Comparison of Titanium and Biodegradable Miniplates for Fixation of Mandibular Fractures

doi:10.1016/j.joms.2009.08.004

Journal of Oral and Maxillofacial Surgery

Volume 68, Issue 9, September 2010, Pages 2065-2069

https://doi.org/10.1016/j.joms.2009.08.004 Get rights and content

Purpose

The purpose of the present study was to compare the use of biodegradable miniplates and titanium miniplates for the fixation of mandibular fractures.

Patients and Methods

BioSorb FX biodegradable plates and screws and titanium miniplates were used in 91 patients (65 males and 26 females; age range 11 to 69 years) for the treatment of mandibular fractures. The clinical and radiographic findings were recorded at 1, 3, 6, and 12 months after surgery.

Results

The overall complication rate was 4.41%. In the biodegradable plate group, infection occurred in 2 cases (4.26%) and was resolved by incision and drainage and antibiotics. In the titanium plate group, infection occurred in 1 case and plate fracture in 1 case (4.56%). The fractured plate was removed, and a new titanium miniplate was applied using a trocar. The infection was resolved with antibiotics. No adverse tissue reactions, malocclusions, or malunions occurred during the observation period.

Conclusions

Our results have shown that the rate of morbidity is very low with the use of biodegradable plates and titanium plates, suggesting that biodegradable and titanium plates have the potential for successful use in the fixation of mandibular fractures.

Section snippets

Patients and Methods

The present study involved 91 patients (65 males and 26 females) with mandibular fractures who had undergone open reduction at the Department of Oral and Maxillofacial Surgery, Chosun University Hospital from May 2005 to August 2007. The patient age range was 11 to 69 years (mean 28.4). The fractures consisted of 34 cases of symphysis fracture, 23 of mandibular angle fracture, 13 of symphysis fracture accompanied by mandibular condylar fracture, and 21 of concurrent mandibular angle fracture

Results

A titanium metal plate was applied in 43 patients (in the median area in 33 fractures and the mandibular angle in 23 fractures). An absorbable plate was applied in a total of 48 patients (in the median area in 35 fractures and the mandibular angle in 21 fractures; Table 1). The postoperative complications included 3 cases of infection and 1 fracture of a fixation plate for an overall incidence of complications of 4.41%. All the complications that developed in the patients who had received

Discussion

Persistent attempts have been made to develop equipment that can minimize complications by fixing the bone fragments after fracture or osteotomy and induce solid bone union with stabilized fixation. The requirements for such a bone fixation device include sufficient strength and rigidity to induce bony union, the absence of a tendency to produce a foreign body reaction or infection within the body, no interference with the bony union, an inability to be palpated or visualized, and spontaneous

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Cited by (46)

Biomechanical comparison of polylactide-based versus titanium miniplates in mandible reconstruction in vitro
2020, Journal of Stomatology, Oral and Maxillofacial Surgery
Evaluation of the mechanical integrity and reliability of polylactide-based miniplates for osseous free flap fixation at the mandible in an experimental study setup of a mandible reconstruction model.
1.0 mm titanium miniplates (group TI) (MatrixMandible, DePuy Synthes, Umkirch, Germany) and 1.5 mm polylactide miniplates (group PL) (Inion CPS, Inion Oy, Tampere, Finland) were used to fix a polyurethane (PU) fibula segment to a PU mandible reconstruction model using monocortical non-locking screws. Mastication was simulated via unilateral cyclic dynamic loading at 1 Hz with increasing loads (+ 0.15 N/cycle, Bionix, MTS, USA). A 3D optical tracking system (Aramis, GOM, Braunschweig, Germany) was used to determine interosteotomy movements (IOM).
IOM were higher in the polylactide group (distal: P = 0.001, mesial: P = 0.001). Differences in mean stiffness (titanium: 478 ± 68 N/mm; polylactide: 425 ± 38 N/mm, P = 0.240) and mean force at a vertical displacement of 1.0 mm (titanium: 201.6 ± 87.1 N; polylactide: 141.3 ± 29.9 N, P = 0.159) were not significant.
The results of this study suggest that polylactide-based miniplates provide reduced mechanical integrity and higher interosteotomy movements in comparison to titanium miniplates in vitro. Indications for clinical use of polylactide-based miniplates in mandible reconstruction have to be placed critically. Future studies will focus on clinical complications of polylactide-based plates in risk patients.
Biodegradable versus titanium osteosynthesis in maxillofacial traumatology: a systematic review with meta-analysis and trial sequential analysis
2020, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The screw diameter ranged from 1.3 mm to 2.0 mm with corresponding plates, depending on the location of the fracture. The most frequently used biodegradable osteosynthesis systems were the Inion CPS (79/15/6 poly-l-lactic acid (PLLA)/poly-dl-lactic acid (PDLLA)/trimethylene carbonate)2,11,14,33,35,36,44,46,47 and the BioSorb FX (self-reinforced 70/30 PLLA/PDLLA)38,41,42,46,51 (Supplementary Material Table S4). The screw diameters ranged from 1.5 mm to 2.5 mm; these were generally larger compared to the titanium systems for similar fracture types.
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 osteosynthesis 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 or morbidity between biodegradable and titanium osteosynthesis. The risk of perioperative screw breakage was significantly higher (risk ratio 17.13, 95% confidence interval 2.19–34.18) and the symptomatic plate removal rate lower in the biodegradable group (risk ratio 0.11, 95% confidence interval 0.02–0.57), which was confirmed by the trial sequential analysis. The quality of evidence ranged from very low to moderate. Based on the narrative review and meta-analyses, current evidence shows that biodegradable osteosynthesis is a viable alternative to titanium osteosynthesis 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 group compared to the titanium group.
Stability of bioresorbable plates following reduction of mandibular body fracture: Three-dimensional analysis
2019, Journal of Cranio-Maxillofacial Surgery
The recent development of bioresorbable bone plates and screws allows plates to be applied to the load-bearing regions of the mandible and to remain in place over time without the need for removal. We hypothesized that the stability of composite plates and screws forged from unsintered hydroxyapatite particles and poly-l-lactide (u-HA/PLLA) is comparable to that of standard titanium fixation systems for the reduction of fractures of load-bearing regions of the mandibular body.
40 patients underwent open reduction and internal fixation of the fractured mandibular body with either a titanium or u-HA/PLLA bone plate. Cone-beam CT images were obtained immediately postoperatively and at 6-month follow-up, and were analyzed for positional changes of the affected mandible.
There were no significant differences in the postoperative positional changes of reference points between the titanium and u-HA/PLLA miniplates, except for that for the coronoid process (p-value = 0.03). Multivariate regression analysis revealed no significant differences in spatial changes between the immediate postoperative and 6-month follow-up images, after adjusting for age and sex.
The stability of bioresorbable u-HA/PLLA miniplates and screws was comparable to that of titanium miniplates and screws immediately postoperatively and at 6-month follow-up, following surgical reduction of fractures of load-bearing regions of the mandibular body. Bioresorbable osteosynthesis can be considered a viable alternative to titanium osteosynthesis.
Overview of innovative advances in bioresorbable plate systems for oral and maxillofacial surgery
2018, Japanese Dental Science Review
Maxillofacial osteosynthetic surgeries require stable fixation for uneventful boney healing and optimal remodeling. Although conventional titanium plates and screws for osteofixation are considered the gold standard for rigid fixation in maxillofacial surgeries, bioresorbable implants of plates and screw systems are commonly used for various maxillofacial osteosynthetic surgeries such as orthognathic surgery, maxillofacial fractures, and reconstructive surgery. Titanium plates are limited by their palpability, mutagenic effects, and interference with imaging, which may lead to the need for subsequent removal; the use of a biologically resorbable osteofixation system could potentially address these limitations. However, several problems remain including fundamental issues involving decreased mechanical strength and stability, slow biodegradation, complex procedures, and the available bioresorbable implant materials. Major advances in bioresorbable plate systems have been made with the use of bioactive/resorbable osteoconductive materials and an accelerator of bioresorption, such as polyglycolic acid. This report presents an overview of currently available resorbable implant materials and their applications, with a focus on recent innovative advances and new developments in this field.
Bioabsorbable plates versus metal miniplate systems for use in endoscope-assisted open reduction and internal fixation of mandibular subcondylar fractures
2018, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
Even now, several clinicians are reluctant to use bioabsorbable devices for mandibular fractures because of their low strength and rigidity to induce bony union and material-related complications (Eppley, 2005; Alkan et al., 2007). However, with an increase in the material strength of bioabsorbable plates, more studies are demonstrating that metallic and resorbable plate systems do not differ significantly, even when used for high load-bearing sites such as the mandible (Lee et al., 2010), osteotomies (van Bakelen et al., 2014), and reconstructions (Kim et al., 2015). In the present study, we demonstrated that there were no differences in postoperative stability and fracture healing, assessed by the evaluation of postoperative occlusal changes and comparison of immediate postoperative CBCT images with 3-month postoperative CBCT images, between the bioabsorbable plate and titanium miniplate groups.
To compare bioabsorbable plates with metal miniplate systems for use in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondylar fractures.
This retrospective cohort study included patients with mandibular subcondylar fractures treated with EAORIF using bioabsorbable unsintered hydroxyapatite/poly l-lactide composite plates or titanium miniplate systems. The outcome variables included preoperative fracture conditions, postoperative stability during fracture healing, and complications during the follow-up period. Other variables included clinical characteristics (age, sex, fracture site, and total follow-up duration) and intra- and postoperative data (surgical duration, duration of intermaxillary fixation/elastic band guidance). Variables were evaluated using descriptive statistics and compared between groups using the Mann–Whitney test and the chi-square test or Fisher's exact test, as appropriate.
In total, 28 patients were analyzed, including 13 who underwent EAORIF using bioabsorbable plates and 15 who underwent EAORIF using titanium miniplates. With the exception of second surgery for plate removal, none of the assessed variables showed significant differences between the two groups (p < 0.05).
Our results suggest that EAORIF using biodegradable plates is a stable and reliable method for the management of mandibular subcondylar fractures and eliminates the need for secondary surgery for plate removal.
Controversies in Maxillofacial Trauma
2017, Oral and Maxillofacial Surgery Clinics of North America

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Basic and patient-oriented researchComparison of Titanium and Biodegradable Miniplates for Fixation of Mandibular Fractures

Purpose

Patients and Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Maxillofac Surg

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Pathol Oral Radiol J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Sensory disturbances associated with rigid internal fixation of mandible fractures

J Oral Maxillofac Surg

Internal fixation plates after fifty-six years of implantation: Report of a case

Clin Orthop Relat Res

Basic and patient-oriented research
Comparison of Titanium and Biodegradable Miniplates for Fixation of Mandibular Fractures