Resorbable implants in maxillofacial surgery: a reality check

Laser texturing of additively manufactured implants: A tool to programme biological response

The advent of additive manufacturing (AM) is rapidly shaping healthcare technologies pushing forward personalisation and enhanced implant functionalisation to improve clinical outcomes. AM techniques such as powder bed fusion (PBF) have been adopted despite the need to modify the as-built surface post manufacture. Medical device manufacturers have focused their efforts on refining various physical and chemical surface finishing approaches, however there is little consensus and some methods risk geometry alteration or contamination. This has led to a growing interest in laser texturing technologies to engineer the device surface. Herein, several bioinspired micro and nano textures were applied to laser PBF Ti-6Al-V4 substrates to alter physicochemical properties and in-turn we sought to understand what influences these alterations had on a human osteosarcoma cell line (MG63). Significant variations in roughness and time dependent contact angles were revealed between different patterns provide a tool to elicit desired biological responses. All surface treatments effectively enhanced early cell behaviour and in particular coverage was increased for the micro-textures. Influence of the patterns on cell differentiation was less consistent with alkaline phosphatase content increased only for the channel, grid and dual textures. While long term (21 days) mineralisation was found to be significantly enhanced in grids, dual, triangles and shark skin textures. Further regression analysis of all physicochemical and biological variables indicated that several properties should be used to strongly correlate cell behaviour, resulting in 82 % of the 21 day mineralisation dataset explained through a combination of roughness kurtosis and glycerol contact angle. Overall, this manuscript demonstrates the ability of laser texturing to offer tailored cell-surface interactions, which can be tuned to offer a tool to drive functional customisation of anatomically customised medical devices.

Comparison between resorbable plates vs. titanium plates for treatment of zygomatic fractures: a systematic review with meta-analysis

PURPOSE

To compare resorbable plates with titanium plates for the fixation of zygomatic fractures, taking into account postoperative complications.

METHODS

This systematic review followed the guidelines of PRISMA and the recommendations of the Cochrane Handbook and was registered in PROSPERO. The electronic search was performed in the Web of Science, PubMed, Virtual Health Library, and Cochrane Library databases and in the gray literature. The study selection and the data extraction were performed by three calibrated and independent researchers. The assessment of the risk of bias in the studies was performed using the Cochrane Risk of Bias Tool for clinical trials. Meta-analyses were performed using Review Manager Software version 5.3, using the Peto's Odds Ratios (PORs), and when I² > 30, the random effect model was used. The evaluation of the quality of the evidence was carried out through GRADE.

RESULTS

A total of 2651 studies were screened and only nine were included; 7 of which were used for quantitative assessment. The follow-up time for patients ranged from 6 months to 5 years. All studies showed a low risk of bias in the "incomplete outcome data" domain. The need for plate removal (POR: 0.11, 95% CI: 0.02 to 0.81, I² = 0%) and dehiscence (POR 0.12, 95% CI 0.02 to 0.63, I² = not applied) was lower for the group of patients who used resorbable plates than for titanium plates.

CONCLUSION

There was no difference in the occurrence of infection, diplopia, or paresthesia between the fixation methods. Resorbable plates showed better postoperative clinical performance.