Use of resorbable implants for mandibular fixation: a systematic review.

Titanium plating is recognized as the criterion standard for the treatment of mandibular fractures and osteotomies. Use of resorbable implants is well documented in the literature for a range of craniofacial fractures. However, no clear review exists of the use of resorbable implants on the mandible. In this systematic review, we searched MEDLINE/PubMed and the Cochrane Database for studies of resorbable mandibular fixation. Two independent reviewers analyzed the search results using specific inclusion/exclusion criteria. Twenty-two articles detailing 19 studies, including 1 randomized controlled trial were analyzed in this study. These studies included fixation of mandibular fractures at various locations or fixation of bilateral sagittal split osteotomies. Overall, we found a total of 326 patients treated with resorbable plates and screws and 112 patients treated with resorbable screws alone. Analysis of these studies indicates that several material types are used in resorbable mandibular implants, including poly-L-lactic acid (PLLA) and 70% poly-L-lactic acid/30% poly-D,L-lactic acid (PLLA 70/PDLLA 30), coming from at least 10 different manufacturers. Mean follow-up ranged from 3 to 348 weeks. Based on the reported data, we found a total of 14 to 15 infections, 2 foreign body reactions, 7 malocclusions, 8 malunions, and 8 to 10 premature removals in the plate group and 1 foreign body reaction and 2 malocclusions in the screws-only group. These results should be interpreted in the context of the patient selection criteria in the studies. This systematic review demonstrates the need for further randomized controlled trials in this area and concludes with such a study design.