intensity laser irradiation (LILI) on the fracture healing process, through radiodensitometric assessment of the bone callus. PATIENTS AND METHODS: Eighteen patients with mandibular fractures at the tooth bearing area participated in this prospective study. They were treated by closed reduction using maxillo-mandibular fixation (MMF) and were consecutively assigned into 1 of 3 groups. In group A, the fracture sites were exposed to PEMF for 2 h daily for 12 days. In group B, the fracture sites were exposed to LILI on the tenth and twelfth postoperative days (2 sessions of 6 min per day 2 h apart). The fracture sites in group C acted as controls. MMF was maintained for 2 weeks in group A and 4 weeks in groups B and C. The bone fracture healing was evaluated clinically by investigating the union of the fractured segments and radiographically using computerized densitometry. The union of the fractured segments was tested by manual manipulation and the occlusion was assessed upon removal of MMF. Standardized digital panoramic radiographs were performed for each patient, immediately postoperatively as well as at 2 and 4 weeks. The digital images were manipulated using the IDRISI software. A rectangular area of 10 × 15 mm was drawn along the center of the fracture line. The obtained densitometry values were expressed in gray levels from 0 to 256. The collected data were then tabulated and statistically analyzed. RESULTS: After releasing the MMF, the bimanual mobility test of the fractured segments in all patients showed stability of the segments. The preinjury occlusion was maintained in all patients. The postoperative radiographs of all patients revealed good bony alignment of the bony segments. In all groups, comparison between the study intervals with respect to both means and changes percentages of the bone density values showed insignificant differences. At 2nd postoperative week, the mean bone density at the fracture sites decreased by 4.74, 6.6 and 27.89 % in groups A, B and C respectively. The period from the 2nd to the 4th postoperative weeks showed increase in the bone density by 1.49, 1.95 and 14.12 % in groups A, B and C respectively. Insignificant difference was found between the means of bone densities of group A and B throughout the study intervals. On the other hand, both groups showed insignificant difference with group C immediately postoperative and significant increase in bone density at the 2nd and 4th postoperative weeks. CONCLUSIONS: Short period immobilization of mandibular fractures for 2 weeks supplemented with PEMF is recommended. Further studies are needed to evaluate the efficacy of LILI as a supplement to reduce the mandibular fracture immobilization period.

Machine Enhanced Logic

AI evidence extraction

Structured fields below were generated from the paper’s abstract and metadata to make the evidence easier to inspect. Automated extraction may be incomplete or incorrect; verify important details against the original paper.

Study typerandomized_trial

Effect directionmixed

PopulationPatients with mandibular fractures at the tooth bearing area treated by closed reduction with maxillo-mandibular fixation (MMF)

Sample size18

Exposure2 h daily for 12 days

Evidence strengthLowConfidence: 74% · Peer reviewed: yes

Main findings

All patients showed stability of fractured segments after MMF release, maintained preinjury occlusion, and good radiographic alignment. Across intervals, within-group changes in bone density were not statistically significant, but PEMF and LILI groups showed a significant increase in bone density versus control at 2 and 4 weeks; no significant differences were found between PEMF and LILI groups.

Outcomes measured

Radiodensitometric bone density (gray levels) at fracture line on panoramic radiographs
Clinical stability/union of fractured segments (bimanual mobility test)
Occlusion after MMF removal
Radiographic alignment of bony segments

Limitations

Preliminary clinical trial with small sample size (18 patients)
Consecutive assignment into groups (randomization not explicitly stated)
PEMF and LILI groups had different immobilization (MMF) durations than control (2 weeks vs 4 weeks), which may confound comparisons
PEMF exposure parameters (e.g., frequency/intensity) not reported
Short follow-up (up to 4 weeks)

View raw extracted JSON

{
  "study_type": "randomized_trial",
  "exposure": {
    "band": null,
    "source": "therapeutic pulsed electromagnetic field (PEMF) stimulation",
    "frequency_mhz": null,
    "sar_wkg": null,
    "duration": "2 h daily for 12 days"
  },
  "population": "Patients with mandibular fractures at the tooth bearing area treated by closed reduction with maxillo-mandibular fixation (MMF)",
  "sample_size": 18,
  "outcomes": [
    "Radiodensitometric bone density (gray levels) at fracture line on panoramic radiographs",
    "Clinical stability/union of fractured segments (bimanual mobility test)",
    "Occlusion after MMF removal",
    "Radiographic alignment of bony segments"
  ],
  "main_findings": "All patients showed stability of fractured segments after MMF release, maintained preinjury occlusion, and good radiographic alignment. Across intervals, within-group changes in bone density were not statistically significant, but PEMF and LILI groups showed a significant increase in bone density versus control at 2 and 4 weeks; no significant differences were found between PEMF and LILI groups.",
  "effect_direction": "mixed",
  "limitations": [
    "Preliminary clinical trial with small sample size (18 patients)",
    "Consecutive assignment into groups (randomization not explicitly stated)",
    "PEMF and LILI groups had different immobilization (MMF) durations than control (2 weeks vs 4 weeks), which may confound comparisons",
    "PEMF exposure parameters (e.g., frequency/intensity) not reported",
    "Short follow-up (up to 4 weeks)"
  ],
  "evidence_strength": "low",
  "confidence": 0.74,
  "peer_reviewed_likely": "yes",
  "keywords": [
    "pulsed electromagnetic field",
    "PEMF",
    "low intensity laser irradiation",
    "LILI",
    "mandibular fracture",
    "fracture healing",
    "radiodensitometry",
    "bone density",
    "maxillo-mandibular fixation"
  ],
  "suggested_hubs": [
    {
      "slug": "clinical-therapeutic-emf",
      "weight": 0.9,
      "reason": "Clinical trial evaluating pulsed electromagnetic field stimulation as a therapeutic intervention for bone fracture repair."
    }
  ]
}

AI can be wrong. Always verify against the paper.

AI-extracted fields are generated from the abstract and metadata and may be incomplete or incorrect. This material is for informational purposes and is not medical advice.

Identifiers and source

DOI: 10.1007/s12663-013-0551-2
PubMed: 26225010

Read the original paper →

Related papers

← Back to the Research Library