Review question
Are resorbable (biodegradable) plates better than titanium (metal) plates for the fixation of facial bones after corrective (orthognathic) jaw surgery?
Background
Under- or overgrowth of one or both of the jaw bones can lead to reduced function and an unattractive facial appearance, either of which may have lasting and significant psychosocial effects. Treatment of severe cases may require a combination of orthodontic appliances and orthognathic (corrective jaw) surgery. After surgery the cut bone needs to be immobilised to ensure that optimal healing takes place. Titanium plates used for fixation are recognised to be the 'gold standard' but recent developments in biomaterials have led to an increased use of bioresorbable plates or screws for corrective jaw surgery. The use of bioresorbable plates for the fixation of facial bones might appear to reduce the need for a further operation for the removal of metal plates. However, whilst resorbable plates do appear to offer certain advantages over metal plates, concerns remain about the stability of fixation, the length of time required for their resorption (being reabsorbed), the possibility of foreign body reactions, and with some of the technical difficulties experienced with resorbable plates.
Study characteristics
We included two studies that analysed a total of 103 participants. The evidence in this review is up to date as of 20 January 2017. Study participants were adults older than 16 years of age. One study compared titanium with resorbable plates and screws and the other titanium with resorbable screws. One study was conducted in China, the other in Germany.
Key results
Both studies were at high risk of bias and provided very limited data. We do not have sufficient evidence to determine if titanium plates or resorbable plates are superior for the fixation of bones after corrective jaw 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.
Quality of the evidence
Both included studies were assessed as being at high risk of bias and the very limited and weak evidence was of very low quality.
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.
Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. This review compares the use of titanium versus bioresorbable plates in orthognathic surgery and is an update of the Cochrane Review first published in 2007.
To compare the effects of bioresorbable fixation systems with titanium systems used during orthognathic surgery.
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 January 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11) in the Cochrane Library (searched 20 January 2017); MEDLINE Ovid (1946 to 20 January 2017); and Embase Ovid (1980 to 20 January 2017). We searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (clinicaltrials.gov; searched 20 January 2017), and the World Health Organization International Clinical Trials Registry Platform (searched 20 January 2017) for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
Randomised controlled trials comparing bioresorbable versus titanium fixation systems used for orthognathic surgery in adults.
Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We resolved disagreement by discussion. Clinical heterogeneity between the included trials precluded pooling of data, and only a descriptive summary is presented.
This review included two trials, involving 103 participants, one comparing titanium with resorbable plates and screws and the other titanium with resorbable screws. Both studies were at high risk of bias and provided very limited data for the primary outcomes of this review. All participants in one trial suffered mild to moderate postoperative discomfort with no statistically significant difference between the two plating groups at different follow-up times. Mean scores of patient satisfaction were 7.43 to 8.63 (range 0 to 10) with no statistically significant difference between the two groups throughout follow-up. Adverse effects reported in one study were two plate exposures in each group occurring between the third and ninth months. Plate exposures occurred mainly in the posterior maxillary region, except for one titanium plate exposure in the mandibular premolar region. Known causes of infection were associated with loosened screws and wound dehiscence with no statistically significant difference in the infection rate between titanium (3/196), and resorbable (3/165) plates.