Biomechanical evaluation of CAD/CAM magnesium miniplates as a fixation strategy for the treatment of segmental mandibular reconstruction with a fibula free flap

Titanium vs PEO Surface-Modified Magnesium Plate Fixation in a Mandible Bone Healing Model in Sheep

“…In displaced fractures of the mandible, open reduction and internal fixation with titanium plates and screws are the current gold standard. , Despite good biocompatibility and sufficient biomechanical features to ensure bone healing, complications following implantation of nondegradable titanium occur, and plate removal is often necessary. − The most frequently reported reasons for plate removal are infections, extrusion, facial deformity, and pain. , Additionally, titanium causes imaging artifacts . As the e-modulus of titanium and bone is substantially different, its implantation entails the risk of stress shielding. , Magnesium as a bioresorbable material affords several advantages, such as a reduced risk of stress shielding due to an elastic modulus closer to cortical bone, while radiological imaging is less compromised. ,, Moreover, magnesium has beneficial effects on bone formation and may thus enhance the clinical outcome of surgical procedures. ,, Previous in silico, ex vivo, and in vivo examinations have shown that the magnesium-based miniplates have similar biomechanical characteristics to titanium-based miniplates. − The application of magnesium-based implants is concomitant with side effects of its corrosion. When exceeding the local resorption rate, the (hydrogen) gas formation may interfere with the healing process. − To control the corrosion rate, a wide range of surface modifications and coatings were examined in previous studies. , PEO markedly reduces the corrosion rate of magnesium-based implants in vivo. − For certain indications, CE-certified WE43 cannulated screws are already in clinical use and demonstrate satisfactory results comparable to fixation with titanium screws. − However, to the best of our knowledge, no magnesium-based plate fixation system for fracture treatment or orthognathic or reconstructive surgery is available.…”