Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances

Barzi Gareb*, Nico van Bakelen, Arjan Vissink, Ruud R.M. Bos, Baucke van Minnen

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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Abstract

Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.

Original languageEnglish
Article number2782
Number of pages34
JournalPolymers
Volume14
Issue number14
DOIs
Publication statusPublished - 7-Jul-2022

Keywords

  • biocompatible materials
  • absorbable implants
  • polymers
  • orthopedic fixation devices
  • reconstructive surgical procedures
  • fracture fixation
  • POLY-L-LACTIDE
  • FOREIGN-BODY REACTION
  • POLY(L-LACTIDE) BONE PLATES
  • CHEMICAL-VAPOR-DEPOSITION
  • SAGITTAL SPLIT OSTEOTOMY
  • DIFFERENT FRACTURE SITES
  • FINITE-ELEMENT-ANALYSIS
  • MECHANICAL-PROPERTIES
  • UNSINTERED HYDROXYAPATITE
  • ORTHOGNATHIC SURGERY

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