The use of biodegradable osteosynthesis materials in orthognathic surgery
Aris NTOMOUCHTSIS, Lampros ZOULOUMIS, Maria LAZARIDOU, Nikolaos TOPOUZELIS, Ioannis DIMITRAKOPOULOS, Nikolaos LAZARIDIS
Clinic of Oral and Maxillofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki (Head: Professor N. Lazaridis)
Hellenic Archives of Oral & Maxillofacial Surgery (2010) 3, 129-139
SUMMARY: Bioadegradable osteosynthesis materials are an alternative solution to titanium material that have been used for many decades. Their introduction into Oral and Maxillofacial Surgery was gradual, and now they are also used in osteotomies. Patients - Methods: Representative cases of patients who underwent osteotomies, in which osteosynthesis was achieved by means of bioabsorbable material are presented. Results: Depending on their individual preoperative planning, patients underwent the following operations: typical LeFort I maxillary osteotomy, mandibular sagittal split osteotomy and horizontal genioplasty to correct progenism. In 3 of these 4 cases, no complications were reported in the immediate postoperative period. In one case of bimaxillary osteotomy, the bioabsorbable material was fractured at the LeFort I osteotomy line. That patient underwent a second operation, and the bioabsorbable devices were replaced by titanium plates. Conclusions: It can be said that, after their introduction into craniofacial traumatology, biodegradable materials claim their share in orthognathic surgery as well. In certain cases of orthognathic osteotomies and following instructions for their use, bioabsorbable osteosynthesis material can produce significant benefits for patients, without sacrificing preoperative orthognathic planning.
KEY WORDS: Orthognathic surgery, absorbable materials, complications
REFERENCES
Bos RR, Rozema FR, Boering G Leenslag JW, Verwey AB, Pennings AJ: Bioabsorbable poly(L-actide) osteosynthesis plates and screws for the fixation of zygomatic bone fractures. Dtsch Z Mund Kiefer Gesichtschir 13:422-24, 1989
Cutright DE, Hunsuck EE,Beasley JD: Fracture reduction using a biodegradable material, polylactic acid. J Oral Surg 29:393-97, 1971
Edwards RC, Kiely KD: Resorbable fixation of Le Fort I osteotomies. J. Craniofac. Surg. 9: 210-14, 1998
Edwards RC, Kiely KD, Eppley BL: Fixation of bimaxillary osteotomies with resorbable plates and screws: Experience in 20 consecutive cases. J Oral Maxillofac Surg 59:271-276, 2001
Fiala TG, Novelline RA, Yaremchuk MJ: Comparison of CT imaging artifacts from craniomaxillofacial internal fixation devices. Plast Reconstr Surg 92:1227-32, 1993
Fiala TG, Page KT, Davis TL, Campbell TA, Rosen BR, Yaremchuk MJ: Comparison of artifact from craniomaxillofacial internal fixation devices: magnetic resonance imaging. Plast Reconstr Surg 93: 725-31, 1994
Haers PE, Suuronen R, Lindqvist C, Sailer HF: Biodegradable polylactid acid plates and screws in orthognathic surgery.Technical note. J Craniomaxillofac. Sur 26 : 87-91, 1998
Haers PE, Sailer HF: Biodegradable self-reinforced poly-L/DL-lactide plates and screws in bimaxillary orthognathic surgery: short term skeletal stability and material related failures. J Craniomaxillofac Surg 26: 363-372, 1998
Illi OE, Stauffer UG, Sailer HF, Weigum H: Resorbable implants in craniofacial surgery in childhood. A contribution to the development of poly(lactide) implants. Helv Chir Acta 58:123-27,1991
Jorgenson DS, Mayer MH, Ellenbogen RG, Centeno JA, Johnson FB, Mullick FG, Manson PN: Detection of titanium in human tissues after craniofacial surgery. Plast Reconstr Surg 99:976-9,1997
Kahnberg KE, Zouloumis L, Widmark G: Correction of open bite by maxillary osteotomy. A comparison between bone plate and wire fixation. J Cranio-Maxillofac Surg 22:250-255, 1994
Kallela L, P Laine, R. Suuronen, Z Iizuka, C. Lindqvist: Sagittal split osteotomies stabilized with biodegradable polylactide screws: a clinical and radiological study. Int J Oral Maxillofac Surg 27;3-8, 1998
Kulkarni RK, Pani K C, Neuman C, Leonard F: Polylactic acid for surgical implants. Arch Surg 93:839-43,1966
Laine P, Kontio R, Lindqvist C, Suuronen R: Are there any complications with bioabsorbable fixation devices? A 10 year review in orthognathic surgery. Int J Oral Maxillofac Surg 33: 240, 2004
Landes CA, Ballon A: Skeletal Stability in Bimaxillary Orthognathic Surgery: P(L/DL)LA Resorbable versus Titanium Osteofixation. Plast Reconstr Surg 118: 703, 2006
Lazaridis Ν: Historical development of orthognathic Surgery. Stoma 34:153-167, 2006
Lazaridis N, Antoniades K, Zouloumis L, Dimitrakopoulos I: The use of miniplates in the orthognathic surgery. Stomatologia 48(3):132-6, 1991
Mazzonetto R, Paza AO, Spagnoli DB: A retrospective evaluation og rigid fixaton in orthognathic surgery using biodegradable self reinforced polylactide. Int J Oral Maxillofac Surg 33:664-9, 2004
Norholt SE, Pedersen TK, Jensen J: Le Fort I miniplate osteosynthesis: a randomized, prospective study comparing resorbable PLLA/PGA with titanium. Int J Oral Maxillofac Surg. 3:245–252, 2004
Obwegeser H: Eingriffe am Oberkiefer zur Korrektur des progenen Zustantsbildes. Sweiz Mschr Zahnheilk 75:365-371, 1965
Obwegeser H: Die einzeitige Vorbewegung des Oberkiefers und Rueckbewegung des Unterkiefers zur Korrektur der extremen Progenie. Schweiz Mschr Zahnheilk 80:347-356, 1970
Obwegeser JA: Osteosynthesis using biodegradable poly-pdioxanon (PDS II) in Le Fort I osteotomy without postoperative intermaxillary fixation. J Craniomaxillofac Surg 22:129-137, 1994
Rosenberg A, Gratz KW, Sailer HF: Should titanium miniplates be removed after bone healing is complete? Int J Oral Maxillofac Surg 22:185-8, 1993
Spiessl B: Osteosynthese bei sagittaler Osteotomie nach ObwegeserDal Pont. Fortschr Kiefer Gesichtschir, Stuttgart; Thieme, 1974, Bd18 Uhthoff H, Boisvert D, Finnegan M: Cortical porosis under plates. Reaction to unloading or to necrosis? J Bone Joint Surg 76:1507- 12, 1994.
Yerit KC, Hainich S, Enislidis G, Turhani D, Klug C, Wittwer G, Ockher M, Undt G, Kermer C, Watzinger F, Ewers R: Biodegradable fixation of mandibular fractures in children: Stability and early results. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100:17-24, 2005
Clinic of Oral and Maxillofacial Surgery, School of Dentistry, Aristotle University of Thessaloniki (Head: Professor N. Lazaridis)
Hellenic Archives of Oral & Maxillofacial Surgery (2010) 3, 129-139
SUMMARY: Bioadegradable osteosynthesis materials are an alternative solution to titanium material that have been used for many decades. Their introduction into Oral and Maxillofacial Surgery was gradual, and now they are also used in osteotomies. Patients - Methods: Representative cases of patients who underwent osteotomies, in which osteosynthesis was achieved by means of bioabsorbable material are presented. Results: Depending on their individual preoperative planning, patients underwent the following operations: typical LeFort I maxillary osteotomy, mandibular sagittal split osteotomy and horizontal genioplasty to correct progenism. In 3 of these 4 cases, no complications were reported in the immediate postoperative period. In one case of bimaxillary osteotomy, the bioabsorbable material was fractured at the LeFort I osteotomy line. That patient underwent a second operation, and the bioabsorbable devices were replaced by titanium plates. Conclusions: It can be said that, after their introduction into craniofacial traumatology, biodegradable materials claim their share in orthognathic surgery as well. In certain cases of orthognathic osteotomies and following instructions for their use, bioabsorbable osteosynthesis material can produce significant benefits for patients, without sacrificing preoperative orthognathic planning.
KEY WORDS: Orthognathic surgery, absorbable materials, complications
REFERENCES
Bos RR, Rozema FR, Boering G Leenslag JW, Verwey AB, Pennings AJ: Bioabsorbable poly(L-actide) osteosynthesis plates and screws for the fixation of zygomatic bone fractures. Dtsch Z Mund Kiefer Gesichtschir 13:422-24, 1989
Cutright DE, Hunsuck EE,Beasley JD: Fracture reduction using a biodegradable material, polylactic acid. J Oral Surg 29:393-97, 1971
Edwards RC, Kiely KD: Resorbable fixation of Le Fort I osteotomies. J. Craniofac. Surg. 9: 210-14, 1998
Edwards RC, Kiely KD, Eppley BL: Fixation of bimaxillary osteotomies with resorbable plates and screws: Experience in 20 consecutive cases. J Oral Maxillofac Surg 59:271-276, 2001
Fiala TG, Novelline RA, Yaremchuk MJ: Comparison of CT imaging artifacts from craniomaxillofacial internal fixation devices. Plast Reconstr Surg 92:1227-32, 1993
Fiala TG, Page KT, Davis TL, Campbell TA, Rosen BR, Yaremchuk MJ: Comparison of artifact from craniomaxillofacial internal fixation devices: magnetic resonance imaging. Plast Reconstr Surg 93: 725-31, 1994
Haers PE, Suuronen R, Lindqvist C, Sailer HF: Biodegradable polylactid acid plates and screws in orthognathic surgery.Technical note. J Craniomaxillofac. Sur 26 : 87-91, 1998
Haers PE, Sailer HF: Biodegradable self-reinforced poly-L/DL-lactide plates and screws in bimaxillary orthognathic surgery: short term skeletal stability and material related failures. J Craniomaxillofac Surg 26: 363-372, 1998
Illi OE, Stauffer UG, Sailer HF, Weigum H: Resorbable implants in craniofacial surgery in childhood. A contribution to the development of poly(lactide) implants. Helv Chir Acta 58:123-27,1991
Jorgenson DS, Mayer MH, Ellenbogen RG, Centeno JA, Johnson FB, Mullick FG, Manson PN: Detection of titanium in human tissues after craniofacial surgery. Plast Reconstr Surg 99:976-9,1997
Kahnberg KE, Zouloumis L, Widmark G: Correction of open bite by maxillary osteotomy. A comparison between bone plate and wire fixation. J Cranio-Maxillofac Surg 22:250-255, 1994
Kallela L, P Laine, R. Suuronen, Z Iizuka, C. Lindqvist: Sagittal split osteotomies stabilized with biodegradable polylactide screws: a clinical and radiological study. Int J Oral Maxillofac Surg 27;3-8, 1998
Kulkarni RK, Pani K C, Neuman C, Leonard F: Polylactic acid for surgical implants. Arch Surg 93:839-43,1966
Laine P, Kontio R, Lindqvist C, Suuronen R: Are there any complications with bioabsorbable fixation devices? A 10 year review in orthognathic surgery. Int J Oral Maxillofac Surg 33: 240, 2004
Landes CA, Ballon A: Skeletal Stability in Bimaxillary Orthognathic Surgery: P(L/DL)LA Resorbable versus Titanium Osteofixation. Plast Reconstr Surg 118: 703, 2006
Lazaridis Ν: Historical development of orthognathic Surgery. Stoma 34:153-167, 2006
Lazaridis N, Antoniades K, Zouloumis L, Dimitrakopoulos I: The use of miniplates in the orthognathic surgery. Stomatologia 48(3):132-6, 1991
Mazzonetto R, Paza AO, Spagnoli DB: A retrospective evaluation og rigid fixaton in orthognathic surgery using biodegradable self reinforced polylactide. Int J Oral Maxillofac Surg 33:664-9, 2004
Norholt SE, Pedersen TK, Jensen J: Le Fort I miniplate osteosynthesis: a randomized, prospective study comparing resorbable PLLA/PGA with titanium. Int J Oral Maxillofac Surg. 3:245–252, 2004
Obwegeser H: Eingriffe am Oberkiefer zur Korrektur des progenen Zustantsbildes. Sweiz Mschr Zahnheilk 75:365-371, 1965
Obwegeser H: Die einzeitige Vorbewegung des Oberkiefers und Rueckbewegung des Unterkiefers zur Korrektur der extremen Progenie. Schweiz Mschr Zahnheilk 80:347-356, 1970
Obwegeser JA: Osteosynthesis using biodegradable poly-pdioxanon (PDS II) in Le Fort I osteotomy without postoperative intermaxillary fixation. J Craniomaxillofac Surg 22:129-137, 1994
Rosenberg A, Gratz KW, Sailer HF: Should titanium miniplates be removed after bone healing is complete? Int J Oral Maxillofac Surg 22:185-8, 1993
Spiessl B: Osteosynthese bei sagittaler Osteotomie nach ObwegeserDal Pont. Fortschr Kiefer Gesichtschir, Stuttgart; Thieme, 1974, Bd18 Uhthoff H, Boisvert D, Finnegan M: Cortical porosis under plates. Reaction to unloading or to necrosis? J Bone Joint Surg 76:1507- 12, 1994.
Yerit KC, Hainich S, Enislidis G, Turhani D, Klug C, Wittwer G, Ockher M, Undt G, Kermer C, Watzinger F, Ewers R: Biodegradable fixation of mandibular fractures in children: Stability and early results. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100:17-24, 2005
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