Resorbable Implants for Mandibular Fracture Fixation: A Systematic Review and Meta-Analysis

Abstract

Background:Mandibular fractures in adults commonly require rigid fixation to ensure proper occlusion while minimizing infection risks. Numerous centers have assessed the efficacy of resorbable materials as a potential alternative to metallic plates. The purpose of the current systematic review and meta-analysis is to shed light on overall outcomes for resorbable implants and to compare these results to those for metallic counterparts.Methods:A systematic review of clinical studies reporting outcomes for resorbable plates for mandible fractures was carried out. The reported outcomes were hardware failure/exposure, infection, wound dehiscence, reoperation, malocclusion, and nonunion. The results were pooled descriptively and stratified according to fracture and implant type. A subset meta-analysis of prospective studies comparing metallic and resorbable implants was also carried out.Results:Eighteen studies were included for a total of 455 patients managed with resorbable implants (mean follow-up, 8.95 months) with an overall complication rate of 19.8 % (n = 90/455). Infection (n = 31/455, 6.8%) and wound dehiscence (n = 28/455, 6.2%) were the most common complications. Nonunion occurred in 1.1% (n = 5/455) of patients. Seven studies were included in a meta-analysis, and the rates of adverse events in the resorbable and metallic groups were 18.0% (n = 32/178) and 18.3% (n = 33/180), respectively, with no statistically significant difference between both cohorts (95% CI 0.58, 1.82, P = 0.93).Conclusions:This study suggests that there are no statistical differences in outcomes for patients with mandible fractures managed with resorbable or metallic implants. In the absence of meta-analyses or large randomized controlled trials, the current study provides surgeons with an evidence-based reference to guide decision-making.

Are Magnesium Screws Proper for Mandibular Condyle Head Osteosynthesis?

“…However, with the development of advanced copolymers, self-reinforcing materials, and increased control over degradation rates [33][34][35][36], biodegradable implants have shown promising results. However, the mechanical strength of polymer fixation remains low [37], which is why biodegradable screws are normally thicker than metallic screws [38]. Finally, the application polymer screws require bone fragment reduction; provisional stabilization; drilling; tapping; and, finally, screwing.…”

In vivo osseointegration and erosion of nacre screws in an animal model

“…Usually, the management of facial fractures requires rigid and firm fixation to avoid the risks of secondary displacement and plate breaking. In a recent meta‐analysis, no statistical differences in the outcome was noted for patients with mandible fractures osteo‐synthesized with resorbable or metallic implants 8 . However, in their article, there was no study comparing the mechanical properties of titanium vs nacre.…”

“…Several types of resorbable devices have been evaluated and some are marketed for the current surgical practice. Polylactide, polyglycolide or copolymers are used to prepare screws and plates for maxillofacial surgery 6‐8 . However, these biodegradable polymers do not have the same mechanical properties than titanium and a number of reports have reported local inflammation due to the release of acids during resorption 9,10 …”

Bone Union Quality after Fracture Fixation of Mandibular Head with Compression Magnesium Screws

“…The main disadvantage remained—low mechanical strength [ 29 ]. This is because polymer screws are usually thicker than titanium screws in the case of mandibular head osteosynthesis [ 30 ]. The use of polymer screws requires a reduction in bone fragments, provisional stabilization, drilling of both fragments, tapping the hole, and finally screwing together with a thick screw with limited rigidity.…”