Assessment of Resorbable and Non-resorbable Fixation Systems in Sagittal Split Ramus Osteotomy: An In vitro Study

Abstract

Objective The internal fixation has been purpose of study for many years, but there is still no consensus on the best method of fixation in relation to resistance for bilateral sagittal split ramus osteotomy (BSSO) using plates. Therefore, the aim of this study was to assess five different methods of osteosynthesis using resorbable and non-resorbable plates and screws in simulated sagittal split osteotomy (SSO) of the mandibular ramus. Materials and Methods SSO was performed in 25 polyurethane synthetic mandibular replicas. The distal segments were moved forward 5 mm, and the specimens were grouped according to the fixation method: Inion resorbable plate, KLS resorbable plate, standard four-hole titanium miniplate (Medartis), two standard four-hole titanium miniplates (Medartis) and an adjustable titanium miniplate (Slider/Medartis). Mechanical evaluation was performed by applying compression loads to first molar using an Instron universal testing machine up to a 5 mm displacement of the segments. Resistance forces were obtained in Newtons (N), and statistical analysis was performed using the software R v. 3.5 with significance level of 0.05. Linear mixed models were used to compare the force required to move each type of plate. ResultsThe results showed that the resistance of SSO was better accomplished using two titanium miniplates and KLS resorbable plate showed the least resistance. However, both titanium and resorbable plates behaved similarly in small displacements, which are most commonly observed in BSSO postoperative time. Conclusion It can be concluded that both resorbable and non-resorbable systems might offer suitable mechanical resistance in the procedures where there are no mechanical postoperative complications.

Resorbable Osteosynthesis in Mandibular Fractures. An Exploratory Systematic Review

“…Biodegradable osteosynthesis devices are increasingly used in trauma cases to avoid problems associated with conventional metallic osteofixation (7,8). With the emergence and increasing use of resorbable materials, controversy has arisen as to whether the traditional use of titanium plates for mandibular fractures has better results than more modern alternatives (8-10).…”

“…Regarding mechanical resistance, they were fully evaluated in mandibular replicas simulating different types of fractures (7,8,11,12,14,15). The resistance of resorbable plates in bilateral branch fractures showed worse resistance (7).…”

“…Regarding mechanical resistance, they were fully evaluated in mandibular replicas simulating different types of fractures (7,8,11,12,14,15). The resistance of resorbable plates in bilateral branch fractures showed worse resistance (7). However, in clinical situations with great bone contact, favorable movements, less influence on muscles and joints, both types of fixation can be used (7).…”

“…With the introduction of this technology, it was discovered that polylactic acid is not toxic, does not react with tissues, does not accumulate in vital organs and has a slow degradation process (6). Since then its application has evolved and over time significant results have been achieved in its research (7). This material offers advantages such as mitigating the risk of growth restriction in the pediatric population, plate infection, implant migration and the need for extraction through reintervention (5)(6)(7).…”

“…Since then its application has evolved and over time significant results have been achieved in its research (7). This material offers advantages such as mitigating the risk of growth restriction in the pediatric population, plate infection, implant migration and the need for extraction through reintervention (5)(6)(7). Resorbable screws are monocortical, which mitigates the risk of damage to the tooth bud and the inferior alveolar nerve (6,7).…”