Highlighted review: Resorbable versus titanium plates for orthognathic surgery

Anirudha Agnihotry, Zbys Fedorowicz, Mona Nasser, Karanjot S Gill

Plain language summary: Resorbable versus titanium plates for corrective jaw surgery

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.

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Citation: 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.