Abstract
The advent of bioresorbable materials to overcome limitations and replace traditional bone-reconstruction titanium-plate systems for bone fixation, thus achieving greater efficiency and safety in medical and dental applications, has ushered in a new era in biomaterial development. Because of its bioactive osteoconductive ability and biocompatibility, the forged composite of uncalcined/unsintered hydroxyapatite and poly L-lactic acid (u-HA/PLLA) has attracted considerable interest from researchers in bone tissue engineering, as well as from clinicians, particularly for applications in maxillofacial reconstructive surgery. Thus, various in vitro studies, in vivo studies, and clinical trials have been conducted to investigate the feasibility and weaknesses of this biomaterial in oral and maxillofacial surgery. Various technical improvements have been proposed to optimize its advantages and limit its disadvantages. This narrative review presents an up-to-date, comprehensive review of u-HA/PLLA, a bioactive osteoconductive and bioresorbable bone-reconstruction and -fixation material, in the context of oral and maxillofacial surgery, notably maxillofacial trauma, orthognathic surgery, and maxillofacial reconstruction. It simultaneously introduces new trends in the development of bioresorbable materials that could used in this field. Various studies have shown the superiority of u-HA/PLLA, a third-generation bioresorbable biomaterial with high mechanical strength, biocompatibility, and bioactive osteoconductivity, compared to other bioresorbable materials. Future developments may focus on controlling its bioactivity and biodegradation rate and enhancing its mechanical strength.
Highlights
Bone reconstruction and bone fixation device systems play crucial roles in the success of oral and maxillofacial surgical treatments
Bone is a hierarchically ordered structure with a unique arrangement of two main phases: an inorganic phase that consists of calcium phosphate (CaP) and water (65–70% and 5–8%, respectively) and an organic phase that mainly consists of collagen, a sizeable fibrous protein with a triple-helix structure [74,75,76]
In 2016, Sukegawa et al [142] reported the clinical evaluation of u-HA/poly L-lactide (PLLA) composite devices used for the internal fixation of mandibular fractures in 21 patients
Summary
Bone reconstruction and bone fixation device systems play crucial roles in the success of oral and maxillofacial surgical treatments. PDLLA degrades more rapidly than either PLLA or PDLA [37], the constant degradation rates of these materials have the disadvantages of foreign-body reactions and late-degradation tissue responses caused by their by-products long after the original surgery [37,38] Such limitations have led to restricted use of these first-generation materials in oral and maxillofacial surgery [23]. A copolymer of 82% PLLA and 18% PGA with sufficient strength for 6–8 weeks and a resorption time of 12–18 months [44] is suitable for the manufacture of clinical fixation devices that can be used in midface osteosynthesis [27]. Numerous studies conducted in vitro and in vivo have shown that this bioresorbable material possesses physical, chemical, and biological features superior to other previous materials
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