Efficacy and morbidity of biodegradable versus titanium osteosyntheses in orthognathic surgery: A systematic review with meta-analysis and trial sequential analysis

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Abstract

Titanium osteosynthesis is currently the gold standard in orthognathic surgery. Use of biodegradable osteosyntheses avoids removal of plates/screws in a second operation. This systematic review aimed to assess the efficacy and morbidity of biodegradable vs. titanium osteosyntheses in orthognathic surgery (PROSPERO CRD42018086477). Patients with syndromic disorder(s) and/or cleft lip/palate were excluded. Randomised, prospective and retrospective controlled studies were searched for in nine databases (February 2021). The time periods perioperative, short-term, intermediate, long-term, and overall follow-up were studied. Meta-analyses were performed using random-effects models. A total of 9073 records was assessed, of which 33 were included, comprising 2551 patients. Seven RCTs had 'some concerns' while another seven RCTs had 'high' risk of bias (Cochrane-RoB2). No differences in malunion (qualitative analyses), mobility of bone segments [RR 1.37 (0.47; 3.99)], and malocclusion [RR 0.93 (0.39; 2.26)] were found. The operative time was longer in the biodegradable group [SMD 0.50 (0.09; 0.91)]. Symptomatic plate/screw removal was comparable among both groups [RR 1.29 (0.68; 2.44)]. Skeletal stability was similar in most types of surgery. Biodegradable osteosyntheses is a valid alternative to titanium osteosyntheses for orthognathic surgery, but with longer operation times. Since the quality of evidence varied from very low to moderate, high-quality research is necessary to elucidate the potential of biodegradable osteosyntheses.

Original languageEnglish
Article number12800
Number of pages29
JournalEuropean Journal of Oral Sciences
Volume129
Issue number5
Early online date15-Jun-2021
DOIs
Publication statusPublished - 2021

Keywords

  • absorbable implant
  • biocompatible materials
  • orthopedic fixation devices
  • osteotomy
  • polymers
  • SPLIT RAMUS OSTEOTOMY
  • FORT-I OSTEOTOMY
  • L-LACTIC ACID
  • SKELETAL STABILITY
  • MAXILLOFACIAL SURGERY
  • FIXATION SYSTEMS
  • SCREW FIXATION
  • BIORESORBABLE FIXATION
  • MANDIBULAR ADVANCEMENT
  • MAXILLARY STABILITY

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