Biodegradable versus titanium osteosynthesis in maxillofacial traumatology: a systematic review with meta-analysis and trial sequential analysis

Abstract

Titanium osteosynthesis is currently the fixation system of choice in maxillofacial traumatology.Biodegradable osteosynthesis systems have the ability to degrade in the human body. The aim of this study was to conduct a systematic review, with meta-and trial sequential analyses, to assess the efficacy and morbidity of biodegradable versus titanium osteosyntheses after maxillofacial trauma. MEDLINE, EMBASE, and CENTRAL were searched for randomized controlled trials, and prospective and retrospective controlled studies. Five time periods were studied: perioperative, short-term (0-4 weeks), intermediate (6-12 weeks), long-term (>12 weeks) and overall follow-up. After screening 3542 records, 24 were included. All had a high risk of performance and detection bias due to the nature of the interventions. Meta-analysis showed no differences in efficacy and morbidity between biodegradable and titanium osteosyntheses. Risk of perioperative screw breakage was significantly higher (RR 17.13, 95% CI: 2.19;34.18) and the symptomatic plate removal rate lower in the biodegradable group (RR 0.11; 95% CI 0.02;0.57), which was confirmed by the trial sequential analysis. The quality of evidence ranged from very low to moderate. Based on both narrative review and meta-analyses, current evidence shows that biodegradable osteosyntheses are a viable alternative to titanium osteosyntheses when applied in the treatment of maxillofacial trauma with similar efficacy but significantly lower symptomatic plate removal rates. Perioperative screw breakage occurred significantly more often in the biodegradable compared to the titanium group.

Efficacy and morbidity of biodegradable versus titanium osteosyntheses in orthognathic surgery: A systematic review with meta‐analysis and trial sequential analysis

“…poly‐L‐lactic or polyglycolic acid) and may reduce removal rates of these osteosynthesis systems in a second operation while also avoiding the disadvantages of titanium osteosyntheses. Biodegradable systems have, however, their own limitations including lower strength and stiffness [ 9 ] that could lead to higher malunion rates and less skeletal stability after orthognathic surgery, palpability due to bulkiness, [ 10 ] and possible foreign body reactions [ 11 ]. As a consequence, biodegradable implants are removed in up to 17% of the cases in a second operation [ 2 , 10 , 12 ].…”

“…Biodegradable systems have, however, their own limitations including lower strength and stiffness [ 9 ] that could lead to higher malunion rates and less skeletal stability after orthognathic surgery, palpability due to bulkiness, [ 10 ] and possible foreign body reactions [ 11 ]. As a consequence, biodegradable implants are removed in up to 17% of the cases in a second operation [ 2 , 10 , 12 ].…”

Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery

“…Additionally, this study shows that the newer CrossDrive (2018) and MaxDrive osteosynthesis systems remain to have higher mechanical properties than the tested biodegradable osteosynthesis systems. However, as clinical studies have shown that biodegradable and titanium osteosynthesis systems have similar efficacy in maxillofacial traumatology 9 , both systems have mechanical properties that suffice for clinical application.…”

“…When also considering the dimensions and volumes, and the (co-)polymer compositions of these two systems, the SonicWeld Rx/Rx system is preferred as it is less bulky (i.e., − 14% in volume) and has a more favourable degradative copolymer composition 13,59 . Whenever low pull-out forces are expected, we recommend not tapping the SonicPins burr holes as this remains an extra perioperative, time-consuming step for surgeons 9 . On the other hand, whenever high torsional forces are expected (e.g., fixating mandibular symphysis fractures 41 ), the Inion CPS 2.5 mm system is recommended although it might be bulky due to the plate and screw dimensions.…”

Bioabsorbable Osteofixation Materials for Maxillofacial Bone Surgery: A Review on Polymers and Magnesium-Based Materials

“…It was demonstrated that the possibility of intraoperative switches due to the material failure of the bioabsorbable system also reduced the justification of the use of absorbable plates and screws in maxillofacial surgery [ 65 ]. Furthermore, in another meta-analysis, it was reported that perioperative screw breakage was more frequent in the bioabsorbable osteosynthesis group than the titanium osteosynthesis group [ 66 ]. Eventually, due to these limitations and complications of polymer-based absorbable osteofixation materials, there is a desire for materials with higher strength while having the advantages of absorbable osteosynthesis, and Mg is in the spotlight as a material which can satisfy such conditions.…”