Abstract
BackgroundBiodegradable fixation systems could reduce or eliminate problems associated with titanium removal of implants in a second operation.AimThe aim of this study was to compare the long-term (i.e. >5 years postoperatively) clinical performance of a titanium and a biodegradable system in oral and maxillofacial surgery.Materials and methodsThe present multicenter Randomized Controlled Trial (RCT) was performed in four hospitals in the Netherlands. Patients treated with a bilateral sagittal split osteotomy (BSSO) and/or a Le Fort-I osteotomy, and those treated for fractures of the mandible, maxilla, or zygoma were included from December 2006 to July 2009. The patients were randomly assigned to either a titanium (KLS Martin) or a biodegradable group (Inion CPS).ResultsAfter >5 years postoperatively, plate removal was performed in 22 of the 134 (16.4%) patients treated with titanium and in 23 of the 87 (26.4%) patients treated with the biodegradable system (P = 0.036, hazard ratio (HR) biodegradable (95% CI) = 2.0 (1.05–3.8), HR titanium = 1). Occlusion, VAS pain scores, and MFIQ showed good and (almost) pain free mandibular function in both groups.ConclusionIn conclusion, the performance of the Inion CPS biodegradable system was inferior compared to the KLS Martin titanium system regarding plate/screws removal in the abovementioned surgical procedures.Trial registrationhttp://controlled-trials.com ISRCTN44212338.
Highlights
Titanium osteosynthesis is currently the fixation system of choice in maxillofacial traumatology and orthognathic surgery
Patients treated with a bilateral sagittal split osteotomy (BSSO) and/or a Le Fort-I osteotomy, and those treated for fractures of the mandible, maxilla, or zygoma were included from December 2006 to July 2009
After >5 years postoperatively, plate removal was performed in 22 of the 134 (16.4%) patients treated with titanium and in 23 of the 87 (26.4%) patients treated with the biodegradable system (P = 0.036, hazard ratio (HR) biodegradable = 2.0 (1.05–3.8), HR titanium = 1)
Summary
Titanium osteosynthesis is currently the fixation system of choice in maxillofacial traumatology and orthognathic surgery. Most studies in the literature comparing titanium versus biodegradable osteofixation systems lack a control group or have insufficient follow-up [12]. In 2006, we started a randomized controlled trial comparing titanium vs biodegradable plates and screws in maxillofacial surgery [3]. The risk of removal of biodegradable plates and screws was 2.2 times higher compared to titanium implants, within the first 2 postoperative years [4]. These results are of importance, studies focusing on long-term outcome Biodegradable fixation systems could reduce or eliminate problems associated with titanium removal of implants in a second operation
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