Phd ceremony N.B. Bakelen: Biodegradable versus titanium plates and screws in maxillofacial surgery

Nowadays, titanium is regarded as the ‘golden standard’ for fixation of bone segments. It appears to be necessary that titanium is removed following bone healing in a second operation in 5-40% of the cases. Biodegradable fixation systems have been developed to dissolve gradually in the human body in order to reduce or even delete the problems associated with titanium plate removal. Despite this supposed advantage of biodegradable osteofixation devices, these systems have not replaced the titanium systems, and are currently applied in only limited numbers. The major drawback for general use of biodegradable devices is the lack of clinical evidence for well-defined indications. Therefore, we performed a prospective multicenter randomized controlled trial. 230 patients who underwent an osteotomy and those treated for fractures of/in the facial skeleton, were randomly assigned to a titanium group (KLS Martin) or to a biodegradable group (Inion CPS).

Briefly, short-term healing outcomes were similar between biodegradable and titanium fixation. However, there were more biodegradable plate removals, due to adverse tissue reactions to degradation products of the biodegradable material, within the first 2 post-operative years, and the costs associated with the biodegradable system were higher. Therefore, the biodegradable system was considered less cost-effective. The relapse 2 years post-operatively in patients who underwent an osteotomy was comparable between both groups.

Considering the above, there appears to be no place for biodegradable plates and screws of Inion CPS in the regular treatment spectrum of osteotomies and fractures in/of the facial skeleton, and titanium should remain the ‘golden standard’.