The Implications of Titanium Alloys Applied in Maxillofacial Osteosynthesis

Riviș, Mircea; Roi, Ciprian Ioan; Roi, Alexandra; Nica, Diana; Valeanu, Adina N.; Rusu, Laura-Cristina

doi:10.3390/app10093203

Cited by 16 publications

(11 citation statements)

References 98 publications

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“…Titanium osteosynthesis systems are commonly made of pure titanium or titanium alloys [ 20 , 96 ]. The most frequently used titanium alloy for maxillofacial osteosynthesis systems consists of 90% titanium, 6% aluminum, and 4% vanadium (Ti6Al4V, also called titanium alloy grade 5) [ 96 , 97 , 98 , 99 ].…”

Section: Pre-clinical Evidencementioning

confidence: 99%

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

Gareb¹,

Bakelen²,

Vissink³

et al. 2022

Polymers

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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.

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Section: Pre-clinical Evidencementioning

confidence: 99%

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

Gareb¹,

Bakelen²,

Vissink³

et al. 2022

Polymers

View full text Add to dashboard Cite

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“…The therapeutic gold standard for the treatment of simple mandibular fractures is open reduction and internal fixation with titanium miniplates and screws. Titanium alloys like Ti-6Al-4V are biocompatible, are resistant to corrosion, and provide high mechanical strength ( Riviş et al, 2020 ). However, the use of titanium is associated with several drawbacks.…”

Section: Introductionmentioning

confidence: 99%

In Silico Biomechanical Evaluation of WE43 Magnesium Plates for Mandibular Fracture Fixation

Orassi

Fischer

Duda

et al. 2022

Front. Bioeng. Biotechnol.

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Titanium fixation devices are the gold standard for the treatment of mandibular fractures; however, they present serious limitations, such as non-degradability and generation of imaging artifacts. As an alternative, biodegradable magnesium alloys have lately drawn attention due to their biodegradability and biocompatibility. In addition, magnesium alloys offer a relatively high modulus of elasticity in comparison to biodegradable polymers, being a potential option to substitute titanium in highly loaded anatomical areas, such as the mandible. This study aimed to evaluate the biomechanical competence of magnesium alloy WE43 plates for mandibular fracture fixation in comparison to the clinical standard or even softer polymer solutions. A 3D finite element model of the human mandible was developed, and four different fracture scenarios were simulated, together with physiological post-operative loading and boundary conditions. In a systematic comparison, the material properties of titanium alloy Ti-6Al-4V, magnesium alloy WE43, and polylactic acid (PLA) were assigned to the fixation devices, and two different plate thicknesses were tested. No failure was predicted in the fixation devices for any of the tested materials. Moreover, the magnesium and titanium fixation devices induced a similar amount of strain within the healing regions. On the other hand, the PLA devices led to higher mechanical strains within the healing region. Plate thickness only slightly influenced the primary fixation stability. Therefore, magnesium alloy WE43 fixation devices seem to provide a suitable biomechanical environment to support mandibular fracture healing in the early stages of bone healing. Magnesium WE43 showed a biomechanical performance similar to clinically used titanium devices with the added advantages of biodegradability and radiopacity, and at the same time it showed a remarkably higher primary stability compared to PLA fixation devices, which appear to be too unstable, especially in the posterior and more loaded mandibular fracture cases.

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“…Іншим недоліком цього методу є можлива травматизація кортикального шару фіксуючими елементами через нерівномірне розподілення навантаження при неповному приляганні міні-пластини. Застосування стандартних титанових міні-пластин подовжує час оперативного втручання та збільшує інтраопераційну травматизацію тканин, а також не завжди дозволяє забезпечити надійну іммобілізацію відламків через малу кількість точок фіксації міні-пластин [37,38,39].…”

Section: обговорення результатів дослідженняunclassified

Support System of Doctor’s Decision-Making on the Choice of a Method for Treating Fractures of the Midface Area

Kochina¹,

Firsov²

2021

Ukr. ž. med. bìol. sportu

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The purpose of the study is to develop a support system of doctor’s decision-making on the choice of a method for treating fractures of the midface are. Materials and methods. The study includes the results of examination and treatment of 112 patients with fractures of the midface area, who were undergoing inpatient treatment in the Department of Head and Neck Surgery of the Municipal Noncommercial Enterprise of Kharkiv Regional Council «Regional Clinical Hospital», Kharkiv. All patients at hospitalization underwent examination according to the local protocol. The diagnosis was based on the results of cone-beam computed tomography, or multislice computed tomography. To determine the initial condition, as well as to assess the functional and cosmetic effects in the treatment process (1st, 3rd, 5th and 7th days) a visual analogue scale was used, at hospitalization we also used a visual analogue scale modified by us, which contains a point evaluation of the patient's condition for 12 signs of trauma. The Scilab computer algebra system was used to develop models for predicting the results of treatment of the midface area fractures using various methods, and a graphical application for the Windows operating system was developed for the practical use of the support system of doctor’s decision-making, in which the Sugeno fuzzy inference machine was integrated into the developed models Results and discussion. To predict the displacement of bone fragments that will remain after the surgery, the following indicators and signs were used: the nature of the fracture, the presence of paraesthesia in the infraorbital area, the presence of hemosinus; method of treatment; indicator by the modified visual analogue scale. To predict the indicator on a visual analogue scale a day after the surgery, the following indicators and signs were used: the nature of the fracture, the presence of paraesthesia in the infraorbital area, the presence of hemosinus; method of treatment, the number of plates in the case of metal osteosynthesis, the indicator by a visual analogue scale before surgery. To predict indicators by a visual analogue scale in the subsequent terms, the values of indicators by this scale in the previous terms are added to the input indicators of the model. Conclusion. As a result of the research it was found that the following can be used as the functional and cosmetic results of treatment of the midface area fracture in the development of predicting models: the amount of displacement of bone fragments, which was determined by computed tomography after surgery, and the values of indicators by a visual analogue scale after a day, 3, 5 and 7 days after surgery. The developed models for predicting functional and cosmetic results of treatment as a result of testing using indicators of 112 patients with fractures of the midface area showed an overall accuracy of 91.6%, sensitivity – 95%, specificity –96.4%.

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The Implications of Titanium Alloys Applied in Maxillofacial Osteosynthesis

Cited by 16 publications

References 98 publications

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

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

In Silico Biomechanical Evaluation of WE43 Magnesium Plates for Mandibular Fracture Fixation

Support System of Doctor’s Decision-Making on the Choice of a Method for Treating Fractures of the Midface Area

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