To evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures: A prospective study

Abstract

Aims:The present study was undertaken to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures and to study the morbidity associated with the use of biodegradable plates and screws.Materials and Methods:This prospective study consisted of 10 patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection, comminuted and pathological fractures were excluded. All were plated with biodegradable system (Inion CPS) using standard plating principles and observed for a total period of 24 weeks. Characteristics of the fractures, ease of use of bioresorbable plate/screw system and post operative complications were assessed.Results:Of total 10 patients, eight patients were of midface fracture and two pediatric patients with mandibular fracture, with nine male and one female. The mean age was 32.8 years. Out of 20 plates and 68 screws applied to the 10 fractures sites; there were three incidences of screw breakage with no other intraoperative difficulties. Paresthesia of the infraorbital nerve was present in two patients, and recovered completely in four weeks after surgery. Fracture reduction was considered to be satisfactory in all cases. One patient developed postsurgical infection and was managed with oral antibiotics and analgesics.Conclusions:Favorable healing can be observed through the use of biodegradable plates and screws to stabilize selected midface fractures in patients of all ages, as well as mandible fractures in early childhood, however further studies with more sample size are required.

Overview of innovative advances in bioresorbable plate systems for oral and maxillofacial surgery

“…Additionally, application has been extended to craniomaxillofacial trauma regions, from the mandible to the mid-face, especially in three-dimensional orbital trauma reconstruction [15] , [16] , [17] , [18] , [19] , [51] . The resorbable system is applicable for rigid internal fixation under specific conditions where muscular and stress forces are not a determining factor in fragment displacement, including mid-face and whole mandibular fractures [14] , [15] , [16] , [17] , [18] , [19] , [51] . In paediatric patients, the effective use of resorbable polyglycolic and poly- l -lactic acid plating systems was well reported by Stanton et al [52] , when combined with a brief postoperative period of intermaxillary fixation for mandibular fractures surgical treatment.…”

“…Thus, a resorbable osteofixation implant material is free of toxic and mutagenic effects. Nonetheless, there are some problems related to the use of these materials, such as an inflammatory response, rapid loss of initial implant strength, higher refracture rates, inadequate stiffness of the implants, and weakness compared to metallic implants [13] , [14] , [15] . Biodegradable osteofixation implants are characterized by biomaterials that disintegrate after implantation with no sign of elimination from the body.…”

“…Biodegradable osteofixation implants are characterized by biomaterials that disintegrate after implantation with no sign of elimination from the body. The biodegradation process depends on contact with body fluids, temperature, motion, molecular weight, the crystal form and geometry of the material, and the tissue that is implanted [13] , [14] , [15] . The ideal biodegradable osteofixation implant material provides appropriate strength while degrading in a predictable fashion throughout the healing process without causing adverse reactions [1] , [6] , [7] , [8] , [9] .…”

“…On the other hand, the limitations of biodegradable osteofixation implants are associated mainly with their mechanical properties [13] , [14] , [16] ; they are weaker than conventional such titanium metal implants, leading to low confidence levels regarding the stability of reduced fractures [13] , [16] . Biocompatibility may be another limitation of these materials as they can provoke adverse tissue responses that have characteristics of an inflammatory, bacterial foreign-body reaction [16] , [17] .…”

“…However, bioresorbable implant materials for oral and maxillofacial osteosynthetic applications are currently becoming more common. These materials are safe, effective, and sufficiently flexible for use at many maxillofacial boney surgical sites [13] , [14] , [15] , [16] , [17] . Numerous clinical studies and several review articles have documented the feasibility of bioresorbable materials and these osteofixation plate and screw systems, showing comparable results between the use of resorbable and titanium plates and screws in various maxillofacial surgeries.…”