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

Abstract

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.

Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis

“…We have a few hypotheses as to why this increase in open bite diagnoses occurred. First, titanium hardware has been increasingly utilized instead of stainless steel hardware over the past few decades partly because of its purported greater flexibility and benefits for bone-healing capacity 35 . However, the increased flexibility of titanium hardware may permit more movement of fracture fragments and facilitate subsequent malreductions and malocclusions.…”

“…First, titanium hardware has been increasingly utilized instead of stainless steel hardware over the past few decades partly because of its purported greater flexibility and benefits for bone-healing capacity. 35 However, the increased flexibility of titanium hardware may permit more movement of fracture fragments and facilitate subsequent malreductions and malocclusions. Second, VSP has been increasingly utilized over the past few decades to achieve better jaw positioning and reduce rates of postoperative misalignment.…”

Design and analysis of multi-material structures of 3D printed implants of mandible

“…The biomechanical properties of hard and soft tissue interfaces can be improved with the use of multi-material implants developed with an additive manufacturing approach [6]. According to the recent review on biodegradable polymers and titanium in osteosynthesis systems for reducing symptomatic osteosynthetic removal of the maxillofacial region, it is suggested that biodegradable polymers will be an alternative for titanium osteosynthetic system [7]. The multi-material structures of implants developed for mandibular defects with polymer-based composites of photo-curable acrylic resin for the inner region and photo-curable glass fibre for the outer region resulted in better stiffness [8].…”

Microstructure and Mechanical Properties of Hot-Extruded Mg–Zn–Ga–(Y) Biodegradable Alloys

“…Titanium alloys have been used for bone fixation implants. However, the titanium systems have disadvantages including temperature sensitivity, tactile sensation of implants, possible growth restrictions, hampering of imaging and radiotherapy, presence of titanium particles in surrounding tissue, and potential mutagenicity [ 1 ]. These disadvantages result in symptomatic removal in up to 40% of cases [ 1 ].…”

“…However, the titanium systems have disadvantages including temperature sensitivity, tactile sensation of implants, possible growth restrictions, hampering of imaging and radiotherapy, presence of titanium particles in surrounding tissue, and potential mutagenicity [ 1 ]. These disadvantages result in symptomatic removal in up to 40% of cases [ 1 ]. At present, temporary biodegradable implants are gaining popularity, that gradually dissolve as the healing process progresses [ 2 ].…”