While titanium plates are considered to be the ‘gold standard’ for fixation following orthognathic surgery there can be drawbacks. Although considered to be biocompatible they are routinely removed by some operators following healing and may cause stress shielding of underling bone. Consequently, biodegradable plates have been developed from polylactic acid, polyglycolic acid, and polydioxanone. These biodegradable systems are thought to offer advantages for orthognathic surgery.
The aim of this Cochrane review was to compare bioresorbable fixation systems with titanium systems used in orthognathic surgery.
Methods
Searches were conducted in the Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) MEDLINE, Embase, the US National Institutes of Health Ongoing Trials Register and the World Health Organization International Clinical Trials Registry Platform without restriction on date or language. Randomised controlled trials (RCTs) comparing bioresorbable and titanium plates used for orthognathic surgery were considered.
Two reviewers independently screened the results of the electronic searches, extracted data and assessed the risk of bias. Disagreements were resolved by discussion. Studies were not pooled.
Results
- 2 RCTs involving a total of 103 patients were included.
- Both studies were at high risk of bias.
- There was no statistically significant difference between the two groups for patient satisfaction.
- There was also no statistically significant difference in the infection rate between titanium (3/196) and resorbable (3/165) plates.
Conclusions
The authors concluded: –
We do not have sufficient evidence to determine if titanium plates or resorbable plates are superior for fixation of bones after orthognathic surgery. This review provides insufficient evidence to show any difference in postoperative pain and discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials.
Comments
This review was only able to include two small low quality studies comparing titanium versus biodegradable plates and both of these are now more than 10 years old. As the authors suggest the limited quality of these studies do not provide sufficient evidence to determine whether one is better than the other. Clearly further large well conducted and reported high quality studies are needed to determine if one approach is superior to the other. In addition to effectiveness further research is required to establish cost-effectiveness.
Links
Primary paper
Agnihotry A, Fedorowicz Z, Nasser M, Gill KS. Resorbable versus titanium plates for orthognathic surgery. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD006204. DOI: 10.1002/14651858.CD006204.pub3.
Other references
Cochrane Oral Health Group Blog – Resorbable or titanium plates? Which is better for corrective jaw surgery?
Dental Elf – 13th Nov 2013
Some evidence to suggest that bioresorbable plates may be effective for orthognathic surgery
