Internal fixation for orthognathic surgery is commonly performed using titanium plates and screws although in recent years there has been an increase in the use of bioresorbable fixation systems.  However there are concerns about the stability of fixation. The aim of this review was to include all publicly available literature on the skeletal stability of orthognathic surgery with an absorbable plate and/or screws fixation from prospective, comparative studies or randomized controlled trials (RCTs).

Searches were conducted in PubMed, Embase, Cochrane Central Register of Systemic Reviews and Cochrane Central Register of Controlled Trials. Two reviewers conducted study selection independently. A qualitative summary was performed considering 3 main surgical procedures, Bilateral sagittal split ramus osteotomy (BSSRO), Le Fort I procedures and Maxillary operations.

• 5 Randomised controlled trials (RCTs) and 15 controlled studies were included.  The qualitative summary suggests that bioresorbable plates may be used is appropriate conditions.

The authors concluded

This review has found that published data show that bioresorbable fixation systems are reliable in terms of skeletal stability.

Comment

This review does not include any formal assessment of study quality and includes both RCTs and other study designs. Designs other than RCTs are more prone to bias and likely to overestimate the effects. Consequently care needs to be exercised when interpreting the results.  The authors noted  a earlier Cochrane review of this question published in 2007  (Fedorowicz et al) . That review only included RCTs, at that time only two small trials involving 103 patients were included and their conclusion was:-

 This review provides some evidence to show that there is no statistically significant difference in postoperative discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials in orthognathic surgery.

Another Cochrane review published in 2008 (Dorri et al) looked at resorbable plates for facial fractures however they did not identify any relevant trials to address the question.

Links

Yang L, et al., Skeletal stability of bioresorbable fixation in orthognathic surgery: A systemic review, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/j.jcms.2013.08.003

Fedorowicz Z, Nasser M, Newton T, Oliver R. Resorbable versus titanium plates for orthognathic surgery. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD006204. DOI: 10.1002/14651858.CD006204.pub2.

Dorri M, Nasser M, Oliver R. Resorbable versus titanium plates for facial fractures. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007158. DOI: 10.1002/14651858.CD007158.pub2.