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

Abstract

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Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances

“…Within the limitations of finite element analyses (e.g., assuming the masticatory forces are fixed), three-dimensional analyses indicated that the biomechanical stresses surrounding osteosynthesis systems remain far below the threshold of their ultimate strength of both biodegradable and titanium osteosynthesis systems [ 163 , 172 , 182 , 183 ]. In addition, the empirical evidence of fracture [ 19 ] and osteotomy [ 184 ] osteosyntheses shows that the efficacy of titanium and biodegradable osteosyntheses is similar (e.g., absence of malunion), indicating that the less favorable mechanical properties of biodegradable osteosynthesis are still sufficient to achieve similar healing outcomes. However, as also observed from the empirical evidence, the mechanical properties of biodegradable osteosyntheses of mandibular osteotomies may be insufficient to avoid micromovements [ 184 ].…”

“…In addition, the empirical evidence of fracture [ 19 ] and osteotomy [ 184 ] osteosyntheses shows that the efficacy of titanium and biodegradable osteosyntheses is similar (e.g., absence of malunion), indicating that the less favorable mechanical properties of biodegradable osteosynthesis are still sufficient to achieve similar healing outcomes. However, as also observed from the empirical evidence, the mechanical properties of biodegradable osteosyntheses of mandibular osteotomies may be insufficient to avoid micromovements [ 184 ]. Future research should also focus on these micromovements since they play an important role in developing foreign body reactions [ 26 ].…”

“…In contrast to the abovementioned trauma population [ 19 ], a non-significant difference in symptomatic biodegradable and titanium osteosynthesis system removal was observed in the aforementioned orthognathic population [ 184 ]. The main reasons for biodegradable osteosynthesis removal in both populations were chronic inflammation and discomfort [ 19 , 184 ].…”

Biocompatibility and degradation comparisons of four biodegradable copolymeric osteosynthesis systems used in maxillofacial surgery: A goat model with four years follow-up

“…Currently, titanium osteosynthesis systems are considered the gold standard to fixate bone segments in oral and maxillofacial surgery (OMF-surgery) [ 7 , 8 ], and orthopedics and trauma surgery [ 9 ]. However, the disadvantages of titanium systems include temperature sensitivity [ 10 ], tactile sensations of the plates and screws [ 11 ], growth restrictions [ 12 ], hampering of imaging and radiotherapy [ [13] , [14] , [15] ], presence of titanium particles in lymph nodes [ 16 ], extreme stiffness causing stress shielding of the underlying bone [ 2 ] and increased risk of medication-related osteonecrosis of the jaws [ 6 , 17 ].…”

“…The removal rate of polymeric biodegradable osteosynthesis systems in OMF-surgery is less and the disadvantages of titanium osteosyntheses are avoided [ 7 , 8 ]. Biodegradable systems should, preferably, be completely resorbed after 3–12 months [ 6 ].…”