Resorbable versus titanium plates for orthognathic surgery

Under- or overgrowth of one or both of the jaw bones can lead to reduced function and an unattractive facial appearance either of which may have lasting and significant psychosocial effects. Treatment of severe cases may require a combination of orthodontic appliances and orthognathic (corrective jaw) surgery.
After surgery the cut bone needs to be immobilised to ensure that optimal healing takes place. Titanium plates used for fixation are recognised to be the 'gold standard' but recent developments in biomaterials have led to an increased usage of bioresorbable plates or screws for orthognathic surgery.
The use of bioresorbable plates for the fixation of facial bones might appear to reduce the necessity of a further operation for the removal of metal plates. However, whilst resorbable plates do appear to offer certain advantages over metal plates, concerns remain about the stability of fixation, the length of time required for their resorption, the possibility of foreign body reactions, and with some of the technical difficulties experienced with resorbable plates.
The authors of the review identified a limited number of randomised controlled trials which addressed only a few of the preferred outcomes and provided some evidence for the effectiveness of resorbable plating systems for orthognathic surgery.
The review authors concluded that future research should aim to provide evidence for people to make informed decisions about whether resorbable plating systems are as effective as titanium ones and that further randomised controlled trials should be well designed and reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (http://www.consort-statement.org).

Authors' conclusions: 

This review provides some evidence to show that there is no statistically significant difference in postoperative discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials in orthognathic surgery.

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Background: 

Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions.

Objectives: 

To compare the effectiveness of bioresorbable fixation systems with titanium systems used during orthognathic surgery.

Search strategy: 

We searched the following databases: Cochrane Oral Health Group Trials Register (to 26th January 2006); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE (without filter) (from 1966 to 26th January 2006); and EMBASE (without filter) (from 1980 to 26th January 2006).

Selection criteria: 

Randomised controlled trials comparing resorbable versus titanium fixation systems used for orthognathic surgery.

Data collection and analysis: 

Clinical heterogeneity between the included trials precluded pooling of data, and only a descriptive summary is presented.

Main results: 

This review included two trials, involving 103 participants, one compared titanium with resorbable plates and screws and the other titanium with resorbable screws, both provided very limited data for the primary outcomes of this review. All patients in one trial suffered mild to moderate postoperative discomfort with no statistically significant difference between the two plating groups at different follow-up times. Mean scores of patient satisfaction were 7.43 to 8.63 (range 0 to 10) with no statistically significant difference between the two groups throughout follow up. Adverse effects reported in one study were two plate exposures in each group occurring between the third and ninth months. Plate exposures occurred mainly in the posterior maxillary region, except for one titanium plate exposure in the mandibular premolar region. Known causes of infection were associated with loosened screws and wound dehiscence with no statistically significant difference in the infection rate between titanium (3/196), and resorbable (3/165) plates P = 0.83 (published as P = 0.67).

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