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Thet PH, Kaboosaya B. Cephalometric evaluation of skeletal stability and pharyngeal airway changes after mandibular setback surgery: Bioabsorbable versus titanium plate and screw fixation. Imaging Sci Dent 2024; 54:181-190. [PMID: 38948194 PMCID: PMC11211026 DOI: 10.5624/isd.20230269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose This study compared sequential changes in skeletal stability and the pharyngeal airway following mandibular setback surgery involving fixation with either a titanium or a bioabsorbable plate and screws. Materials and Methods Twenty-eight patients with mandibular prognathism undergoing bilateral sagittal split osteotomy by titanium or bioabsorbable fixation were randomly selected in this study. Lateral cephalometric analysis was conducted preoperatively and at 1 week, 3-6 months, and 1 year postoperatively. Mandibular stability was assessed by examining horizontal (BX), vertical (BY), and angular measurements including the sella-nasion to point B angle and the mandibular plane angle (MPA). Pharyngeal airway changes were evaluated by analyzing the nasopharynx, uvula-pharynx, tongue-pharynx, and epiglottis-pharynx (EOP) distances. Mandibular and pharyngeal airway changes were examined sequentially. To evaluate postoperative changes within groups, the Wilcoxon signed-rank test was employed, while the Mann-Whitney U test was used for between-group comparisons. Immediate postoperative changes in the airway were correlated to surgical movements using the Spearman rank test. Results Significant changes in the MPA were observed in both the titanium and bioabsorbable groups at 3-6 months post-surgery, with significance persisting in the bioabsorbable group at 1 year postoperatively (2.29°±2.28°; P<0.05). The bioabsorbable group also exhibited significant EOP changes (-1.21±1.54 mm; P<0.05) at 3-6 months, which gradually returned to non-significant levels by 1 year postoperatively. Conclusion Osteofixation using bioabsorbable plates and screws is comparable to that achieved with titanium in long-term skeletal stability and maintaining pharyngeal airway dimensions. However, a tendency for relapse exists, especially regarding the MPA.
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Affiliation(s)
- Phu Hnin Thet
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Boosana Kaboosaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Ueki K, Takayama A, Gomi K, Takekawa T, Ono S, Moroi A, Yoshizawa K. Bone healing and stability after advancement genioplasty using a pre-bent absorbable plate and screws. J Craniomaxillofac Surg 2023; 51:536-542. [PMID: 37573222 DOI: 10.1016/j.jcms.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/30/2023] [Indexed: 08/14/2023] Open
Abstract
This study aimed to compare the bone healing and stability of the chin with a pre-bent absorbable plate and a manually bent absorbable plate after advancement genioplasty. Patients with class II malocclusion who underwent genioplasty with bimaxillary surgery were included. After genioplasty, two absorbable bicortical screws were fixed on both sides. Then, a pre-bent absorbable plate and screws were used in the center area to fix the segment in advancement genioplasty (PB group). A manually bent absorbable plate was used for the remaining patients (MB group). Computed tomography (CT) was performed before surgery and 1 week and 1 year after surgery. Changes in the pogonion (Pog) and menton (Me) points, soft tissue points, and the ratio of bone squares under the plate were evaluated using lateral cephalometric images reconstructed with 3-dimensional CT data. 32 patients were included in the study. There were no significant differences in the cephalometric measurements in the time interval from 1 week to 1 year. However, the bone square ratio in the PB group showed a significant increase after 1 year (P = 0.0021). Within the limitations of the study it seems that the use of a pre-bent absorbable plate is effective in promoting bone healing after advancement genioplasty.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Akihiro Takayama
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Karen Gomi
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Takahiro Takekawa
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Sumire Ono
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
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Chanachol P, Chongruangsri NN, Arunjaroensuk S, Rochanavibhata S, Siriwatana K, Pimkhaokham A. Comparative study of stability between two different fixation systems after orthognathic surgery in mandibular prognathism skeleton. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101431. [PMID: 36914005 DOI: 10.1016/j.jormas.2023.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE This study is intended to compare the skeleton stability of bioabsorbable and titanium systems after orthognathic surgery in mandibular prognathism patients. STUDY DESIGN A Retrospective study of 28 mandibular prognathism patients who underwent BSSRO setback surgery at Chulalongkorn University. Both titanium and the bioabsorbable group would take lateral cephalometrics immediately postoperative in 1-week(T0), 3(T1), 6(T2), and 12(T3) months. These radiographs were analyzed with Dolphin imaging programTM. The vertical, horizontal, and angular indices were measured. To compare immediately postoperative and follow-up periods within the group, the Friedman difference was used, and the Man-Whitney U test was used between the two groups. RESULT The measurements within the group presented no statistically significant differences. But this study showed that at T0-T1, there was a statistically significant difference between the two groups in the mean of Me in horizontal linear measurement. T0-T2 found differences between Me in both horizontal and vertical linear measurements, and the difference between ANB. The differences between B-point, Pog, and Me in vertical linear measurements at T0-T3 were also reported. CONCLUSION The significant difference values were within the normal range which indicated that using the bioabsorbable system could be well maintained as well as the titanium system. STATEMENT OF CLINICAL RELEVANCE The second operation for removing titanium plate and screw after conventional orthognathic surgery may leads patient discomforts. While a resorbable system might be the role change if the stability is place on the same level.
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Affiliation(s)
- Pawaris Chanachol
- Department of oral and maxillofacial surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | | | - Sirida Arunjaroensuk
- Department of maxillofacial surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sunisa Rochanavibhata
- Department of maxillofacial surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Kiti Siriwatana
- Department of maxillofacial surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Atiphan Pimkhaokham
- Department of maxillofacial surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
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Rajewska J, Kowalski J, Matys J, Dobrzyński M, Wiglusz RJ. The Use of Lactide Polymers in Bone Tissue Regeneration in Dentistry-A Systematic Review. J Funct Biomater 2023; 14:jfb14020083. [PMID: 36826882 PMCID: PMC9961440 DOI: 10.3390/jfb14020083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Different compositions of biodegradable materials are being investigated to successfully replace non-resorbable ones in bone tissue regeneration in dental surgery. The systematic review tried to address the question, "Can biodegradable polymers act as a replacement for conventional materials in dental surgery procedures?" (2) Methods: An electronic search of the PubMed and Scopus databases was conducted in October 2022. The following keywords were used: (lactide polymers) and (hydroxyapatite or fluorapatite) and (dentistry) and (regeneration). Initially, 59 studies were found. Forty-one studies met the inclusion criteria and were included in the review. (3) Results: These usually improved the properties and induced osteogenesis, tissue mineralisation and bone regeneration by inducing osteoblast proliferation. Five studies showed higher induction of osteogenesis in the case of biomaterials, UV-HAp/PLLA, ALBO-OS, bioresorbable raw particulate hydroxyapatite/poly-L-lactide and PLGA/Hap, compared to conventional materials such as titanium. Four studies confirmed improvement in tissue mineralisation with the usage of biomaterials: hydroxyapatite/polylactic acid (HA/PLA) loaded with dog's dental pulp stem cells (DPSCs), Coll/HAp/PLCL, PDLLA/VACNT-O:nHAp, incorporation of hydroxyapatite and simvastatin. Three studies showed an acceleration in proliferation of osteoblasts for the use of biomaterials with additional factors such as collagen and UV light. (4) Conclusions: Lactide polymers present higher osteointegration and cell proliferation rate than the materials compared. They are superior to non-biodegradable materials in terms of the biocompability, bone remodelling and healing time tests. Moreover, because there is no need of reoperation, as the material automatically degrades, the chance of scars and skin sclerosis is lower. However, more studies involving greater numbers of biomaterial types and mixes need to be performed in order to find a perfect biodegradable material.
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Affiliation(s)
- Justyna Rajewska
- Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Jakub Kowalski
- Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Jacek Matys
- Laser Laboratory Dental Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
- Department of Orthodontics, Technische Universitat Dresden, 01307 Dresden, Germany
- Correspondence: (J.M.); (M.D.); (R.J.W.)
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland
- Correspondence: (J.M.); (M.D.); (R.J.W.)
| | - Rafal J. Wiglusz
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland
- Correspondence: (J.M.); (M.D.); (R.J.W.)
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Grillo R, Gomes B, Reis T, Candido IR, Miloro M, Borba AM. Should orthognathic surgery be performed in growing patients? A scoping review. J Craniomaxillofac Surg 2023; 51:60-66. [PMID: 36658055 DOI: 10.1016/j.jcms.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/16/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to determine whether the benefits of orthognathic surgery in a growing individual outweigh its risks. A scoping review was performed according to the PRISMA-ScR guideline. A bibliographic search from MEDLINE, Cochrane Library and LILACS was conducted until February 1, 2022. Scientific publications which reported orthognathic surgery in individuals under 18 years of age were considered. Inclusion criteria were performed according to PICOS model: do individuals with dentofacial deformity submitted to orthognathic surgery with an immature skeleton other than waiting growth cessation have overall benefits over any possible pos-operative consequences? Predictor of interest was growth status and outcome variables were positive benefits or negative consequences related to orthognathic surgery. Two reviewers screened records independently, and any disagreement between them was resolved by a third reviewer. Eligible studies were compiled into an extraction data form and were verified for validity and reliability. Risk of bias between studies was carried out using Review Manager. A total of 15 articles were included in this scoping review, comprising retrospective studies (9), case reports (3), and surveys (3). The topics covered varied from assessment of the functional needs, role, quality of life after orthognathic surgery, impact on growth, relation with temporomandibular joint surgical treatments, minimal referral age for surgery by orthodontists and complex cranio-maxillofacial deformities. Due to the heterogeneity of the articles, it was not possible to perform a meta-analysis. Within the limitations of the study it seems that the existing evidence seems favorable towards the intervention, improving quality of life in growing individuals, even at the risk of a second surgery.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil.
| | - Bruno Gomes
- Department of Oral and Maxillofacial Surgery, General Hospital of Cuiaba, Cuiaba, Mato Grosso, Brazil
| | - Tenyson Reis
- Department of Oral and Maxillofacial Surgery, General Hospital of Cuiaba, Cuiaba, Mato Grosso, Brazil
| | - Isabella Romão Candido
- Department of Oral and Maxillofacial Surgery, General Hospital of Cuiaba, Cuiaba, Mato Grosso, Brazil; Research Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiaba - UNIC, Cuiaba, Mato Grosso, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexandre Meireles Borba
- Department of Oral and Maxillofacial Surgery, General Hospital of Cuiaba, Cuiaba, Mato Grosso, Brazil; Research Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiaba - UNIC, Cuiaba, Mato Grosso, Brazil
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Complications on maxilar impaction: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e268-e272. [PMID: 34755611 DOI: 10.1016/j.jormas.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Maxillary impactions are seen as an orthognathic surgical movement that increases the number of complications. The aim of this paper is to research literature on this topic, with special attention to avoiding of complications. METHODS A systematic review was carried out according to the PRISMA guidelines. The PROSPERO registration has been performed. A risk of bias assessment was carried out with RevMan and graphics were created. A total of 20 articles were included in this systematic review. RESULTS Some interesting and conclusive facts about maxillary impactions. Relapses are not common due to the higher bone contact. Bleeding is a common complication due to the location of palatal artery. Aesthetic and functional complications can arise, especially in the nasal region. Bimaxillary orthognathic surgeries has a higher incidence of complications. CONCLUSIONS Today it is not possible to confirm that maxillary impactions alone are responsible for a higher incidence of complications due to the complexity of the three-dimensional movements. Some surgical steps could be safer and cause fewer complications.
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Clinical Evaluation of Unsintered Hydroxyapatite Particles/Poly L-Lactide Composite Device in Craniofacial Surgery. J Craniofac Surg 2021; 32:2148-2151. [PMID: 33534313 DOI: 10.1097/scs.0000000000007491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT A total of 47 patients who underwent the craniofacial implantation of unsintered hydroxyapatite particles and a poly-L-lactide device were evaluated for clinical local findings and computed tomography (CT) images after about 6 months. Long-term follow-up of 3 patients was done from 5 to 11 years. The patients underwent CT imaging pre- and postoperatively, while local clinical examination was done upon follow-up. For the 3 patients who were followed up for more than 5 years, implant changes were evaluated by using CT. Computed tomography revealed 3 patients of dislocation, 2 patients of insufficient bone union, and 3 patients of implant breakage. All patients healed well with no complications requiring a secondary operation. The CT findings of the long-term cases revealed the following: a plate and screw were still present 5 years postsurgery (patient 1), mesh implants were completely resorbed after 9 years and 6 months (patient 2), and plates were almost resorbed after 11 years but some of their shapes remained (patient 3).The unsintered hydroxyapatite/poly-L-lactide device is useful in the maxillofacial region in terms of strength and radiographic contrast. However, since the absorption rate is slow, it is necessary to keep in mind its long-term radiographic detectability and the possibility of late-onset granuloma.
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Nishikubo S, Ogisawa S, Nakajima J, Azaki H, Shinozuka K, Tonogi M. New method of Le Fort I osteotomy with increased stability. J Oral Sci 2021; 63:298-300. [PMID: 34193780 DOI: 10.2334/josnusd.21-0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Backsliding is a major problem when moving the maxilla significantly forward in orthognathic surgery. For example, in sleep surgery, maxillomandibular advancement is an application of orthognathic surgery, and it is well known that the anterior movement of the maxilla back and forth is an important factor that greatly widens the pharyngeal airway. However, postoperative backsliding is a major problem in this surgery. Therefore, a surgical method was devised to prevent the maxilla from retracting by adjusting the bone when moving the maxilla forward.
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Affiliation(s)
- Shuichi Nishikubo
- First Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
| | - Shouhei Ogisawa
- First Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
| | - Junya Nakajima
- First Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
| | - Hiroaki Azaki
- First Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
| | - Keiji Shinozuka
- First Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
| | - Morio Tonogi
- First Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
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Ishizuka S, Dong QN, Ngo HX, Bai Y, Sha J, Toda E, Okui T, Kanno T. Bioactive Regeneration Potential of the Newly Developed Uncalcined/Unsintered Hydroxyapatite and Poly-l-Lactide-Co-Glycolide Biomaterial in Maxillofacial Reconstructive Surgery: An In Vivo Preliminary Study. MATERIALS 2021; 14:ma14092461. [PMID: 34068558 PMCID: PMC8126161 DOI: 10.3390/ma14092461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
Uncalcined/unsintered hydroxyapatite (HA) and poly-l-lactide-co-glycolide (u-HA/PLLA/PGA) are novel bioresorbable bioactive materials with bone regeneration characteristics and have been used to treat mandibular defects in a rat model. However, the bone regenerative interaction with the periosteum, the inflammatory response, and the degradation of this material have not been examined. In this study, we used a rat mandible model to compare the above features in u-HA/PLLA/PGA and uncalcined/unsintered HA and poly-l-lactic acid (u-HA/PLLA). We divided 11 male Sprague–Dawley rats into 3- and 16-week groups. In each group, we assessed the characteristics of a u-HA/PLLA/PGA sheet covering the right mandibular angle and a u-HA/PLLA sheet covering the left mandibular angle in three rats each, and one rat was used as a sham control. The remaining three rats in the 16-week group were used for a degradation assessment and received both sheets of material as in the material assessment subgroup. At 3 and 16 weeks after surgery, the rats were sacrificed, and mandible specimens were subjected to micro-computed tomography, histological analysis, and immunohistochemical staining. The results indicated that the interaction between the periosteum and u-HA/PLLA/PGA material produced significantly more new bone regeneration with a lower inflammatory response and a faster resorption rate compared to u-HA/PLLA alone. These findings may indicate that this new biomaterial has ideal potential in treating maxillofacial defects of the midface and orbital regions.
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Affiliation(s)
| | | | | | | | | | | | | | - Takahiro Kanno
- Correspondence: ; Tel.: +81-(0)853-20-2301; Fax: +81-(0)853-20-2299
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Morizane K, Goto K, Kawai T, Fujibayashi S, Otsuki B, Shimizu T, Matsuda S. Bone Coverage around Hydroxyapatite/Poly( L-Lactide) Composite Is Determined According to Depth from Cortical Bone Surface in Rabbits. MATERIALS 2021; 14:ma14061458. [PMID: 33802655 PMCID: PMC8002476 DOI: 10.3390/ma14061458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Composites of unsintered hydroxyapatite (HA) and poly(L-lactide) (PLLA) reinforced by compression forging are biodegradable, bioactive, and have ultrahigh strength. However, foreign body reactions to PLLA and physical irritation can occur when not covered by bone. We aimed to confirm the relationships between the depth of the implanted HA-PLLA threaded pins and the new bone formation. We inserted HA-PLLA composite threaded pins (diameter: 2.0 or 4.5 mm) into the femoral and tibial bones of 32 mature male Japanese white rabbits (weight 3.0–3.5 kg) with the pin head 1 or 0 mm below or protruding 1 or 2 mm above surrounding cortical bone. Eight euthanized rabbits were radiologically and histologically assessed at various intervals after implantation. Bone bridging was complete over pins of both diameters at ~12 weeks, when inserted 1 mm below the surface, but the coverage of the pins inserted at 0 mm varied. Bone was not formed when the pins protruded >1 mm from the bone surface. No inflammation developed around the pins by 25 weeks. However, foreign body reactions might develop if composites are fixed above the bone surface, and intraosseous fixation would be desirable using double-threaded screws or a countersink to avoid screw head protrusion.
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Affiliation(s)
| | - Koji Goto
- Correspondence: ; Tel./Fax: +81-5-751-3366
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On SW, Cho SW, Byun SH, Yang BE. Bioabsorbable Osteofixation Materials for Maxillofacial Bone Surgery: A Review on Polymers and Magnesium-Based Materials. Biomedicines 2020; 8:biomedicines8090300. [PMID: 32825692 PMCID: PMC7555479 DOI: 10.3390/biomedicines8090300] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/24/2023] Open
Abstract
Clinical application of osteofixation materials is essential in performing maxillofacial surgeries requiring rigid fixation of bone such as trauma surgery, orthognathic surgery, and skeletal reconstruction. In addition to the use of titanium plates and screws, clinical applications and attempts using bioabsorbable materials for osteofixation surgery are increasing with demands to avoid secondary surgery for the removal of plates and screws. Synthetic polymeric plates and screws were developed, reaching satisfactory physical properties comparable to those made with titanium. Although these polymeric materials are actively used in clinical practice, there remain some limitations to be improved. Due to questionable physical strength and cumbersome molding procedures, interests in resorbable metal materials for osteofixation emerged. Magnesium (Mg) gained attention again in the last decade as a new metallic alternative, and numerous animal studies to evaluate the possibility of clinical application of Mg-based materials are being conducted. Thanks to these researches and studies, vascular application of Mg-based biomaterials was successful; however, further studies are required for the clinical application of Mg-based biomaterials for osteofixation, especially in the facial skeleton. The review provides an overview of bioabsorbable osteofixation materials in maxillofacial bone surgery from polymer to Mg.
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Affiliation(s)
- Sung-Woon On
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea;
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
| | - Seoung-Won Cho
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
| | - Soo-Hwan Byun
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
| | - Byoung-Eun Yang
- Graduated School of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea; (S.-W.C.); (S.-H.B.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Korea
- Division of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Korea
- Correspondence: ; Tel.: +82-380-3870
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Abstract
Resorbable and titanium systems have been used in maxillary fixation. The aim of this review was to evaluate stability and morbidity of Le Fort I osteotomy by comparing both systems. It was performed in 11 databases, and reported according to preferred reporting items for systematic reviews and meta-analysis. Randomized and nonrandomized clinical trials, and retrospective comparative studies with patients who underwent nonsegmented Le Fort I osteotomy were included. Eleven articles were selected, with a total of 262 patients treated with resorbable and 252 with titanium fixation. The meta-analysis showed that when measured at point A, horizontal stability was 0.06 mm (95% confidence interval [CI] -0.19, 0.30), vertical stability for impaction was -0.43 mm (95% CI -0.94, 0.07), and for inferior repositioning was -1.29 mm (95% CI -2.62, 0.04). Morbidity was similar in the groups. Regarding infection, resorbable presented an absolute risk (AR) = 0.032, and titanium an AR = 0.025 (P = 1.0). For soft tissue reaction, an AR = 0.120 was shown for resorbable, and an AR = 0.132 for titanium (P = 0.85). Removal of fixation showed an AR = 0.024 for resorbable, and an AR = 0.025 for titanium (P = 1.0). Based on these results, resorbable and metal fixation systems seem to be equivalent with respect to stability and morbidity. This review was limited by the quality of the studies. Future studies should address these quality limitations to improve comparison between these 2 fixation approaches.
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Park B, Jung BT, Kim WH, Lee JH, Kim B, Lee JH. The Stability of Hydroxyapatite/Poly-L-Lactide Fixation for Unilateral Angle Fracture of the Mandible Assessed Using a Finite Element Analysis Model. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E228. [PMID: 31947998 PMCID: PMC6981669 DOI: 10.3390/ma13010228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
Recently, a hydroxyapatite particle/poly-L-lactide (HA-PLLA) composite device was introduced as an alternative to previous fixation systems. In this study, we used finite element analysis to simulate peak von Mises stress (PVMS) and deformation of bone plates and screws with the following four materials-Ti, Mg alloy, PLLA, and HA-PLLA-at a unilateral mandibular fracture. A three-dimensional virtual mandibular model was constructed, and the fracture surface was designed to run from the left mandibular angle. Masticatory loading was applied on the right first molars. Stress was concentrated at the upper part and the neck of the screw. The largest PVMS was observed for Ti; that was followed by Mg alloy, HA-PLLA, and PLLA. The largest deformation was observed for PLLA; next was HA-PLLA, then Mg alloy, and finally Ti. We could rank relative superiority in terms of mechanical properties. The HA-PLLA screw and mini-plate deformed less than 0.15 mm until 300 N. Thus, we can expect good bone healing with usual masticatory loading six weeks postoperatively. HA-PLLA is more frequently indicated clinically than PLLA owing to less deformation. If the quality of HA-PLLA fixation is improved, it could be widely utilized in facial bone trauma or craniofacial surgery.
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Affiliation(s)
- Byungho Park
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea;
| | | | - Won Hyeon Kim
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul 03080, Korea; (W.H.K.); (J.-H.L.)
| | - Jong-Ho Lee
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul 03080, Korea; (W.H.K.); (J.-H.L.)
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul 03080, Korea
| | - Bongju Kim
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul 03080, Korea; (W.H.K.); (J.-H.L.)
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, Korea;
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Kurohara K, Tomomatsu N, Nakakuki K, Sakuma T, Arai N, Yoda T. Treatment of refractory non-union after maxillary osteotomy: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:493-496. [DOI: 10.1016/j.jormas.2018.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/27/2022]
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Dong QN, Kanno T, Bai Y, Sha J, Hideshima K. Bone Regeneration Potential of Uncalcined and Unsintered Hydroxyapatite/Poly l-lactide Bioactive/Osteoconductive Sheet Used for Maxillofacial Reconstructive Surgery: An In Vivo Study. MATERIALS 2019; 12:ma12182931. [PMID: 31514283 PMCID: PMC6766281 DOI: 10.3390/ma12182931] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/21/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
Uncalcined and unsintered hydroxyapatite/poly l-lactide (u-HA/PLLA) material has osteoconductive characteristics and is available for use as a maxillofacial osteosynthetic reconstruction device. However, its bone regeneration ability in the maxillofacial region has not been fully investigated. This study is the first to assess the bone regenerative potential of osteoconductive u-HA/PLLA material when it is used for repairing maxillofacial bone defects. A total of 21 Sprague-Dawley male rats were divided into three groups—the u-HA/PLLA, PLLA, or sham control groups. A critical size defect of 4 mm was created in the mandible of each rat. Then, the defect was covered with either a u-HA/PLLA or PLLA sheet on the buccal side. The rats in each group were sacrificed at 2, 4, or 8 weeks. The rats’ mandibles were sampled for histological analysis with hematoxylin and eosin staining, histomorphometry, and immunohistochemistry with Runx2 and osteocalcin (OCN) antibody. The amount of newly formed bone in the u-HA/PLLA group was significantly higher than that of the PLLA group. The expression of Runx2 and OCN in the u-HA/PLLA group was also significantly higher. These results demonstrate that the u-HA/PLLA material has excellent bone regenerative ability and confirm its applicability as a reconstructive device in maxillofacial surgery.
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Affiliation(s)
- Quang Ngoc Dong
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
| | - Yunpeng Bai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
| | - Jingjing Sha
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
| | - Katsumi Hideshima
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
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Ueki K, Moroi A, Yoshizawa K. Stability of the chin after advancement genioplasty using absorbable plate and screws with template devices. J Craniomaxillofac Surg 2019; 47:1498-1503. [PMID: 31402207 DOI: 10.1016/j.jcms.2019.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/02/2019] [Accepted: 07/21/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the stability of the chin between absorbable plate and screws with a template device and titanium plate after advancement genioplasty in class II patients. PATIENTS AND METHODS The subjects consisted of 22 Japanese class II patients who underwent genioplasty advancement in combination with bi-maxillary surgery. After genioplasty horizontal osteotomy, the template plate and screws were fixed at the central region of the chin temporarily. Then, two absorbable bi-cortical screws (uncalcined and unsintered hydroxyapatite and poly-l-lactic acid: uHA/PLLA) were used and fixed bilaterally. After removal of the template plate and screws, one absorbable plate and screws were added to fix the segment in the advancement genioplasty (n = 14). The remaining 8 patients underwent genioplasty advancement surgery with the conventional titanium plate. For all patients, lateral cephalograms were obtained pre- and immediately after surgery and at 1 year after surgery. Change in the Pogonion (Pog) and Menton (Me) points and the corresponding soft tissue points (PogS and MeS) were evaluated. RESULTS Although there were no significant differences in the change from before to immediately after surgery between the absorbable and titanium groups, there were significant differences in the Pog (Y) (P = 0.0379) and PogS (Y) (P = 0.0379) from immediately after surgery to after 1 year between both groups. CONCLUSION This study shows that predicted advancement of the chin in the absorbable group could be achieved by using a template and screws, and likewise in the titanium group. However, this study suggested that vertical relapse to the inferior site or resorption at the antero-superior edge of the segment could occur in the absorbable group.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
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Stability of bioresorbable plates following reduction of mandibular body fracture: Three-dimensional analysis. J Craniomaxillofac Surg 2019; 47:1752-1757. [PMID: 31445877 DOI: 10.1016/j.jcms.2019.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The recent development of bioresorbable bone plates and screws allows plates to be applied to the load-bearing regions of the mandible and to remain in place over time without the need for removal. We hypothesized that the stability of composite plates and screws forged from unsintered hydroxyapatite particles and poly-l-lactide (u-HA/PLLA) is comparable to that of standard titanium fixation systems for the reduction of fractures of load-bearing regions of the mandibular body. MATERIALS AND METHODS 40 patients underwent open reduction and internal fixation of the fractured mandibular body with either a titanium or u-HA/PLLA bone plate. Cone-beam CT images were obtained immediately postoperatively and at 6-month follow-up, and were analyzed for positional changes of the affected mandible. RESULTS There were no significant differences in the postoperative positional changes of reference points between the titanium and u-HA/PLLA miniplates, except for that for the coronoid process (p-value = 0.03). Multivariate regression analysis revealed no significant differences in spatial changes between the immediate postoperative and 6-month follow-up images, after adjusting for age and sex. CONCLUSION The stability of bioresorbable u-HA/PLLA miniplates and screws was comparable to that of titanium miniplates and screws immediately postoperatively and at 6-month follow-up, following surgical reduction of fractures of load-bearing regions of the mandibular body. Bioresorbable osteosynthesis can be considered a viable alternative to titanium osteosynthesis.
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Kim SY, Nam SM, Park ES, Kim YB. Evaluation of one-point fixation for zygomaticomaxillary complex fractures using a three-dimensional photogrammetric analysis. J Otolaryngol Head Neck Surg 2019; 48:36. [PMID: 31362786 PMCID: PMC6668153 DOI: 10.1186/s40463-019-0359-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of treatment for zygomaticomaxillary (ZM) complex (ZMC) fractures is to achieve stability and restore aesthetic appearance through three-dimensional reduction and rigid fixation. The purpose of this study was to evaluate the stability and aesthetic appearance outcomes of one-point fixation using a three-dimensional photogrammetric analysis. METHODS From March 2014 to December 2014, 34 patients with ZMC fractures were treated by one-point fixation in the ZM buttress using unsintered hydroxyapatite (u-HA)/poly-L-lactide (PLLA) plates. Differences in soft tissue inter-malar height between the fractured side and unfractured sides were evaluated using photogrammetric analysis with a three-dimensional camera (Morphius®) at the preoperative and 1 week, 1 and 3 months after surgery. The differences in bony inter-malar height between the fractured and unfractured sides were evaluated using computer tomography at the pre-operative and 6 months after surgery. The paired t-test was used to compare differences in malar height. RESULTS Six months after surgery, 34 patients achieved satisfactory bony stability and symmetric malar appearances. Comparisons of differences in soft-tissue inter-malar height revealed statistically significant differences between the pre-operative period and 1 week and 1 month after surgery (p < .01). There was no statistically significant difference between 1 and 3 months after surgery. Comparison of differences in bony inter-malar height revealed a statistically significant difference between before and 6 months after surgery (p < .01). CONCLUSIONS When we conducted a three-dimensional photogrammetric analysis, although it has restricted surgical indications, one-point fixation of the ZM buttress using an u-HA / PLLA plate yielded reliable, satisfactory, and safe clinical results in patients with ZMC fractures. CLINICAL QUESTION / LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Se Young Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea.
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
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Ueki K, Yoshizawa K, Moroi A. Bone healing after Le Fort I osteotomy with SSRO, using uHA/PLLA plates and screws, in class II and III patients. J Craniomaxillofac Surg 2019; 47:1338-1342. [PMID: 31337568 DOI: 10.1016/j.jcms.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to compare bone healing after Le Fort I osteotomy with sagittal split ramus osteotomy (SSRO) in class II and class III patients. PATIENTS AND METHODS The subjects consisted of 46 Japanese class II and III patients. Le Fort I osteotomy was performed in combination with SSRO. They were divided into two groups (23 class II cases and 23 class III cases). Four absorbable plates (uncalcined and unsintered hydroxyapatite and poly-l-lactic acid - uHA/PLLA) and screws were used to fix the maxillary segment in all patients, in the same manner. Postoperative computed tomography (CT) was analyzed for all patients at 1 week and 1 year postoperatively. The anterior and lateral areas between the maxillary segments were measured using two-dimensional frontal and lateral views from the three-dimensional images reconstructed over a constant CT value. RESULTS There were no significant differences in the area of bone defect healing between classes II and III at 1 year postoperatively, although there were significant differences between the two groups at 1 week postoperatively (p < 0.05). Furthermore, there were no significant differences in the areas of bone defect between 1 week and 1 year postoperatively, in both groups. CONCLUSION Using measurements based on CT value threshold within 1 year after Le Fort I osteotomy, this study suggests that the areas of bony defect in the region of the anterior and lateral walls of the maxilla do not always decrease in both classes II and III.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
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Kanno T, Sukegawa S, Karino M, Furuki Y. Navigation-Assisted Orbital Trauma Reconstruction Using a Bioactive Osteoconductive/Bioresorbable u-HA/PLLA System. J Maxillofac Oral Surg 2019; 18:329-338. [PMID: 31371870 DOI: 10.1007/s12663-019-01207-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Orbital fractures with orbital wall defects are common facial fractures encountered by oral-maxillofacial surgeons, because of the exposed position and thin bony walls of the midface. The primary goal of surgery is to restore the pre-injury anatomy and volume of hard tissue, and to free incarcerated or prolapsed orbital tissue from the fracture by bridging the bony defects with reconstructive implant material and restoring the maxillofacial-orbital skeleton. Numerous studies have reported orbital fracture repair with a wide variety of implant materials that offer various advantages and disadvantages. The ideal orbital implant material will allow conformation to individual patients' anatomical characteristics, remain stable over time, and are radiopaque, especially for the reconstruction of relatively large and/or complex bony walls. Based on these requirements, novel uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA; u-HA/PLLA) composite sheets could be used as innovative, bioactive, and osteoconductive/bioresorbable implant materials for orbital reconstruction. In addition, intraoperative navigation is a powerful tool. Navigation- and computer-assisted surgeries have improved execution and predictability, allowing for greater precision, accuracy, and minimal invasiveness during orbital trauma reconstructive surgery of relatively complex and large orbital wall defects with ophthalmological malfunctions and deformities. This review presents an overview of navigation-assisted orbital trauma reconstruction using a bioactive, osteoconductive/bioresorbable u-HA/PLLA system.
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Affiliation(s)
- Takahiro Kanno
- 1Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane Japan
| | - Shintaro Sukegawa
- 2Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa Japan
| | - Masaaki Karino
- 1Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane Japan
| | - Yoshihiko Furuki
- 2Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa Japan
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Comparative study on long-term stability in mandibular sagittal split ramus osteotomy: hydroxyapatite/poly-l-lactide mesh versus titanium miniplate. Maxillofac Plast Reconstr Surg 2019; 41:8. [PMID: 30886836 PMCID: PMC6395455 DOI: 10.1186/s40902-019-0192-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/04/2019] [Indexed: 11/19/2022] Open
Abstract
Background Resorbable devices have recently been adopted in the field of orthognathic surgery with controversies about their postoperative skeletal stability. Hence, we determined the long-term skeletal stability of unsintered hydroxyapatite/poly-l-lactic acid (HA/PLLA) mesh for osteofixation of mandibular sagittal split ramus osteotomy (SSRO), and compared it with that of titanium miniplate. Methods Patients were divided into resorbable mesh and titanium miniplate fixation groups. A comparative study of the change in the mandibular position was performed with preoperative, 1-day, 6-month, and 2-year postoperative lateral cephalograms. Results At postoperative 6 months—compared with postoperative 1 day, point B (supra-mentale) was significantly displaced anteriorly in the titanium-fixation group. Moreover, at postoperative 2 years—compared with postoperative 6 months, point B was significantly displaced inferiorly in the titanium-fixation. However, the HA/PLLA mesh-fixation group did not show any significant change with respect to point B postoperatively. Conclusions The HA/PLLA mesh-fixation group demonstrated superior long-term skeletal stability with respect to the position of mandible, when compared with the titanium-fixation group.
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Liu JN, Ong HS, Wang MY, Wan K, Qu XZ, Zhang CP. Randomized control trial comparing the titanium osteosynthesis and the biodegradable osteosynthesis in mandibulotomy access. Head Neck 2019; 41:915-923. [PMID: 30758110 DOI: 10.1002/hed.25509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/01/2018] [Accepted: 08/15/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jian Nan Liu
- Department of Oral Maxillofacial‐Head & Neck OncologyNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Hui Shan Ong
- Department of Oral Maxillofacial‐Head & Neck OncologyNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ming Yi Wang
- Department of Oral Maxillofacial‐Head & Neck OncologyNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Kenneth Wan
- Oral Maxillofacial Surgery DepartmentOral Health Centre of Western Australia, University of Western Australia Crawley Western Australia Australia
- Oral Maxillofacial Surgery DepartmentRoyal Perth Hospital Perth Western Australia Australia
| | - Xing Zhou Qu
- Department of Oral Maxillofacial‐Head & Neck OncologyNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chen Ping Zhang
- Department of Oral Maxillofacial‐Head & Neck OncologyNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China
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Morizane K, Shikinami Y, Fujibayashi S, Goto K, Otsuki B, Kawai T, Shimizu T, Matsuda S. Implantable composite devices of unsintered hydroxyapatite and poly-l-lactide with dispersive marbling morphology to enhance in vivo bioactivity and bioresorbability. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 97:698-706. [PMID: 30678958 DOI: 10.1016/j.msec.2018.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/21/2018] [Accepted: 12/09/2018] [Indexed: 01/04/2023]
Abstract
A bone fixation device made of unsintered hydroxyapatite (u-HA) particles uniformly dispersed in a poly-l-lactide matrix and reinforced by compressive forging (uniformly dispersed composite; UDC) has been clinically applied in several fields. However, it has reported some foreign body reactions over a long implantation period due to its slow bioresorbability. To further enhance its bioresorbability, we developed devices comprising a fibrous assembly of poly-l-lactide only three-dimensionally intertwined with particulate hydroxyapatite/poly-l-lactide composite. The biological behavior of the proposed material, provisionally referred to as complementarily reinforced composite (CRC), was compared with that of UDC in vivo. Cylindrical rods of UDC and CRC with 3.2-mm diameters were inserted bilaterally into the intramedullary distal femurs of 32 male Japanese white rabbits. Eight rabbits were euthanized at four, eight, 12, and 25 weeks after insertion. There were no significant differences between the mechanical properties of UDC and CRC over time. However, the results from histological analyses, surface characterization, radiological analyses, and push-out mechanical testing substantiated CRC's superior affinity to bone and enhanced bioactivity and bioresorbability in comparison with UDC. These characteristics were attributed to the dispersive marbling morphology produced by the CRC material's successive connectivity of u-HA particles throughout the PLLA matrix, which would accelerate PLLA hydrolysis degradation by H2O intrusion and enhance the bioactivity of u-HA particles exposed on the interface soon after implantation.
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Affiliation(s)
- Kazuaki Morizane
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, Japan.
| | - Yasuo Shikinami
- Shikinami Yasuo Institute, 14 4F Lty932 1-1-1 Oji, Kusatsu, Shiga, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, Japan
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Sukegawa S, Kanno T, Manabe Y, Matsumoto K, Sukegawa-Takahashi Y, Masui M, Furuki Y. Is the removal of osteosynthesis plates after orthognathic surgery necessary? Retrospective long-term follow-up study. Int J Oral Maxillofac Surg 2018; 47:1581-1586. [DOI: 10.1016/j.ijom.2018.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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Sakamoto A, Okamoto T, Matsuda S. Unsintered Hydroxyapatite and Poly-L-Lactide Composite Screws/Plates for Stabilizing β-Tricalcium Phosphate Bone Implants. Clin Orthop Surg 2018; 10:253-259. [PMID: 29854351 PMCID: PMC5964276 DOI: 10.4055/cios.2018.10.2.253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/15/2017] [Indexed: 11/22/2022] Open
Abstract
Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate (Super-Fixsorb MX40 Mesh) systems made of u-HA/PLLA are typically used in small bones in maxillofacial surgeries. After the resection of bone tumors in larger bones, reconstructions with β-tricalcium phosphate (β-TCP) implants of strong compression resistance have been reported. After a resection, when the cavity is hemispheric- or concave-shaped, stabilization of the implanted β-TCP block is necessary. In the current series, u-HA/PLLA were used to stabilize the mechanically strong implanted low-porous β-TCP blocks in six bone tumor cases, including three giant cell tumors of bone, and one case each of chondroblastoma, chondrosarcoma, and parosteal osteosarcoma. The mean age of patients at the time of surgery was 31.3 years (range, 19 to 48 years). The bones involved were two ilia (posterior), a femur (diaphysis to distal metaphysis), and three tibias (proximal epiphysis, proximal metaphysis to epiphysis, and distal metaphysis to epiphysis). Neither displacement of the implanted β-TCP block nor any u-HA/PLLA-related complications were observed. The radiolucent character of the u-HA/PLLA did not hinder radiological examinations for potential signs of tumor recurrence. The method of using u-HA/PLLA components for the stabilization of β-TCP blocks makes the procedure easy to perform and reliable. It can extend the application of β-TCP blocks in reconstruction surgery.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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Liu JN, Wang MY, Wan K, Han J, Zhang SJ, Qu XZ, Ong HS. WITHDRAWN: A Randomized Controlled Trial Comparing Between Titanium Osteosynthesis and Biodegradable Osteosynthesis in Access Mandibulotomy for Oral Malignancy. J Oral Maxillofac Surg 2018:S0278-2391(18)30301-X. [PMID: 29715446 DOI: 10.1016/j.joms.2018.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/03/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Abstract
Available online April 7, 2018. This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Jian Nan Liu
- Registrar, Department of Oral and Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Yi Wang
- Registrar, Department of Oral and Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kenneth Wan
- Consultant, Oral Maxillofacial Surgery Department, Oral Health Centre of Western Australia, University of Western Australia, Perth, Western Australia, Australia; and Consultant, Oral Maxillofacial Surgery Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jing Han
- Registrar, Department of Oral and Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi Jian Zhang
- Registrar, Department of Oral and Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Zhou Qu
- Consultant, Department of Oral and Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Shan Ong
- Registrar, Department of Oral and Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Overview of innovative advances in bioresorbable plate systems for oral and maxillofacial surgery. JAPANESE DENTAL SCIENCE REVIEW 2018; 54:127-138. [PMID: 30128060 PMCID: PMC6094489 DOI: 10.1016/j.jdsr.2018.03.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 02/17/2018] [Accepted: 03/10/2018] [Indexed: 11/09/2022] Open
Abstract
Maxillofacial osteosynthetic surgeries require stable fixation for uneventful boney healing and optimal remodeling. Although conventional titanium plates and screws for osteofixation are considered the gold standard for rigid fixation in maxillofacial surgeries, bioresorbable implants of plates and screw systems are commonly used for various maxillofacial osteosynthetic surgeries such as orthognathic surgery, maxillofacial fractures, and reconstructive surgery. Titanium plates are limited by their palpability, mutagenic effects, and interference with imaging, which may lead to the need for subsequent removal; the use of a biologically resorbable osteofixation system could potentially address these limitations. However, several problems remain including fundamental issues involving decreased mechanical strength and stability, slow biodegradation, complex procedures, and the available bioresorbable implant materials. Major advances in bioresorbable plate systems have been made with the use of bioactive/resorbable osteoconductive materials and an accelerator of bioresorption, such as polyglycolic acid. This report presents an overview of currently available resorbable implant materials and their applications, with a focus on recent innovative advances and new developments in this field.
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Immediate and long-term results of unsintered hydroxyapatite and poly L-lactide composite sheets for orbital wall fracture reconstruction. J Plast Reconstr Aesthet Surg 2018; 71:1069-1075. [PMID: 29759951 DOI: 10.1016/j.bjps.2018.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/24/2018] [Accepted: 03/10/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Bone defect reconstruction in orbital wall fractures with absorbable alloplastic such as the unsintered hydroxyapatite and poly L-lactide composite (u-HA/PLLA) system is gaining popularity. The u-HA/PLLA material has osteoconductive and osteosynthetic properties. However, quantitative, long-term outcome data after the use of u-HA/PLLA for orbital wall fractures are lacking. PATIENTS AND METHODS We retrospectively analyzed 115 patients who underwent surgical repair of orbital wall fractures with a u-HA/PLLA sheet from 2011 to 2016. A chart review was performed, and the time-dependent changes at fracture sites were assessed by imaging. The immediate postoperative and the latest follow-up bony orbital volumes of the affected side were compared. RESULTS Seventy patients were eligible for this study (mean age, 44.6 ± 22.1 years; 48 men and 22 women; mean follow-up period, 29.7 ± 12.8 months). Except for one case of hematoma, there were no postoperative wound complications. Of the 70 patients, 10 had postoperative diplopia and 2 had enophthalmos; these conditions were presumably caused by the extension and severity of the fracture. Satisfactory reduction in the entire orbital wall, without pathological changes, was demonstrated. There were no significant differences in the mean bony orbital volumes of the affected side immediately after surgery (24.774 ± 3.092 cm3) and at the latest follow-up (24.749 ± 3.205 cm3) (p = 0.756). CONCLUSION The u-HA/PLLA sheet is useful for orbital wall fracture reconstruction because of its desirable handling characteristics, initial mechanical strength, long-term maintenance of structural stability, radiopacity, and few associated complications. Future randomized controlled trials need to be performed to compare u-HA/PLLA with other conventional materials.
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Clinical Evaluation of an Unsintered Hydroxyapatite/Poly-L-Lactide Osteoconductive Composite Device for the Internal Fixation of Maxillofacial Fractures. J Craniofac Surg 2018; 27:1391-7. [PMID: 27428913 PMCID: PMC5023762 DOI: 10.1097/scs.0000000000002828] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: OSTEOTRANS MX (Takiron Co, Ltd, Osaka, Japan) is a resorbable osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its osteoconductive capacity has been documented. The authors here report their clinical experience using OSTEOTRANS MX. Methods: The authors treated 35 patients (19 men, 16 women; age, 14–88 years; mean ± standard deviation, 38.4 ± 19.9 years) with maxillofacial fractures. The authors used standard surgery to stabilize fractures in all patients, fitting resorbable plates (thickness, 1.0 or 1.4 mm) and screws (diameter, 2 mm) according to Arbeitsgemeinschaft für Osteosynthesefragen/Association (AO) for the Study of Internal Fixation guidelines. Results: All patients eventually achieved satisfactory healing with favorable restoration of form and function without foreign body reaction. Complications occurred in 3 patients—plate exposure in 2 and discomfort in 1. However, fracture sites healed in all patients. Scanning electron microscopy revealed that the devices bonded directly to the bone without interposition of nonmineralized tissue. Conclusion: OSTEOTRANS MX is a useful material with few complications. Its osteoconductive bioactivity is advantageous for the early functional improvement of maxillofacial fractures.
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Skeletal stability following bioresorbable versus titanium fixation in orthognathic surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2018; 47:141-151. [DOI: 10.1016/j.ijom.2017.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/31/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022]
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Modified hybrid fixation using absorbable plate and screw for mandibular advancement surgery. J Craniomaxillofac Surg 2017; 45:1788-1793. [DOI: 10.1016/j.jcms.2017.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/27/2017] [Accepted: 08/02/2017] [Indexed: 11/19/2022] Open
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Stability and surgical complications in segmental Le Fort I osteotomy: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1071-1087. [DOI: 10.1016/j.ijom.2017.05.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 05/17/2017] [Indexed: 11/19/2022]
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Sukegawa S, Kanno T, Manabe Y, Matsumoto K, Sukegawa-Takahashi Y, Masui M, Furuki Y. Biomechanical Loading Evaluation of Unsintered Hydroxyapatite/poly-l-lactide Plate System in Bilateral Sagittal Split Ramus Osteotomy. MATERIALS 2017; 10:ma10070764. [PMID: 28773126 PMCID: PMC5551807 DOI: 10.3390/ma10070764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 11/16/2022]
Abstract
OSTEOTRANS MX® (Takiron Co., Ltd., Osaka, Japan) is a bioactive resorbable maxillofacial osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its effective osteoconductive capacity has been previously documented. However, the mechanical strength of this plate system is unclear. Thus, the aim of this in vitro study was to assess its tensile and shear strength and evaluate the biomechanical intensity of different osteosynthesis plate designs after sagittal split ramus osteotomy by simulating masticatory forces in a clinical setting. For tensile and shear strength analyses, three mechanical strength measurement samples were prepared by fixing unsintered hydroxyapatite/poly-l-lactide composed plates to polycarbonate skeletal models. Regarding biomechanical loading evaluation, 12 mandibular replicas were used and divided into four groups for sagittal split ramus osteotomy fixation. Each sample was secured in a jig and subjected to vertical load on the first molar teeth. Regarding shear strength, the novel-shaped unsintered hydroxyapatite/poly-l-lactide plate had significantly high intensity. Upon biomechanical loading evaluation, this plate system also displayed significantly high stability in addition to bioactivity, with no observed plate fracture. Thus, we have clearly demonstrated the efficacy of this plate system using an in vitro model of bilateral sagittal split ramus osteotomy of the mandible.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Takahiro Kanno
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Shimane 693-8501, Japan.
| | - Yoshiki Manabe
- Admission Center, Kagawa University, Takamatsu, Kagawa 760-0016, Japan.
| | - Kenichi Matsumoto
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Yuka Sukegawa-Takahashi
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Masanori Masui
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
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Ueki K, Moroi A, Yoshizawa K, Hotta A, Tsutsui T, Fukaya K, Hiraide R, Takayama A, Tsunoda T, Saito Y. Comparison of skeletal stability after sagittal split ramus osteotomy among mono-cortical plate fixation, bi-cortical plate fixation, and hybrid fixation using absorbable plates and screws. J Craniomaxillofac Surg 2017; 45:178-182. [DOI: 10.1016/j.jcms.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/28/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022] Open
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Slotplates revisited - A retrospective analysis. J Craniomaxillofac Surg 2016; 45:171-177. [PMID: 27956141 DOI: 10.1016/j.jcms.2016.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/11/2016] [Accepted: 10/25/2016] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Slotplates were specifically designed to meet the special requirements of corrective surgeries of the facial skeleton. This design enables small readjustments of bone fragments in the midface and chin area during surgery without complete removal of plates and screws. OBJECTIVE, DESIGN, AND SETTING The aim of this study was to compare morbidity rates of slotplates versus meshplates after Le Fort I osteotomy, genioplasty and/or zygoma 'sandwich' osteotomy performed in a tertiary care centre. RESULTS The investigators analyzed chart records of 190 patients, including a total of 257 surgeries. Slotplates were used in 109 patients, meshplates in 81 patients. Plate infection rates were 9.2% in the slotplate group and 7.4% in the meshplate group. Twelve patients (11.0%) from the slotplate group underwent plate removal versus four patients (4.9%) from the meshplate group. In total, there were two cases of delayed union, both in the slotplate group, one progressed to non-union. CONCLUSION Due to the low study power significant differences between the two types of plates could not be detected. However, there is a slight tendency towards higher morbidity associated with the use of slotplates. The probability of mechanical weakness of the configuration being responsible for the fatigue fractures is also discussed in this article.
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Zhao B, Qiu X, Wang D, Li H, He X. Application of bioabsorbable screw fixation for anterior cervical decompression and bone grafting. Clinics (Sao Paulo) 2016; 71:320-4. [PMID: 27438565 PMCID: PMC4930666 DOI: 10.6061/clinics/2016(06)06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/21/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine the application of bioabsorbable screws for anterior cervical decompression and bone grafting fixation and to study their clinical effects in the treatment of cervical spondylosis. METHODS From March 2007 to September 2012, 56 patients, 36 males and 20 females (38-79 years old, average 58.3±9.47 years), underwent a novel operation. Grafts were fixed by bioabsorbable screws (PLLA, 2.7 mm in diameter) after anterior decompression. The bioabsorbable screws were inserted from the midline of the graft bone to the bone surface of the upper and lower vertebrae at 45 degree angles. Patients were evaluated post-operatively to observe the improvement of symptoms and evaluate the fusion of the bone. The Japanese Orthopaedic Association (JOA) score was used to evaluate the recovery of neurological functions. RESULTS All screws were successfully inserted, with no broken screws. The rate of symptom improvement was 87.5%. All of the grafts fused well with no extrusion. The average time for graft fusion was 3.8±0.55 months (range 3-5 months). Three-dimensional reconstruction of CT scans demonstrated that the grafts fused with adjacent vertebrae well and that the screws were absorbed as predicted. The MRI findings showed that the cerebrospinal fluid was unobstructed. No obvious complications appeared in any of the follow-up evaluations. CONCLUSIONS Cervical spondylosis with one- or two-level involvement can be effectively treated by anterior decompression and bone grafting with bioabsorbable screw fixation. This operative method is safe and can avoid the complications induced by metal implants.
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Affiliation(s)
- Bo Zhao
- The Second Affiliated Hospital of Xi’an Jiaotong University, Department of Orthopedics, Xi’an/Shaanxi Province, PR China
- # Co-first authors
| | - Xiaowen Qiu
- The Second Affiliated Hospital of Xi’an Jiaotong University, Department of Orthopedics, Xi’an/Shaanxi Province, PR China
- # Co-first authors
| | - Dong Wang
- The Second Affiliated Hospital of Xi’an Jiaotong University, Department of Orthopedics, Xi’an/Shaanxi Province, PR China
| | - Haopeng Li
- The Second Affiliated Hospital of Xi’an Jiaotong University, Department of Orthopedics, Xi’an/Shaanxi Province, PR China
| | - Xijing He
- The Second Affiliated Hospital of Xi’an Jiaotong University, Department of Orthopedics, Xi’an/Shaanxi Province, PR China
- E-mail:
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Park JH, Kim M, Kim SY, Jung HD, Jung YS. Three-dimensional analysis of maxillary stability after Le Fort I osteotomy using hydroxyapatite/poly-l-lactide plate. J Craniomaxillofac Surg 2016; 44:421-6. [DOI: 10.1016/j.jcms.2016.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 11/27/2022] Open
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Kanno T, Tatsumi H, Karino M, Yoshino A, Koike T, Ide T, Sekine J. Applicability of an Unsintered Hydroxyapatite Particles/Poly-L-Lactide Composite Sheet with Tack Fixation for Orbital Fracture Reconstruction. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
- Division of Oral and Maxillofacial Surgery, Oki Hospital
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Aya Yoshino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Takashi Koike
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Taichi Ide
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
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Peng W, Zheng W, Shi K, Wang W, Shao Y, Zhang D. An
in vivo
evaluation of PLLA/PLLA-gHA nano-composite for internal fixation of mandibular bone fractures. Biomed Mater 2015; 10:065007. [DOI: 10.1088/1748-6041/10/6/065007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Park YW. Bioabsorbable osteofixation for orthognathic surgery. Maxillofac Plast Reconstr Surg 2015; 37:6. [PMID: 25722967 PMCID: PMC4333128 DOI: 10.1186/s40902-015-0003-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/11/2015] [Indexed: 11/10/2022] Open
Abstract
Orthognathic surgery requires stable fixation for uneventful healing of osteotomized bony segments and optimal remodeling. Titanium plates and screws have been accepted as the gold standard for rigid fixation in orthognathic surgery. Although titanium osteofixation is the most widely used approach, the use of bioabsorbable devices has been increasing recently. Biodegradation of bioabsorbable devices eliminates the need for a second operation to remove metal plates and screws. However, long-term stability and relapse frequency in bioabsorbable osteofixation are still insufficiently studied, especially in cases of segmental movements of great magnitude or segmental movements to a position where bony resistance exists. This paper reviews the background, techniques, and complications of bioabsorbable osteofixation and compares bioabsorbable and titanium osteofixation in orthognathic surgery in terms of skeletal stability.
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Affiliation(s)
- Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung, 210-702 Korea
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Al-Moraissi EA, Ellis E. Biodegradable and Titanium Osteosynthesis Provide Similar Stability for Orthognathic Surgery. J Oral Maxillofac Surg 2015; 73:1795-808. [PMID: 25864125 DOI: 10.1016/j.joms.2015.01.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to test the hypothesis that there is no difference in skeletal stability and material-related complications for titanium or biodegradable fixation when used for various orthognathic surgeries. MATERIALS AND METHODS A systematic and electronic search of several databases with specific keywords, a reference search, and a manual search through September 2014 was performed. The inclusion criteria were clinical human studies, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing titanium and biodegradable osteosynthesis after various orthognathic surgeries. The outcome variables of horizontal and vertical relapse using cephalometrics and material usability were statistically analyzed. RESULTS The initial PubMed search identified 557 studies, 22 of which met the inclusion criteria (8 randomized controlled trials, 10 controlled clinical trials, and 4 retrospective studies). No statistical difference was found between the 2 groups regarding skeletal stability after various orthognathic surgeries. There was no statistical difference with regard to wound problems, plate and screw removal, and palpability between biodegradable and titanium osteosynthesis, but there was a statistical difference with regard to intraoperative fracture of plates and screws in the biodegradable group. CONCLUSION The results of this meta-analysis support the hypothesis that biodegradable fixation devices offer similar skeletal stability as titanium fixation for orthognathic surgery. The results of this study also show that titanium fixation produced fewer broken screws during surgery compared with biodegradable screws.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - Edward Ellis
- Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX
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Landes C, Ballon A, Ghanaati S, Tran A, Sader R. Treatment of malar and midfacial fractures with osteoconductive forged unsintered hydroxyapatite and poly-L-lactide composite internal fixation devices. J Oral Maxillofac Surg 2014; 72:1328-38. [PMID: 24704037 DOI: 10.1016/j.joms.2014.02.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 02/17/2014] [Accepted: 02/17/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the internal fixation of malar and midfacial fractures, long-term results, and biocompatibility of osteoconductive internal fixation devices composed of a forged composite of unsintered hydroxyapatite and poly-L-lactide (F-u-HA/PLLA). MATERIALS AND METHODS From January 2006 to June 2010, 29 patients (24 males and 5 females; age 33 ± 15 years) were included in the present prospective study. The fracture type was malar in 24 patients, midfacial in 5, isolated orbital floor blowout in 2, and frontal sinus, cranial base in 2 patients. The fractures were fixed with internal fixation devices; these were plates and screws composed of F-u-HA/PLLA. The 24 patients with malar fractures were treated with a single 4-hole L-plate or a straight plate at the infrazygomatic crest. RESULTS All fractures with internal fixation using devices composed of F-u-HA/PLLA healed well. All malar and midfacial fractures had satisfactory long-term stability. The follow-up examinations at 12 to 67 months after surgery showed that most patients had no complaints, although 2 patients (15%) had a foreign body reaction that was treated by implant removal, with complete symptom resolution. At 5 years after fracture fixation, 2 patients had ultrasound and 2 had radiographic evidence of residual material. An exemplar biopsy showed direct bone growth into the material. CONCLUSIONS In patients with malar and midfacial fractures, hardware composed of the F-u-HA/PLLA composite provided reliable and satisfactory internal fixation, intraoperative handling, long-term stability, and biocompatibility. Direct bone growth into the material could be histopathologically exemplified, in contrast to previous polymer fixations that were resorbed and surrounded by a connective tissue layer. This finding indicates that long-term F-u-HA/PLLA residual material will be included into the remodeled bone, which was confirmed on long-term follow-up radiographs.
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Affiliation(s)
- Constantin Landes
- Professor, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany.
| | - Alexander Ballon
- Consultant, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Sharam Ghanaati
- Consultant, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany; and Institute of Pathology, Laboratory for Regenerative Pathology and Interface Research, Johannes Gutenberg University, Mainz, Germany
| | - Andreas Tran
- Research Fellow, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Robert Sader
- Professor and Chair, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany
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