|2009 Annual Meeting Abstracts
The Comparative Effectiveness of Resorbable versus Titanium Plate Fixation of LeFort I type Osteotomy Advancement Procedures
Stanley J. Harper, M.D., Pravin K. Patel, M.D..
University of Illinois at Chicago, Chicago, IL, USA.
PURPOSE: With skeletal fixation evolving toward resorbable systems, the clinical indications have extended from the relatively non-load bearing cranium to the highly load bearing midfacial skeletal region. This retrospective study evaluated the effectiveness of resorbable plate and screw fixation for maxillary osteotomy compared to titanium systems in a population of cleft and non-cleft patients.
METHODS: A select group of 100 patients who required midfacial skeletal advancement with fixation of either 2.0-mm copolymeric poly L-lactic acid/polyglycolic acid (PLLA/PGA) or standard 2.0mm titanium plates and screw fixation at the LeFort I type advancement were chosen for this study. Criteria for inclusion included patients with either cleft or non-cleft developmental dentofacial skeletal deformities (craniofacial cnditions were excluded), requiring maxillary advancement of 10mm or less, without a concomitant mandibular setback and with a minimum follow-up of 24 months. Four groups were studied: Group A: Developmental dentofacial skeletal with titanium plate fixation, Group B: Developmental dentofacial skeletal deformities with PLLA/PGA plate fixation, Group C: Cleft dentofacial skeletal deformities with titanium plate fixation and Group D: Cleft dentofacial skeletal deformities with PLLA/PGA fixation. Each group consisted of 25 patients in a consecutive series that satisfied the inclusion criteria. Skeletal stability was assessed using serial cephalometric studies at 6 weeks, 3 months, 6 months, 12 months and 24 months. Occlusal relationship was assessed by ABO criteria at the time of orthodontic debanding. Complications for each of the groups were analyzed.
RESULTS: The average maxillary advancement was similar between the two groups based on type of fixation (A+C vs B+D). Cephalometric analysis of these two groups at varying time points up to two years did not reveal a significant difference between groups A and B, nor between groups C and D. 4 % of the patients with titanium plates required removal for palpability and cold insensitivity. Resorbable fixation was associated with sterile seroma formation in 18% of the cases, 6% required required surgical removal of the residue, exposure occurred in 4% and a significant allergic reaction occurred in 2% of the cases.
CONCLUSIONS: These findings suggest that resorbable plate fixation is a viable alternative to standard metallic fixation techniques for LeFort I maxillary advancement in either cleft or non-cleft patients for advancements limited to 10mm in terms of skeletal stability. However, the use of the resorbable plates were more problematic with a higher occurrence of minor complications. With continued development of the resorbable fixation system, such problems are likely to be minimized.